Evidence map›Paper›PMID 36631820›Full record

ArticleThe Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association2023

Association of rurality with utilization of palliative care and hospice among Medicare beneficiaries who died from pancreatic cancer: A cohort study.

Niveditta Ramkumar, Qianfei Wang, Gabriel A Brooks, Anna N A Tosteson, Sandra L Wong, Andrew P Loehrer

Open access · greenAbstract read
In one paragraph

Article in The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
2.3field-weighted citation impact, top 13% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it, 8 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Patterns and predictors of palliative care use in acute heart failure hospitalizations.American heart journal plus : cardiology research and practice · 2026
    Article
  4. Inequity in Cancer and Cancer Care Delivery in the United States.Hematology/oncology clinics of North America · 2024
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 5 institutions in 1 country.

Niveditta RamkumarGeisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.
Qianfei WangGeisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.
Gabriel A BrooksGeisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.
Anna N A TostesonGeisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.
Sandra L WongGeisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.
Andrew P LoehrerGeisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.
Dartmouth Cancer CenterDartmouth College · USDartmouth–Hitchcock Medical Center · USDartmouth Institute for Health Policy and Clinical Practice · USDartmouth Psychiatric Research Center · US

Funding

Translational Engineering in Cancer (TEC)P30CA023108 · NCI · DARTMOUTH COLLEGE · PI Fred W Kolling IV · 1985 to 2026
$91.3M
Disparities in access to and outcomes of cancer surgery for rural Medicare patientsR01CA248470 · NCI · DARTMOUTH COLLEGE · PI TOSTESON, ANNA N. A., WONG, SANDRA L · 2021 to 2023
$1.9M
Geospatial drivers of cancer care disparities and their susceptibility to health policy changesK08CA263546 · NCI · DARTMOUTH-HITCHCOCK CLINIC · PI Andrew Phillip Loehrer · 2022 to 2026
$869k
NCI NIH HHS K08 CA263546NCI NIH HHS P30 CA023108NCI NIH HHS R01 CA248470
6 · The paper itself

Abstract

backgroundPancreatic cancer has a 5-year survival of just 10%. Services such as palliative care and hospice are thus crucial in this population, yet their geographic accessibility and utilization remains unknown.

aimWe studied the association between rurality of patient residence and the use of palliative care and hospice. DESIGN, SETTING, AND

participantsCohort study of continuously enrolled fee-for-service Medicare beneficiaries aged ≥65 diagnosed with incident pancreatic cancer between 04/01/2016-08/31/2018 and who died by 12/31/2018.

resultsIn this decedent cohort of 31,460 patients, 77% lived in metropolitan areas, 11% in micropolitan areas, 7% in small towns, and 5% in rural areas. Patient demographics were largely similar across rurality; however, the proportion of White, non-Hispanic patients and social deprivation was highest in rural areas and lowest in metropolitan areas. Overall, 33% of patients used any palliative care and 77% received hospice services. After risk adjustment, there were no statistically significant differences in the use of palliative care for patients residing in metropolitan versus micropolitan, small town, or rural areas. Patients in small town (OR = 0.77, 95% CI: 0.69-0.86) and rural areas (OR = 0.75, 95% CI: 0.66-0.85) had lower adjusted odds of receiving hospice care compared to patients in metropolitan areas.

conclusionsThe use of palliative care services captured in Medicare was low, representing either underutilization or failure to accurately measure the extent of services used. While the overall level of hospice enrollment was high, patients in rural communities had relatively lower use of hospice services compared to those in metropolitan areas.

Indexed as

Hospice CareHospicesPancreatic NeoplasmsAgedCohort StudiesHumansMedicarePalliative CareRetrospective StudiesRural PopulationUnited Stateshospicepalliative carepancreatic cancerrural disparities

Identifiers

PMID36631820
PMCPMC10293103
OpenAlexW4315754554

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.