A Scoping Review of Undocumented Immigrants and Palliative Care: Implications for the Canadian Context

Nielsen, Lisa Seto; Goldstein, Zoë; Leung, Doris; Lee, Charlotte; Buick, Catriona

doi:10.1007/s10903-019-00882-w

Cited by 7 publications

(8 citation statements)

References 25 publications

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“…5,6 Clinicians have observed that undocumented immigrants may face significant barriers to hospice enrollment because of their immigration status, but current data are limited to case series and review articles. [7][8][9][10] Our prior nationwide survey of hospice agencies confirmed that nearly one-third of hospice agencies either limited or refused enrollment of undocumented immigrants. 11 However, these data described only hospice agencies' reported practices with respect to referrals.…”

Section: Introductionmentioning

confidence: 76%

Hospice Access and Scope of Services for Undocumented Immigrants: A Clinician Survey

Gray

Boucher

Cervantes

et al. 2021

Journal of Palliative Medicine

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Objectives: To characterize clinician experiences of hospice access and scope of services for undocumented immigrants. Background: The 10.5 million undocumented immigrants in the United States are not covered by Medicare's hospice benefit and are at high risk for being uninsured. Limited data are available regarding hospice services for this population. Setting/Subjects: Two hundred ninety-four interdisciplinary palliative care clinicians from across the United States. Measurements: Participants completed a web-based survey regarding hospice access and scope of services for undocumented immigrants in their location. We used simple frequencies to report clinician responses and chisquare analysis to evaluate associations between response and location. We performed rapid qualitative analysis of free-text responses to identify common limitations in scope of services. Results: A majority of clinicians (68%) perceived that access to hospice was limited or unavailable for undocumented immigrants in their location, and among respondents who provided data regarding hospice scope, 38% reported that services provided to undocumented immigrants were limited compared to those provided to other patients. Reports of restricted access and scope varied by region, and those in large metropolitan areas were more likely to report restricted scope of care than those in smaller towns (43% vs. 28%; p = 0.03). In our qualitative analysis of free-text responses, common limitations in hospice scope included reduced access to medications and equipment, inability to access inpatient hospice, inadequate translation services, reduced staffing, and restricted duration of services. Conclusions: Undocumented immigrants may face barriers in accessing comprehensive hospice services. Public policy changes that improve access to hospice may improve end-of-life care for undocumented immigrants.

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Section: Introductionmentioning

confidence: 76%

Hospice Access and Scope of Services for Undocumented Immigrants: A Clinician Survey

Gray

Boucher

Cervantes

et al. 2021

Journal of Palliative Medicine

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“…First, we relied on self‐reported immigration status, which may have led to inaccurate representation in our analysis. Second, we could not discern between documented and undocumented immigrants, who are at even higher risk for receiving value inconsistent EoL care 4,24,48 . Third, the propensity score resulted in an immigrant study population of primarily European descent.…”

Section: Discussionmentioning

confidence: 94%

“…Second, we could not discern between documented and undocumented immigrants, who are at even higher risk for receiving value inconsistent EoL care. 4,24,48 Third, the propensity score resulted in an immigrant study population of primarily European descent. Fourth, the study population came from primarily academic medical centers, which are more likely to be in urban settings and have a wider range of treatments offered.…”

Section: Discussionmentioning

confidence: 99%

Association between immigrant status and advanced cancer patients' location and quality of death

Tergas

Prigerson

Shen

et al. 2022

Cancer

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BACKGROUND: Cancer patients often prefer to die at home, a location associated with better quality of death (QoD). Several studies demonstrate disparities in end-of-life care among immigrant populations in the United States. This study aimed to evaluate how immigrant status affects location and quality of death among patients with advanced cancer in the United States. METHODS: Data were derived from Coping with Cancer, a federally funded multi-site prospective study of advanced cancer patients and caregivers. The sample of patients who died during the study period was weighted (N w = 308) to reduce statistically significant differences between immigrant (N w = 49) and nonimmigrant (N w = 259) study participants. Primary outcomes were location of death, death at preferred location, and poor QoD. RESULTS: Analyses adjusted for covariates indicated that patients who were immigrants were more likely to die in a hospital than home (adjusted odds ratio [AOR], 3.33; 95% confidence interval [CI], 1.65-6.71) and less likely to die where they preferred (AOR, 0.42; 95% CI, 0.20-0.90). Furthermore, immigrants were more likely to have poor QoD (AOR, 5.47; 95% CI,. CONCLUSIONS: Immigrants, as compared to nonimmigrants, are more likely to die in hospital settings, less likely to die at their preferred location, and more likely to have poor QoD.

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“…19 While our study does not investigate the underlying causes for the differences observed, it is important to consider that possible contributors may include patient level factors (i.e., patient preferences, which themselves may be informed by prior negative experiences with the healthcare system), or system-level factors including systemic discrimination 23 and inadequate access to palliative care resources. 24 At the patient level, one study demonstrated that immigrant and non-immigrant patients had similar knowledge about palliative care 25 suggesting other factors may be at play. Though we cannot know for certain which factors influence disposition, there is a possibility that some patients of immigrant backgrounds may be wary of institutions based on previous experiences of discrimination, as has been previously discussed regarding undocumented immigrants in the United States.…”

Section: Preferred Language 0¢409mentioning

confidence: 99%

Race and birth country are associated with discharge location from hospital: A retrospective cohort study of demographic differences for patients receiving inpatient palliative care

et al. 2022

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A Scoping Review of Undocumented Immigrants and Palliative Care: Implications for the Canadian Context

Cited by 7 publications

References 25 publications

Hospice Access and Scope of Services for Undocumented Immigrants: A Clinician Survey

Hospice Access and Scope of Services for Undocumented Immigrants: A Clinician Survey

Association between immigrant status and advanced cancer patients' location and quality of death

Race and birth country are associated with discharge location from hospital: A retrospective cohort study of demographic differences for patients receiving inpatient palliative care

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