Symptom-related distress among indigenous Australians in specialist end-of-life care: Findings from the multi-jurisdictional palliative care outcomes collaboration data

Symptom relief is fundamental to palliative care. Aboriginal and Torres Strait Islander 25 (Indigenous) Australians are known to experience inequities in health care delivery and outcomes, 26 but large-scale studies of end-of-life symptoms in this population are lacking. We compared 27 symptom-related distress among Indigenous and non-Indigenous Australian patients in specialist 28 palliative care using the multi-jurisdictional Palliative Care Outcomes Collaboration dataset. Based 29 on patient-reported rating scale responses, adjusted relative risk (aRRs) stratified by care setting 30 were calculated for occurrence of (i) symptom-related moderate-to-severe distress and worsening 31 distress during a first episode of care, and (ii) symptom-related moderate-to-severe distress at the 32 final pre-death assessment. The p-value significance threshold was corrected for multiple 33 comparisons. First-episode frequencies of symptom-related distress were similar among Indigenous 34 (n=1,180) and non-Indigenous (n=107,952) patients in both inpatient and community settings. In 35 final pre-death assessments (681 Indigenous and 67,339 non-Indigenous patients), both groups had 36 similar occurrence of moderate-to-severe distress when care was provided in hospital. In 37 community settings, Indigenous compared with non-Indigenous patients had lower pre-death risks 38 of moderate-to-severe distress from any overall symptom occurrence (aRR 0.78; p=0.001; confidence 39 interval [CI] 0.67–0.91) or from ≥3 different symptoms (aRR 0.65; CI 0.45–0.96). These findings 40 provide reassurance of reasonable equivalence of end-of-life outcomes for Indigenous patients who 41 have been accepted for specialist palliative care.