Allophone home care recipients with terminal cancer may have worse end-of-life outcomes compared to anglophone patients

1. Allophone home care recipients with terminal cancer had an increased risk of death, emergency department visits, and hospital admission within the last 30 days of life compared to anglophones.

Evidence Rating Level: 2 (Good)

Cancer patients and their families with language barriers may face additional challenges when confronted with medical decisions. It is unknown how patient-preferred language impacts health outcomes of patients with cancer. This study thus investigated the association between patient-preferred language and end-of-life outcomes in home care patients who died of cancer. This retrospective cohort study included home care recipients who died of cancer between 2013 and 2018 in Ontario, Canada. The primary outcomes included place of death, emergency department (ED) visits and hospital admissions within the last 30 days of life. Secondary outcomes included aggressive interventions. Among the 33,958 patients analyzed, there were 28,322 (83.4%) anglophones, 786 (2.3%) francophones, and 4,850 (14.3%) allophones. Among allophones, the 5 most spoken languages included: Italian (28.1%), Chinese (12.5%), Portuguese (7.5%), Polish (4.3%), and Russian (3.4%). After adjusting for confounding, allophones had higher odds of death in hospital (OR 1.35, 95% CI 1.25–1.45), hospital admissions (OR 1.16, 95% CI 1.07–1.24), and ED visits (OR 1.16, 95% CI 1.08–1.24) compared to anglophones. Compared to anglophones, allophones also had increased odds of aggressive interventions in the last 30 days of life including mechanical ventilation (OR 1.43, 95% CI, 1.16–1.76), CPR (OR 2.52, 95% CI, 1.73–3.69), initiation of dialysis (OR 1.56, 95% CI, 1.07–2.28), and blood transfusions (OR 1.23, 95% CI, 1.10–1.39). Francophones also had increased odds of death in hospital (OR 1.23, 95% CI 1.04–1.46) compared to anglophones. Overall, this study found that in Ontario, Canada, allophone home care recipients with terminal cancer had an increased risk of death in hospital, ED visits, and hospital admissions compared to anglophones. These findings underscore the importance of language as a determinant of health in end-of-life care.

Click here to read this study in PLOS One

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