A Comparison of Palliative Care Delivery between Ethnically Chinese and Non-Chinese Canadians in the Last Year of Life

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发表日期：

2024年6月26日

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Zhimeng Jia,
Allison Kurahashi,
Rashmi K. Sharma,
Ramona Mahtani,
Brandon M. Zagorski,
Justin J. Sanders,
Christopher Yarnell,
Michael Detsky,
Charlotta Lindvall,
Joan M. Teno,
Chaim M. Bell,
Kieran L. Quinn

摘要

Background

Ethnically Chinese adults in Canada and the United States face multiple barriers in accessing equitable, culturally respectful care at the end-of-life. Palliative care (PC) is committed to supporting patients and families in achieving goal-concordant, high-quality serious illness care. Yet, current PC delivery may be culturally misaligned. Therefore, understanding ethnically Chinese patients’ use of palliative care may uncover modifiable factors to sustained inequities at the end-of-life.

Objective

To compare the use and delivery of PC in the last year of life between ethnically Chinese and non-Chinese adults.

Design

Population-based cohort study.

Participants

All Ontario adults who died between January 1st, 2012, and October 31st, 2022, in Ontario, Canada.

Exposures

Chinese ethnicity.

Main Measures

Elements of physician-delivered PC, including model of care (generalist; specialist; mixed), timing and location of initiation, and type of palliative care physician at initial consultation.

Key Results

The final study cohort included 527,700 non-Chinese (50.8% female, 77.9 ± 13.0 mean age, 13.0% rural residence) and 13,587 ethnically Chinese (50.8% female, 79.2 ± 13.6 mean age, 0.6% rural residence) adults. Chinese ethnicity was associated with higher likelihoods of using specialist (adjusted odds ratio [aOR] 1.53, 95%CI 1.46–1.60) and mixed (aOR 1.32, 95%CI 1.26–1.38) over generalist models of PC, compared to non-Chinese patients. Chinese ethnicity was also associated with a higher likelihood of PC initiation in the last 30 days of life (aOR 1.07, 95%CI 1.03–1.11), in the hospital setting (aOR 1.24, 95%CI 1.18–1.30), and by specialist PC physicians (aOR 1.33, 95%CI 1.28–1.38).

Conclusions

Chinese ethnicity was associated with a higher likelihood of mixed and specialist models of PC delivery in the last year of life compared to adults who were non-Chinese. These observed differences may be due to later initiation of PC in hospital settings, and potential differences in unmeasured needs that suggest opportunities to initiate early, community-based PC to support ethnically Chinese patients with serious illness.

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