Abstract
BackgroundMigrants seem to be underrepresented in palliative care in Germany. Access barriers and challenges in care remain unclear. We aimed to provide a comprehensive insight into palliative care for migrants, using expert interviews.MethodsInterviews with experts on palliative and general health care for migrants were audiotaped and transcribed. Data analysis followed a qualitative content analysis method for expert interviews proposed by Meuser and Nagel.ResultsIn total, 13 experts from various fields (palliative and hospice care, other care, research and training) were interviewed. Experts identified access barriers on the health care system and the patient level as well as the sociopolitical level. Services don’t address migrants, who may use parallel structures. Patients may distrust the health care system, be oriented towards their home country and expect the family to care for them. In care, poor adaptation and inflexibility of health care services regarding needs of migrant patients because of scarce resources, patients’ preferences which may contradict professionals' values, and communication both on the verbal and nonverbal level were identified as the main challenges. Conflicts between patients, families and professionals are at risk to be interpreted exclusively as cultural conflicts. Palliative care providers should use skilled interpreters instead of family interpreters or unskilled staff members, and focus on training cultural competence. Furthermore, intercultural teams could enhance palliative care provision for migrants.ConclusionsThough needs and wishes of migrant patients are often found to be similar to those of non-migrant patients, there are migration-specific aspects that can influence care provision at the end of life. Migration should be regarded as a biographical experience that has a severe and ongoing impact on the life of an individual and their family. Language barriers have to be considered, especially regarding patients' right to informed decision making. The reimbursement of interpreters in health care remains an open question.
Highlights
Migrants seem to be underrepresented in palliative care in Germany
Migrants in Germany experience barriers to health care services in general [3, 4], and international research suggests that this may be the case for specialized palliative care services [5,6,7,8]
In Germany, specialized palliative care is provided by specially trained physicians, nurses and other professions in interdisciplinary teams in a variety of institutions
Summary
Migrants seem to be underrepresented in palliative care in Germany. Access barriers and challenges in care remain unclear. Barriers to home care were understanding of illness and prognosis, family structures and decision-making-processes, living environment and lack of formal information and referral They found that patients and relatives view of what constitutes “good care” (e.g. maximum curative treatment until the end of life) may contradict the norms underlying palliative care (e.g. a focus on improving quality of life and on advance care planning) [13] In Germany, empirical data on migrants access to specialized palliative care as well as care-related problems is sparse [15,16,17], despite a rapid development of specialized palliative care structures [18]. The exploratory pilot study presented here consisted of two parts: an online survey of hospice and palliative care professionals experiences with palliative care for migrants with Turkish or Arabic background in Germany (results are published elsewhere [16]), and expert interviews on palliative care provision for migrants to gain a comprehensive insight into this mostly unknown.topic [20]
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