Duke Palliative Care, Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
J Palliat Med. 2021 Aug;24(8):1167-1173. doi: 10.1089/jpm.2020.0547. Epub 2020 Dec 22.
To characterize clinician experiences of hospice access and scope of services for undocumented immigrants. The 10.5 million undocumented immigrants in the United States are not covered by Medicare's hospice benefit and are at high risk for being uninsured. Limited data are available regarding hospice services for this population. Two hundred ninety-four interdisciplinary palliative care clinicians from across the United States. Participants completed a web-based survey regarding hospice access and scope of services for undocumented immigrants in their location. We used simple frequencies to report clinician responses and chi-square analysis to evaluate associations between response and location. We performed rapid qualitative analysis of free-text responses to identify common limitations in scope of services. A majority of clinicians (68%) perceived that access to hospice was limited or unavailable for undocumented immigrants in their location, and among respondents who provided data regarding hospice scope, 38% reported that services provided to undocumented immigrants were limited compared to those provided to other patients. Reports of restricted access and scope varied by region, and those in large metropolitan areas were more likely to report restricted scope of care than those in smaller towns (43% vs. 28%; = 0.03). In our qualitative analysis of free-text responses, common limitations in hospice scope included reduced access to medications and equipment, inability to access inpatient hospice, inadequate translation services, reduced staffing, and restricted duration of services. Undocumented immigrants may face barriers in accessing comprehensive hospice services. Public policy changes that improve access to hospice may improve end-of-life care for undocumented immigrants.
描述临床医生在为无证移民提供临终关怀服务方面的经验和服务范围。 美国的 1050 万无证移民没有医疗保险的临终关怀福利，而且极有可能没有保险。关于这一人群的临终关怀服务，数据有限。 来自美国各地的 294 名跨学科姑息治疗临床医生。 参与者完成了一项关于他们所在地区无证移民获得临终关怀服务和服务范围的网络调查。我们使用简单的频率报告临床医生的反应，并使用卡方分析评估反应与位置之间的关系。我们对自由文本回复进行了快速定性分析，以确定服务范围的常见限制。 大多数临床医生（68%）认为，他们所在地区的无证移民获得临终关怀的机会有限或无法获得，而在提供临终关怀服务范围数据的受访者中，38%的人报告称，与为其他患者提供的服务相比，为无证移民提供的服务受到限制。报告的准入和范围限制因地区而异，在大城市地区的临床医生比在较小城镇地区的临床医生更有可能报告服务范围受限（43%比 28%；=0.03）。在我们对自由文本回复的定性分析中，临终关怀范围的常见限制包括减少获得药物和设备的机会、无法获得住院临终关怀、翻译服务不足、人员配备减少以及服务期限受限。 无证移民在获得全面临终关怀服务方面可能面临障碍。改善临终关怀准入的公共政策变化可能会改善无证移民的临终关怀。
