Knowledge, beliefs, and misconceptions about palliative care among older adults with cancer

Published:September 28, 2022DOI:



      Older adults with cancer have high symptom burden and unmet needs and may benefit from palliative care (PC). However, little is known about their knowledge and understanding of PC. This study examined the knowledge, beliefs, and misconceptions about PC in older adults with cancer in the United States.

      Materials and Methods

      We used data from National Cancer Institute's 2018 wave of the Health Information National Trends Survey (HINTS). A total of 370 individuals aged 65 and older with a diagnosis of cancer were included in this study. The outcomes included PC knowledge, goals, and misconceptions. The main predictors included general health status, chronic conditions, functional limitations, and types of cancer.


      About two thirds of the sample (65.31%) did not have any knowledge of PC. Among those who had some knowledge, they had good understanding of PC goals, but also had many misconceptions about PC. Multiple regression analysis showed that older age (p < .001), racial minority (p = .021), and lower education (p = .001) was associated with lacking knowledge of PC. Individuals with some functional limitations tended to have better understanding and fewer misconceptions of PC.


      The knowledge about PC is low in older adults with cancer in the US. Educational interventions need to be implemented to increase knowledge and reduce the misconceptions about PC in this population. Increasing knowledge of PC may ultimately lead to increased access to PC and improve the quality of life in this population.


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        • Cinar D.
        • Tas D.
        Cancer in the elderly.
        North Clin Istanb. 2015; 2: 73-80
        • Balducci L.
        • Dolan D.
        • Hoffe S.E.
        Palliative care in older patients with cancer.
        Cancer Control. 2015; 22: 480-488
        • Gift A.
        • Jablonski A.
        • Stommel M.
        • et al.
        Symptom clusters in elderly patients with lung cancer.
        Oncol Nurs Forum. 2004; 31: 202-212
        • Naeim A.
        • Aapro M.
        • Subbarao R.
        • et al.
        Supportive care considerations for older adults with cancer.
        J Clin Oncol. 2014; 32: 2627-2634
        • Roinald R.
        • Heidrich S.
        Symptom clusters and quality of life in older breast cancer survivors.
        Oncol Nurs Forum. 2011; 38: 672-680
        • Leach C.R.
        • Weaver K.E.
        • Aziz N.M.
        • et al.
        The complex health profile of long-term cancer survivors: prevalence and predictors of comorbid conditions.
        J Cancer Surviv. 2015; 9: 239-251
        • Williams G.R.
        • Deal A.M.
        • Lund J.L.
        • et al.
        Patient-reported comorbidity and survival in older adults with cancer.
        Oncologist. 2018; 23: 433-439
        • Harrison J.D.
        • Young J.M.
        • Price M.A.
        • et al.
        What are the unmet supportive care needs of people with cancer? A systematic review.
        Support Care Cancer. 2009; 17: 1117-1128
        • van Weert J.C.M.
        • Bolle S.
        • van Dulmen S.
        • et al.
        Older cancer patients’ information and communication needs: what they want is what they get?.
        Patient Educ Couns. 2013; 92: 388-397
        • Williams G.R.
        • Pisu M.
        • Rocque G.B.
        • et al.
        Unmet social support needs among older adults with cancer.
        Cancer. 2019; 125: 473-481
        • National Institute of Nursing Research (NINR)
        Palliative care: the relief you need when you have serious illness.
        (Available from)
        • World Health Organization (WHO) [Internet]
        Palliative care.
        (Available from)
        • Bakitas M.A.
        • Tosteson T.D.
        • Li Z.
        • et al.
        Early versus delayed initiation of concurrent palliative oncology care: patient outcomes in the ENABLE III randomized controlled trial.
        J Clin Oncol. 2015; 33: 1438-1445
        • Bakitas M.
        • Lyons K.D.
        • Hegel M.T.
        • et al.
        Effects of a PC intervention on clinical outcomes in patients with advanced cancer: the project ENABLE II randomized controlled trial.
        JAMA. 2009; 302: 741-749
        • Bauman J.R.
        • Temel J.S.
        The integration of early PC with oncology care: the time has come for a new tradition.
        J Natl Compr Canc Netw. 2014; 12: 1763-1771
        • Greer J.A.
        • Pirl W.F.
        • Jackson V.A.
        • et al.
        Effect of early PC on chemotherapy use and end-of-life care in patients with metastatic non–small-cell lung cancer.
        J Clin Oncol. 2013; 30: 394-400
        • Irwin K.E.
        • Greer J.A.
        • Khatib J.
        • et al.
        Early PC and metastatic non-small cell lung cancer: potential mechanisms of prolonged survival.
        Chron Respir Dis. 2013; 10: 35-47
        • Temel J.S.
        • Greer J.A.
        • Muzikansky A.
        • et al.
        Early PC for patients with metastatic non–small-cell lung cancer.
        NEJM. 2010; 363: 733-742
        • Burge F.L.
        • Lawson B.J.
        • Johnston G.M.
        • et al.
        A population-based study of age inequalities in access to PC among cancer patients.
        Med Care. 2008; 46: 1203-1211
        • Hui D.
        • Kim S.H.
        • Kwon J.H.
        • et al.
        Access to PC among patients treated at a comprehensive cancer center.
        Oncologist. 2012; 17: 1574-1580
        • Kumar P.
        • Casarett D.
        • Corcoran A.
        • et al.
        Utilization of supportive and PC services among oncology outpatients at one academic cancer center: determinants of use and barriers to access.
        J Palliat Med. 2012; 15: 923-930
        • Parajuli J.
        • Hupcey J.E.
        A systematic review on barriers to PC in oncology.
        AJHPM. 2021; 38: 1361-1377
        • Huo J.
        • Hong Y.R.
        • Grewal R.
        • et al.
        Knowledge of PC among American adults: 2018 health information national trends survey.
        J Pain Symptom Manage. 2019; 58: 39-47
        • National Cancer Institute
        Health information national trends survey.
        (Available from)
        • McInturff B.
        • Harrington E.
        Public opinion research on palliative care: a report based on research by public opinion strategies.
        Center to Advance Palliative Care, 2011
        • Reville B.
        • Miller M.N.
        • Toner R.W.
        • et al.
        End-of-life care for hospitalized patients with lung cancer: utilization of a PC service.
        J Palliat Med. 2010; 13: 1261-1266
        • Zimmermann C.
        • Swami N.
        • Krzyzanowska M.
        • et al.
        Perceptions of PC among patients with advanced cancer and their caregivers.
        CMAJ. 2016; 190: 1-11
        • National Comprehensive Cancer Network
        NCCN clinical practice guidelines in oncology: palliative care.
        (Available from)
        • Ferrell B.R.
        • Temel J.S.
        • Temin S.
        • et al.
        Integration of PC onto standard oncology care: American society of clinical oncology clinical practice guideline update.
        J Clin Oncol. 2017; 35: 96-112
        • National Consensus Project for Quality PC
        Clinical practice guidelines for quality PC.
        4th ed. 2018 (Available from)