Palliative care provided to Indigenous Australians: analysis of a multi-jurisdictional dataset (‘Mini-oral’ presentation)

Background: Aboriginal and Torres Strait Islander people have distinctive end-of-life experiences—they develop life-limiting illnesses at younger average ages than other Australians, more commonly reside outside metropolitan areas, and frequently encounter healthcare-related cultural barriers. Detailed large-scale appraisals of palliative care services for Indigenous Australians are lacking.
Aims: Using multi-jurisdictional data collected by the Palliative Care Outcomes Collaboration, to compare Indigenous with non-Indigenous patients on (i) representation in care by participating services, (ii) demographics and diagnosis, and (iii) equity of care received according to benchmark-derived indices.
Design: Detailed antecedent data quality assessment, quantitative analyses incorporating multiple regression and matching techniques to minimise confounding, with multiple imputation to handle missing data.
Results: The dataset (1/1/2010–30/6/2015) comprised 144,951 subjects: 1515 Indigenous (1.1%, much lower than expected from population data) and 138,438 (95.5%) non- Indigenous. Patients missing an Indigenous identifier (4,998; 3.5%) diminished markedly over the study period, with no corresponding increase in the proportion identified as Indigenous. Indigenous compared with non-Indigenous patients were younger (mean 62.8 versus 73.0 years at entry, p<0.001), and more frequently resided outside major cities (45.3% versus 21.8%, p<0.001). Proportions diagnosed with cancer were similar (79.8% versus 79.2%, p=0.567). Indigenous patients more often encountered initiation-of-care delays, but did not disproportionately experience occurrence of or delayed institution of management for unanticipated/“breakthrough” problems. Symptom/problem trajectory analyses are nearing completion.
Conclusions: Indigenous Australians with life-limiting illnesses are considerably under- represented in specialist palliative care nationwide. However, there is no consistent pattern of measurable inequity in end-of-life care provided to Indigenous patients accessing services.