End-of-life care for immigrants in Germany. An epidemiological appraisal of Berlin

Abstract

BackgroundSince the late 1950’s, a steadily increasing immigrant population in Germany is resulting in a subpopulation of aging immigrants. The German health care system needs to adjust its services—linguistically, culturally, and medically–for this subpopulation of patients. Immigrants make up over 20% of the population in Germany, yet the majority receive inadequate medical care. As many of the labor immigrants of the 1960s and 1970s are in need of hospice and palliative care (HPC), little is known about this specialized care for immigrants. This epidemiological study presents utilization of HPC facilities in Berlin with a focus on different immigrant groups.MethodsA validated questionnaire was used to collect data from patients at 34 HPC institutions in Berlin over 20 months. All newly admitted patients were recruited. Anonymized data were coded and analyzed by using SPSS and compared with the population statistics of Berlin.Results4118 questionnaires were completed and included in the analysis. At 11.4% the proportion of immigrants accessing HPC was significantly (p<0,001) below their proportion in the general Berlin population. This difference was especially seen in the age groups of 51–60 (21.6% immigrants in Berlin population, 17.7% immigrants in HPC population) and 61–70 years (16,9% vs. 13,1%). The largest ethnic groups are Turks, Russians, and Poles, with a different weighting than in the general population: Turkish immigrants were 24% of all Berlin immigrants, but only 13.6% of the study immigrant population (OR: 0.23, 95%CI: 0.18–0.29, p<0.001). Russian and Polish immigrants account for 5.6% and 9.2% in the population, but 11.5% and 24.8% in the study population respectively (Russian: OR 0.88, 95%CI: 0.66–1.16; Polish: OR 1.17, 95%CI: 0.97–1.42). Palliative care wards (PC) were used most often (16.7% immigrants of all PC patients); outpatient hospice services were used least often by immigrants (11.4%). Median age at first admission to HPC was younger in immigrants than non-immigrants: 61–70 vs. 71–80, p = 0.03.ConclusionsImmigrants are underrepresented in Berlin´s HPC and immigrants on average make use of care at a younger age than non-immigrants. In this regard, Turkish immigrants in particular have the poorest utilization of HPC. These results should prompt research on Turkish immigrants, regarding access barriers, since they represent the largest immigrant group. This may be due to a lack of cultural sensitivity of the care-providers and a lack of knowledge about HPC among immigrants. In the comparison of the kinds of institutions, immigrants are less likely to access outpatient hospice services compared to PC. Apparently, PC appear to be a smaller hurdle for utilization. These results show a non-existent, but oft-cited “healthy immigrant effect” of the first generation of work immigrants, now entering old age. These findings correspond with studies suggesting increased health concerns in immigrants. Focused research is needed to promote efforts in providing adequate and fair access to HPC for all...

“An odyssey without receiving proper care” – experts’ views on palliative care provision for patients with migration background in Germany

“…The proposed difference in access for different levels and settings of care, depending on the integration of palliative into curative care, e.g. oncology, is supported by the finding that migrant patients are less underrepresented in palliative care wards in hospitals than in outpatient settings or hospices [19].…”

“…a focus on improving quality of life and on advance care planning) [13] In Germany, empirical data on migrants access to specialized palliative care as well as care-related problems is sparse [15–17], despite a rapid development of specialized palliative care structures [18]. An epidemiological study indicates that migrants may be underrepresented in specialized palliative care in Berlin [19]. The exploratory pilot study presented here consisted of two parts: an online survey of hospice and palliative care professionals experiences with palliative care for migrants with Turkish or Arabic background in Germany (results are published elsewhere [16]), and expert interviews on palliative care provision for migrants to gain a comprehensive insight into this mostly unknown.topic [20].…”

Kultuuritundlikkusest ja rändetausta tähendusest palliatiivravis ja hospiitsitöös patsiendinarratiivide näitel

“…Kultuuri soovitatakse näha ja mõtestada kui üht võimalikku mõjutegurit, mis sõltub määratletud kontekstist ja küsimuseasetusest (Sarría-Santamera et al 2016). Teadlaste ülesanne on püstitada stereotüüpidest vabu küsimusi (Henke et al 2017;Paal 2018), et saada vastuseid, mis aitavad muuta tervishoiusüsteeme keeleliselt, kultuuriliselt ja meditsiiniliselt ühiskonnas valitsevatele mitmekesisustele avatumaks.…”

“…Eelpool loetletud mõisted viitavad mitmekesisusest mõjutatud ühiskonna korraldamisele (diversity management), kus erinevate kultuuritaustadega inimesed üksteise kõrval elavad ja tegutsevad. Saksamaal tähendab see migrantide (vt allpool) vajaduste monitoorimist (Henke et al 2017;Henke et al 2015;Jansky & Nauck 2015;Jansky et al 2017a;Jansky et al 2017b…”

Der Migrationshintergrund als Grenze der Palliativversorgung am Lebensende?

“…Erst seit wenigen Jahren wird in Deutschland zur Palliativversorgung von Menschen mit Zuwanderungsgeschichte geforscht und eine geringe Inanspruchnahme des Angebots vermutet 11 . Die Studien befassen sich jedoch entweder lediglich mit je einer Gruppe mit spezifischem Herkunftskontext 12 13 oder fokussieren ausschließlich die Perspektive von Versorgenden aus dem Gesundheitssystem 14 oder die der Patienten 9 .…”