Challenges and opportunities in caring for low-income immigrant cancer patients at end of life


Each month, Professor Catherine Walshe, Editor-in-Chief of Palliative Medicine, chooses an article that readers may find particularly interesting or useful and invites the authors to draw out the key points on the EAPC blog. Focusing on research that is novel, a robust review, from a specific country or just slightly left of field, the ‘Editor’s Choice’ post aims to share experience and stimulate ideas. We hope you’ll read the longer article in ‘Palliative Medicine’.

Today, Luca Ghirotto (Head of Qualitative Research Unit, Azienda USL – IRCCS [Scientific Institute for Research, Hospitalization and Healthcare – Istituto di Ricovero e Cura a Carattere Scientifico] of Reggio Emilia, Italy), and co-authors, Simona Sacchi, Roberto Capone, Francesca Ferrari, Federica Sforacchi and Silvia Di Leo, give the background to their longer article selected as Editor’s Choice in the February issue of ‘Palliative Medicine’.

A palliative specialist interviewed, told us: “We [palliative physicians] talk about very delicate topics. I don’t just need the patient to give me a ‘Yes’ or ‘No’ answer to the pain. The words, the nuances of the words are particularly important.”

Empirical investigations stem from the real problems we face in the workplace. For many issues in clinical practice, we already have solutions. However, some situations seem resistant to standard or routine solutions or approaches. This study was born just like that: from the experience of some of the authors who found themselves unprepared for assisting low-income immigrant cancer patients. Death is difficult in any language, but it is more complicated if you get an oncological diagnosis and need palliative care in your non-native country. (1)

Between 2000 and 2020, the European region experienced an annual net arrival of approximately 1.6 million immigrants per year. In most cases, immigrants arrive from war-torn and low-income countries. They remain in economically precarious conditions for many years after they come to Europe. In the setting of cancer disease, professionals taking care of them face a two-fold task: managing clinical conditions and considering the social, economic, cultural and spiritual sphere of both patients and their families. How are we doing this?

Luca Ghirotto and co-authors pictured in a recent Zoom meeting. Top row left to right: Simone Saachi, Roberto Capone, Francesca Ferrari. Bottom row: Federica Sforacchi, Silvia Di Leo, Luca Ghirotto.

Within a training programme held by the Qualitative Research Unit of Azienda USL – IRCCS in Reggio Emilia, (2) we conducted a study to explore the caring process for low-income immigrant cancer patients in our context.

Many different stakeholders were involved: family members, interpreters, immigrant association members, nurses, palliative specialists, and oncologists. We found that participants tried to create a care process for immigrant cancer patients by implementing naive skills. Within a setting (a province within the Emilia-Romagna region, in Northern Italy) that was felt as welcoming and inspiring trust, we understood how professionals address cultural differences: minimising them, assuming a paternalistic posture and still committed to “do more”. Conversely, family members and interpreters claimed their cultural identity.

Interviewed professionals tried to alleviate patients’ suffering without taking into account any cultural understanding. Generally, the participants felt inadequate and unprepared to face the complexity of care and type of information to be passed to the patient. What emerged from the study is the meaningful role of the interpreter. Not employing professional interpreters may lead patients and families to an inadequate understanding of diagnosis and prognosis. (3) Moreover, professional interpreters were not used adequately, nor specifically trained.

Caring for low-income immigrant cancer patients can be a “teachable moment” for professionals. It calls for them to acquire cultural competencies and recognise each patient’s (cultural-based) uniqueness. It also evidences that understanding the words “cancer” or “end-of-life care” depends not only on language but also on culture. Meanings across ethnic groups differ, management of end-of-life issues cannot be guaranteed outside an intercultural approach. (4)


  1. Green A, Jerzmanowska N, Green, M, et al. ‘Death is difficult in any language’: A qualitative study of palliative care professionals’ experiences when providing end-of-life care to patients from culturally and linguistically diverse backgrounds. Palliat Med 2018: 1-9.
  2. Ghirotto L, De Panfilis L and Di Leo S. Health professionals learning qualitative research in their workplace: a focused ethnography. BMC Med Educ 2020 Aug17;20(1):269.
  3. Butow PN, Lobb EA, Jefford M, et. al. A bridge between cultures: interpreters’ perspectives of consultations with migrant oncology patients. Supp Care Cancer 2012; 20:235-244.
  4. Hanssen I and Pedersen G. Pain relief, spiritual needs, and family support: three central areas in intercultural palliative care. Palliat Support Care 2013; 11(6):523-30.

Links and resources

This post relates to the longer article, Achieve the best while rushing against time”: A grounded theory study on caring for low-income immigrant cancer patients at end of life by Simona Sacchi,  Roberto Capone, Francesca Ferrari, Federica Sforacchi, Silvia Di Leo and Luca Ghirotto, published in Palliative Medicine Volume 35 issue: 2, page(s): 426-436. Article first published online: 25 December 2020. Issue published: February 1,

Read earlier Palliative Medicine Editor’s Choice posts on the EAPC blog.
Follow Palliative Medicine on Twitter @palliativemedj 

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This entry was posted in EAPC-LINKED JOURNALS, Minority Communities, Palliative Medicine: Editor's Choice, PATIENT & FAMILY CARE, RESEARCH. Bookmark the permalink.

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