Between host country and homeland: a grounded theory study on place of dying and death in migrant cancer patients

Abstract

Background: Migrant cancer patients face unique challenges in end-of-life decision-making. One key yet underexplored aspect is the decision-making process surrounding the place of dying and death. This study explores the factors influencing these decisions involving migrant cancer patients in Italy.

Methods: A constructivist grounded theory approach was employed. Data were collected through semi-structured interviews with 28 participants (patients, family members, cultural mediators, and other key informants, some from a previous grounded theory study). Theoretical sampling guided participant selection for this study, and data analysis followed an iterative coding process, leading to the development of a conceptual model.

Results: The decision-making process was conceptualized as a gradient field in which three forces interact to shape outcomes: (1) Healthcare as an Attracting/Holding Force-quality medical care in Italy encouraged patients to stay, though its influence diminished as curative treatments ended; (2) Bureaucratic and Financial Barriers as an Obstructing Force-challenges related to residency, access to care, and financial constraints often complicated decision-making, particularly for those considering repatriation; and (3) Social Networks as a Stabilizing Force-the strength of familial and community ties in host country and homeland played a decisive role in shaping preferences. A fundamental opacity about terminality was present, with limited communication and awareness regarding prognosis, further expanding the circle of decision-makers.

Conclusions: Palliative care professionals should recognize the importance of transnational networks, consider bureaucratic barriers, and encourage open discussions regarding place of dying and death decision. To navigate these complexities, we propose a question guide for specialists during consultations. This tool aims to enhance culturally sensitive communication, promote shared decision-making, and address the challenges of cross-border end-of-life care. By accommodating transnational ties, palliative care services can better align with the realities of migrant cancer patients, fostering equitable and dignified end-of-life care.

Keywords: Advance care planning; Cancer; Decision-making; End-of-Life; Grounded theory; Migrant patients; Palliative care; Place of death; Transnationalism.

Fig. 1

The GT model