Indigenous compared with non-Indigenous Australian patients at entry to specialist palliative care: Cross-sectional findings from a multi-jurisdictional dataset

John A Woods; Jade C Newton; Sandra C Thompson; Eva Malacova; Hanh T Ngo; Judith M Katzenellenbogen; Kevin Murray; Shaouli Shahid; Claire E Johnson

doi:10.1371/journal.pone.0215403

Indigenous compared with non-Indigenous Australian patients at entry to specialist palliative care: Cross-sectional findings from a multi-jurisdictional dataset

PLoS One. 2019 May 2;14(5):e0215403. doi: 10.1371/journal.pone.0215403. eCollection 2019.

Authors

John A Woods¹, Jade C Newton^{2

3}, Sandra C Thompson¹, Eva Malacova^{4

5}, Hanh T Ngo^{6

7}, Judith M Katzenellenbogen^{5

8}, Kevin Murray⁵, Shaouli Shahid⁹, Claire E Johnson^{2

10

11}

Affiliations

¹ Western Australian Centre for Rural Health, School of Population and Global Health, The University of Western Australia, Nedlands, Western Australia, Australia.
² Cancer and Palliative Care Research and Evaluation Unit, Medical School, The University of Western Australia, Nedlands, Western Australia, Australia.
³ School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, Western Australia, Australia.
⁴ School of Public Health, Curtin University, Bentley, Western Australia, Australia.
⁵ School of Population and Global Health, The University of Western Australia, Nedlands, Western Australia, Australia.
⁶ Rural Clinical School, The University of Western Australia, Nedlands, Western Australia, Australia.
⁷ Discipline of Emergency Medicine, Medical School, The University of Western Australia. Nedlands, Western Australia, Australia.
⁸ Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia.
⁹ Centre for Aboriginal Studies, Curtin University, Bentley, Western Australia, Australia.
¹⁰ Nursing and Midwifery, Monash University, Clayton, Victoria, Australia.
¹¹ Eastern Health, Box Hill, Victoria, Australia.

Abstract

Background: There are few quantitative studies on palliative care provision to Indigenous Australians, a population known to experience distinctive barriers to quality healthcare and to have poorer health outcomes than other Australians.

Objectives: To investigate equity of specialist palliative care service provision through characterising and comparing Indigenous and non-Indigenous patients at entry to care.

Methods: Using data (01/01/2010-30/06/2015) from all services participating in the multi-jurisdictional Palliative Care Outcomes Collaboration, Indigenous and non-Indigenous patients entering palliative care were compared on proportions vis-à-vis those expected from national statutory datasets, demographic characteristics, and entry-to-care status across fourteen 'problem' domains (e.g., pain, functional impairment) after matching by age, sex, and specific diagnosis.

Results: Of 140,267 patients, 1,465 (1.0%, much lower than expected from statutory data) were Indigenous, 133,987 (95.5%) non-Indigenous, and 4,905 (3.5%) had a missing identifier. The proportion of patients with a missing identifier diminished markedly over the study period, without a corresponding increase in the proportion identified as Indigenous. Indigenous compared with non-Indigenous patients were younger (mean 62.8 versus 73.0 years, p<0.001), a higher proportion were female (51.5% versus 46.3%; p<0.001) or resided outside major cities (44.2% versus 21.5%, p<0.001). Across all domains, Indigenous compared with matched non-Indigenous patients had lower or equal risk of status requiring prompt intervention.

Conclusions: Indigenous patients (especially those residing outside major cities) are substantially under-represented in care by services participating in the nationwide specialist palliative care Collaboration, likely reflecting widespread access barriers. However, the similarity of status indicators among Indigenous and non-Indigenous patients at entry to care suggests that Indigenous patients who are able to access these services do not disproportionately experience clinically important impediments to care initiation.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Age Factors
Aged
Australia
Cross-Sectional Studies
Databases, Factual
Female
Health Services, Indigenous / statistics & numerical data*
Humans
Male
Middle Aged
Palliative Care / legislation & jurisprudence*
Risk
Rural Population
Sex Factors

Grants and funding

JW is funded by the Australian National Health and Medical Research Council (https://nhmrc.gov.au/: Postgraduate Research Scholarship 1133793), a University of Western Australia Athelstan and Amy Saw Top-Up Scholarship, and a University Postgraduate Award and Australian Government Research Training Program Scholarship at The University of Western Australia (www.uwa.edu.au). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.