Examining ethnic and geographic disparities in end-of-life care pathways and community specialist palliative care engagement: insights from the Waikato Region.

AIM: This audit aims to evaluate differences in access and care between Māori and Pākehā patients, as well as between urban, rural and aged residential care (ARC) populations.

METHOD: A regional clinical audit reviewed 511 patients referred to community specialist palliative care services in the Waikato Region from January 2021 to January 2023. Key endpoints included time from referral to death, time to first phone and face-to-face contact, and medical team engagement.

RESULTS

Referral times were equal between Māori and Pākehā, though rural patients were referred significantly earlier than urban patients, with medians of 59 and 36 days, respectively (p<0.001). Rural patients also had higher rates of medical team input (52%) compared with urban patients (40%), with ARC patients receiving significantly less at 8.7% (p<001).

CONCLUSION

While referral times were similar for Māori and Pākehā, this may overlook delays for Māori, who likely have greater specialist palliative care needs. Rural patients were referred earlier and received more medical input, reflecting both greater needs and opportunities to improve urban referrer relationships. Disparities in specialist palliative care for aged care patients merit further investigation, particularly with the projected growth of this population.