Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Ontario, Canada.
Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
J Gen Intern Med. 2024 Nov;39(14):2732-2740. doi: 10.1007/s11606-024-08859-8. Epub 2024 Jun 26.
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.
To compare the use and delivery of PC in the last year of life between ethnically Chinese and non-Chinese adults.
Population-based cohort study.
All Ontario adults who died between January 1st, 2012, and October 31st, 2022, in Ontario, Canada.
Chinese ethnicity.
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.
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).
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.
在加拿大和美国的华裔成年人在临终关怀方面面临着多种障碍，无法获得公平、尊重文化的护理。姑息治疗（PC）致力于支持患者和家庭实现目标一致的高质量重病护理。然而，目前的 PC 服务可能在文化上存在错位。因此，了解华裔患者对姑息治疗的使用情况，可以揭示临终关怀方面持续存在不平等现象的可改变因素。
比较华裔和非华裔成年人在生命的最后一年中使用姑息治疗和提供姑息治疗的情况。
基于人群的队列研究。
所有 2012 年 1 月 1 日至 2022 年 10 月 31 日期间在加拿大安大略省去世的安大略省成年人。
华裔种族。
医生提供的姑息治疗要素，包括治疗模式（全科医生；专科医生；混合）、启动时间和地点，以及初始咨询时的姑息治疗医生类型。
最终研究队列包括 527700 名非华裔（50.8%为女性，平均年龄 77.9±13.0 岁，13.0%居住在农村地区）和 13587 名华裔（50.8%为女性，平均年龄 79.2±13.6 岁，0.6%居住在农村地区）成年人。与非华裔患者相比，华裔种族更有可能使用专科医生（调整后的优势比 [aOR] 1.53，95%置信区间 [95%CI] 1.46-1.60）和混合模式（aOR 1.32，95%CI 1.26-1.38）的 PC 治疗模式。华裔种族还更有可能在生命的最后 30 天（aOR 1.07，95%CI 1.03-1.11）、在医院环境中（aOR 1.24，95%CI 1.18-1.30）和由专科 PC 医生（aOR 1.33，95%CI 1.28-1.38）开始接受 PC 治疗。
与非华裔成年人相比，华裔种族在生命的最后一年更有可能采用混合和专科医生模式的 PC 治疗。这些观察到的差异可能是由于 PC 更晚在医院环境中启动，以及潜在的未测量需求存在差异，这表明有机会启动早期、以社区为基础的 PC，以支持有重病的华裔患者。
