Karapetyan Lilit, Dawani Om, Laird-Fick Heather S
1 Department of Medicine, Michigan State University, Edward Sparrow Hospital, East Lansing, MI, USA.
2 Department of Medicine, Michigan State University College of Human Medicine, East Lansing, MI, USA.
J Palliat Care. 2018 Apr;33(2):63-64. doi: 10.1177/0825859718759818. Epub 2018 Mar 7.
The immigrant population in the United States has grown over the past years. Undocumented immigrants account for 14.6% of the uninsured population in the United States. Decisions about end-of-life treatment are often difficult to reach in the best of situations. We present a 43-year-old undocumented Mexican female immigrant with metastatic sarcomatoid squamous cell cervical cancer and discuss the barriers that she faced during her treatment. Limited English proficiency, living below the poverty line, low level of education, and lack access to Medicare, Medicaid, or other insurance coverage under the Affordable Care Act are major causes of decreased health-care access and service utilization by the immigrant population. Latinos are less likely to be referred to hospice by oncologists, and nearly a third of hospice agencies offer limited or no services to undocumented immigrants. Undocumented immigrants with terminal diagnoses generally do not have access to comprehensive or multidisciplinary follow-up treatment. Instead, one of their few options is to return to their home countries without any long-term treatment. This article discusses the many barriers and proposes areas for reform.
在过去几年中，美国的移民人口有所增长。无证移民占美国未参保人口的14.6%。即使在最好的情况下，关于临终治疗的决策往往也很难做出。我们介绍了一位43岁的无证墨西哥女性移民，她患有转移性肉瘤样宫颈鳞状细胞癌，并讨论了她在治疗过程中所面临的障碍。英语水平有限、生活在贫困线以下、教育程度低以及无法获得医疗保险、医疗补助或《平价医疗法案》规定的其他保险覆盖，是移民人口获得医疗保健服务和利用医疗服务减少的主要原因。拉丁裔被肿瘤学家转介到临终关怀机构的可能性较小，近三分之一的临终关怀机构为无证移民提供的服务有限或根本不提供服务。被诊断为绝症的无证移民通常无法获得全面或多学科的后续治疗。相反，他们为数不多的选择之一是在没有任何长期治疗的情况下返回自己的祖国。本文讨论了诸多障碍，并提出了改革领域。
