Access to hospice and palliative care for people with a migration background: a qualitative study on challenges and recommendations in end-of-life care

BACKGROUND: Systemic inequalities shape healthcare access, disproportionately affecting people with a migration background in Germany. Empirical studies on this group in hospice and palliative care are quite limited and highlight a gap in understanding the challenges and potential solutions. OBJECTIVES: To explore, from the perspectives of healthcare providers, the challenges faced by patients with a migration background, their families, and healthcare providers in hospice and palliative care. The aim was to improve accessibility, reduce barriers, and ensure that hospice and palliative care services are accessible and inclusive to them. METHODS: A qualitative study was conducted employing directed content analysis of healthcare providers' responses to open-ended questions on end-of-life care. The analysis was guided by a system-facing social determinants of health framework, emphasising systemic and structural factors influencing care services. Healthcare providers recruited from hospice and palliative care facilities across Germany (n = 332). RESULTS: Language barriers, cultural insensitivity, and systemic inequalities were identified by healthcare providers as major obstacles hindering access to hospice and palliative care for patients with a migration background. Healthcare providers emphasised the need for tailored support services, community-based networks and other innovative solutions to improve accessibility and outcomes. Moreover, they highlighted that the emotional burden on all actors involved in hospice and palliative care is exacerbated by language barriers, cultural misconceptions, and the structural complexity of end-of-life care. CONCLUSION: Prioritising equitable and culturally sensitive care as part of broader support services and innovative solutions can enable broad participation in hospice and palliative care, including patients with a migration background and their families, based on mutual trust. Further research is needed to overcome logistical and financial challenges and facilitate the implementation of actionable recommendations within hospice and palliative care services.