Specialist palliative care provided to Indigenous Australians: findings from a multi-jurisdictional dataset (Oral presentation)

Background: Health service performance influences needs for community-centred end-of- life care. 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 cultural barriers within healthcare systems. 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 and non-Indigenous patients on (i) representation in care by participating specialist palliative care services, (ii) demographics, residence and diagnosis, and (iii) equity of care received according to benchmark-derived indices.
Design: Detailed antecedent data quality assessment, quantitative cross-sectional and longitudinal 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 statutory data) and 138,438 (95.5%) non-Indigenous. Patients missing an “Indigenous identifier” (4,998; 3.5%) diminished markedly over the study period, without a corresponding increase in the proportion identified as Indigenous.
Indigenous compared with non-Indigenous patients were younger at entry (mean 62.8 versus
73.0 years, p<0.001), more frequently resided outside major cities (45.3% versus 21.8%, p<0.001), with similar proportions having a cancer diagnosis (79.8% versus 79.2%, p=0.567). Indigenous patients more often encountered delays in initiating care episodes (adjusted odds ratio 1.41, 95% confidence interval 1.07–1.86), but did not disproportionately experience occurrence of or delayed institution of management for unanticipated/“breakthrough” problems. Symptom/problem trajectory analyses are nearing completion.
Conclusions/Application: There is no consistent pattern of measurable inequity in palliative care provided to Indigenous patients able to access specialist services. However, considerable under-representation of Indigenous Australians with life-limiting illnesses in specialist palliative care nationwide likely reflects access barriers, underscoring heightened importance in this population of capacity building for community-based end-of-life support.