Identifying Paths Forward: Expanding Palliative Care to Low-Income Patients in California

Area of Science:

• Health Services Research
• Qualitative Health Research
• Patient Access to Care

Background:

• Most consumers lack awareness of palliative care services.
• California's Senate Bill 1004 (SB 1004) expanded palliative care access for Medi-Cal Managed Care patients since 2018.
• Underwhelming uptake of palliative care services necessitates exploring patient-centered barriers.

Purpose of the Study:

• To explore patient-centered barriers to palliative care uptake among adult Medicaid managed care patients.
• To understand patient perspectives on palliative care and preferred referral communication methods.

Main Methods:

• Conducted semi-structured qualitative interviews with 27 adult Medicaid managed care patients in Los Angeles.
• Utilized a grounded theory approach for thematic analysis of verbatim interview transcripts.
• Explored patient knowledge, perspectives, and communication preferences regarding palliative care referrals.

Main Results:

• Identified key barriers: lack of knowledge about palliative care and services.
• Highlighted reliance on and trust in primary care physicians for health information.
• Noted significant influence of language, cultural barriers, housing instability, and patient perceptions of need (age/illness severity).

Conclusions:

• Primary care physicians play a crucial role in advocating for low-income patients regarding palliative care.
• Culturally sensitive education is essential to improve understanding and access to palliative care.
• Promoting knowledge among both physicians and consumers is critical for increasing palliative care utilization.