The association between patient preferred language and end-of-life outcomes of home care patients who died from a cancer in Ontario, Canada - A retrospective cohort study.

Abstract

Language is an often-forgotten determinant of health. The impact of patient preferred language on health outcomes of patients with cancer remains under-investigated. To explore the association between patient preferred language and end-of-life outcomes of patients who died of cancer. We conducted a population-based, retrospective cohort study of home care recipients who died of cancer between 2013 and 2018 in Ontario, Canada. We identified patient preferred language from standardized home care assessments. 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. We used descriptive statistics and multivariable logistic regression models to characterize the association between patient language and end-of-life outcomes in this population. 33,958 home care recipients were included, with 28,322 (83.4%) anglophones, 786 (2.3%) francophones, and 4,850 (14.3%) allophones. Allophones were older, more likely to reside in lower-income neighborhoods and more likely to have immigrated to Canada within 5 years. Allophones had significantly 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), ED visits (OR 1.16, 95% CI 1.08-1.24), and increased odds of aggressive interventions in the last 30 days of life compared to anglophones. Francophones also had increased odds of death in hospital (OR 1.23, 95% CI 1.04-1.46) compared to anglophones. Our study showed that in patients with terminal cancer, allophone home care recipients had more hospital deaths and aggressive interventions compared to anglophones. Additional research is needed to identify root causes and strategies to improve care.