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

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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.