Millions of Americans suffering from serious illness lack access to care that could improve their quality of life by relieving pain and other symptoms, a study finds.

Access to so-called palliative care is greatest in the New England, Pacific and mid-Atlantic regions of the U.S., researchers report in the Journal of Palliative Medicine. Far fewer hospitals have palliative care programs in the Southern states.

People who live near larger hospitals are also more likely to have access to palliative care – it’s offered in 90 percent of hospitals with at least 300 beds but just 56 percent of hospitals with fewer beds.

While variation in access to palliative care isn’t surprising and mirrors what happens in many areas of medicine, the study findings help identify gaps in care that could be improved, said senior author Dr. Sean Morrison, a researcher in geriatrics and palliative medicine at Icahn School of Medicine at Mount Sinai in New York.

“Considerable data now demonstrates that when patients receive palliative care in addition to traditional medical care, they have improved quality of life, greater satisfaction with their medical care, are less likely to be re-admitted to the hospital or have to visit an emergency department, and in certain diseases (i.e. cancer) have greater survival,” Morrison said by email.

Morrison and colleagues analyzed data from a variety of sources including the U.S. census and the American Hospital Association as well as from interviews with hospital administrators and program directors.

In addition to hospital size, they found institutions’ tax status was also a significant predictor of access to palliative care.

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