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

Abstract

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.

Dying with dignity: how can we deliver values-concordant end-of-life care for immigrant patients in the United States?

“…While there exist vast heterogeneities among immigrant groups regarding their preferences in EOL care, they share barriers to meeting individual preferences at EOL. 2 In this short comment, we explore the complex barriers faced by immigrants, specifically within the behavioural, physical/built environment, sociocultural, and healthcare systems domains delineated within the National Institute of Minority Health and Health Disparities (NIMHD) framework, 3 and suggest steps forward at the levels of patient, community, and policy that promote equitable access to a good death ( Table 1 ).…”