In a study on the association between immigration status and end-of-life care in Ontario, researchers at the University of Toronto found that recent immigrants, defined as those arriving between 1985 and 2015, are more likely to receive aggressive care and to die in intensive care compared to other Ontario residents. Aggressive care refers to the use of all possible medication and technology to treat illness and preserve and prolong life. Published in JAMA, the study analyzed the records of 967,013 decedents in Ontario.
The team examined end-of-life care provided to patients in Ontario hospitals between 2004 and 2015. Of all records analyzed, 45 per cent died in the hospital, including 10 per cent who died in an intensive care unit (ICU). Among the decedents studied, five per cent, or 47,514, were recent immigrants. ICU deaths for these recent immigrants was 15.6 per cent.
“The message that palliative care is not the same as giving up, is a difficult message for many clinicians to deliver to patients and families,” Robert Fowler told the Dalla Lana School of Public Health. Fowler is the Program Director at the Institute of Health Policy, Management and Evaluation and a physician at Sunnybrook Health Sciences Centre.
Palliative care is an approach aimed at improving the quality of life of patients experiencing life-threatening illnesses. This is done through relief of suffering by treating pain along with other physical, psychological, and spiritual difficulties.
According to Fowler, the current default practice in Ontario hospitals is often focused on tests, procedures, and medication that target a disease rather than providing care for a patient. He believes a palliative approach should complement disease treatment from the beginning of the diagnosis.
The disparity found between immigrants and residents was strongly associated with region of birth — immigrants from Northern Europe were 16 per cent less likely to die in ICU than non-recent immigrants, while South Asian immigrants were twice as likely to die in ICU. The researchers cited several quantitative studies conducted in racial and ethnic minority groups in the United States to support this finding.
The researchers attributed their findings to variations in region of birth and time spent in Canada. The differences in end-of-life care are not explained by variations in age, sex, cause of death, comorbidity, or socioeconomic position because they could be caused by several other factors, which were not identified in the study.
According to the study, recent immigrants in Canada are likely to better assimilate and develop necessary skills of expressing their preference of health care options than in other countries.
While the study did not investigate the possible mechanisms to explain the disparity between recent immigrants and long-term residents, it did suggest that differences between palliative care choices may be attributed to health literacy and diverse cultural beliefs.
This disparity in palliative care lends to the body of research that investigates the observed differences in care provided to immigrants and non-immigrants in Canada.