Equal palliative care for foreign-born patients: A national quality register study

Abstract

Objectives To use data from a national quality register to investigate if there are differences relating to migrant background in the quality of end-of-life care of patients dying in Sweden. Methods A retrospective, comparative register-based study. In total, 81,418 deceased patients, over 18 years of age, registered in the Swedish Register of Palliative Care during 2017 and 2018, of expected death were included in the study. Of these, 72,012 were Swedish-born and 9,395 were foreign-born. Descriptive and analytical statistical methods were used. Results No general pattern of differences in quality regarding end-of-life care was found between Swedish- and foreign-born patients. There were several significant differences in various quality indicators but not in a specific direction. Sometimes, the quality indicators showed an advantage for Swedish-born patients but just as often, they were also favorable for foreign-born patients. Swedish-born patients had greater access to specialized palliative care than foreign-born patients. Foreign-born patients were more often cared for in general home care setting, despite a higher frequency of cancer diagnosis. Significance of results Foreign-born patients were less likely to be cared for in specialized palliative care units and had poorer access to palliative care teams than Swedish-born patients, despite having a higher proportion of cancer diagnoses. However, no general pattern was found indicating that foreign-born patients were disadvantaged in the quality indicators measured in the present study. Perhaps, this is an indication that the palliative care in Sweden is individualized; nonetheless, the quality of end-of-life care would be higher if dying patients, regardless of country of birth, have better access to specialized palliative care.

Place of death among foreign-born individuals: a national population-based register study

“…The findings from this study might reflect barriers (including infrastructure and competency) or different preferences regarding place of death – or even differences in terms of access to specialist palliative care since both Swedish and international studies indicate that foreign-born individuals and ethnic minorities are less likely to be cared for within specialized palliative care. 19 , 26 , 44 , 45 …”

“… 25 A German study shows that immigrants are underrepresented in Hospice and Palliative Care (HPC), foremost Turkish immigrants 19 and a study conducted in Sweden shows that foreign-born individuals are less likely of being cared for in specialized palliative care units. 26 Thus, there is a need for population-based studies to ensure that palliative care needs are met in whole populations, including people who have immigrated. Investigating place of death and associated factors in a population is a way of learning about and understanding patterns and inequalities regarding access to and utilization of healthcare services.…”

Palliative and End-of-Life Care Access for Immigrants Living in High-income Countries: A Scoping Review

“…These studies demonstrate that communication can be a barrier to health literacy in relation to palliative and EOL care which can lead to limited access to services. While the studies identified above found communication and culture as barriers to accessing palliative and EOL care, one study (Carlsson & Hjelm, 2021) only reported on the difference in access to palliative care between Swedish-born patients and foreign-born, reporting that the Swedish-born patients accessed the services more than the foreign-born. The reason for not providing more information on the access ratios between the two population was because the study was conducted using deceased patients’ registers.…”