Investigating Disparities in End-of-Life Care in Undocumented Hispanic Immigrants

调查无证西班牙裔移民临终关怀方面的差异

• 批准号: 10593462
• 负责人: Valeria Lucia Cardenas
• 金额: $ 3.62万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-15 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10593462
• 关键词: Accident and Emergency department; Address; Adult; Affect; Affordable Care Act; Ambulatory Care; Ambulatory Care Facilities; Area; Audiotape; Award; Behavioral Model; California; Caring; Cause of Death; Chronic Disease; Chronic Obstructive Pulmonary Disease; Continuity of Patient Care; Data; Development; Diagnosis; Disparity; Elderly; Eligibility Determination; End stage renal failure; Enrollment; Ethnic Population; Exclusion; Face; Fright; Future; Genetic Transcription; Goals; Guidelines; Health; Health Insurance; Health Personnel; Health Services Accessibility; Healthcare; Heart failure; Hispanic; Hispanic Populations; Hospitals; Immigrant; Individual; Intervention; Intervention Studies; Interview; Liver diseases; Malignant Neoplasms; Medical; Not Hispanic or Latino; Palliative Care; Patients; Population; Provider; Public Health; Public Hospitals; Published Comment; Quality of life; Reporting; Research; Risk; Services; Source; Structure; Surveys; Symptoms; Training and Education; Transcript; Translating; Uninsured; United States National Institutes of Health; advanced disease; aged; care outcomes; care seeking; end of life; end of life care; ethnic minority population; experience; health care availability; health care model; health care service; health care service utilization; hospice environment; improved; patient navigation; programs; racial minority population; racial population

Project Summary/Abstract The U.S. undocumented immigrant population ranges from 10.5 million to 12 million and makes up to 3.2% to 3.6% of the population. Over 80% of these undocumented immigrants are Hispanic. This population faces numerous barriers to obtaining healthcare services, largely due to fear of deportation and limited access to healthcare. Undocumented immigrants’ lack of eligibility for hospice services and palliative care limits them to care in outpatient clinics or emergency departments, contributing to poor end-of-life care outcomes. Undocumented immigrants are at greater risk of dying from untreated and undiagnosed chronic diseases, such as cancer and heart failure, the top two leading causes of death among Hispanics. Yet, little is known about the end-of-life care outcomes of this population and less is known about the challenges healthcare providers face when caring for this population. The objectives of the proposed project are two-fold: 1) to determine challenges and facilitators hospital-based palliative care healthcare providers encounter in caring for seriously ill undocumented Hispanic immigrants; and 2) to explore the healthcare service use experiences of seriously ill undocumented Hispanic immigrants and factors affecting their access to care. I will conduct individual, semi- structured interviews with seriously ill undocumented Hispanic older adults and palliative care healthcare providers at two public hospitals. Ten to 12 palliative care healthcare providers who regularly treat undocumented Hispanic immigrants will be invited to participate in a 30 to 45 minute audiotape-recorded interview. In addition, I will interview 18 to 20 patients who are aged 18 and older, identify as Hispanic, and are diagnosed with one of the following serious illness diagnoses: cancer, heart failure, chronic obstructive pulmonary disease, liver disease, or end-stage renal disease. All interviews will be transcribed and translated into English and transcripts will be analyzed in NVivo 12 using thematic analysis. This study is guided by Andersen’s Behavioral Model of Health Care Use and will follow the Consolidated Criteria for Reporting Qualitative Studies (COREQ) guidelines, a 32-item checklist for interviews. Results from the proposed project will inform the development of targeted interventions that aim to mitigate the identified barriers and promote quality of life for undocumented immigrants at end of life.

项目总结/摘要 美国无证移民人口从1050万到1200万不等，占美国人口的3.2%， 占人口的3.6%。这些无证移民中有80%以上是西班牙裔。这些人面临着 在获得医疗保健服务方面存在许多障碍，主要是由于担心被驱逐出境和获得医疗服务的机会有限。 健康护理无证移民缺乏临终关怀服务和姑息治疗的资格， 在门诊或急诊室的护理，导致穷人的临终关怀结果。 无证移民死于未经治疗和未经诊断的慢性疾病的风险更大， 癌症和心力衰竭是拉美裔人死亡的两大主要原因。然而，人们对它知之甚少。 这一人群的临终关怀结果，而对医疗保健提供者面临的挑战知之甚少 照顾这个群体。拟议项目的目标有两个方面：1）确定挑战 和促进者医院为基础的姑息治疗医疗保健提供者在照顾重病 无证西班牙裔移民;和2）探讨重病患者的医疗服务使用经验 无证西班牙裔移民和影响他们获得护理的因素。我将进行个人，半- 与患有重病的无证西班牙裔老年人和姑息治疗医疗保健的结构化访谈 两家公立医院的服务人员。10到12个姑息治疗医疗保健提供者，他们定期治疗 无证西班牙裔移民将被邀请参加一个30至45分钟的录音带， 采访此外，我将采访18至20名年龄在18岁及以上的患者，他们被认为是西班牙裔， 被诊断患有以下严重疾病之一：癌症、心力衰竭、慢性阻塞性肺疾病 肺病、肝病或终末期肾病。所有的采访将被转录和翻译 翻译成英文，并将在NVivo 12中使用主题分析对成绩单进行分析。这项研究是由 Andersen的卫生保健使用行为模型，并将遵循统一的报告标准 质性研究（COSTO）指南，一个32项的访谈清单。拟议项目的成果 将为制定有针对性的干预措施提供信息，这些干预措施旨在缓解已确定的障碍， 无证移民在生命结束时的生活质量。