Vol.:(0123456789) 1 3 Journal of Immigrant and Minority Health https://doi.org/10.1007/s10903-019-00882-w REVIEW PAPER A Scoping Review of Undocumented Immigrants and Palliative Care: Implications for the Canadian Context Lisa Seto Nielsen 1  · Zoë Goldstein 1  · Doris Leung 2  · Charlotte Lee 3  · Catriona Buick 4 © Springer Science+Business Media, LLC, part of Springer Nature 2019 Abstract Approximately 30–40 million undocumented immigrants worldwide sufer restricted health care. A scoping review was conducted to determine what is known about this population’s palliative end-of-life care experiences. The scoping review followed Arksey and O’Malley’s methodological framework. Databases searched included CINAHL, Medline, ProQuest, Scopus, and PHRED. Search terms included uninsured care, palliative care, undocumented immigrants, and terminally ill. The search revealed limited peer-reviewed and grey literature on the topic. A total of six articles met inclusion criteria, of which four were case descriptions. Barriers to palliative care included lack of advanced care planning, lack of health insur- ance, poverty, fear of deportation, and limited English ability. Undocumented immigrants were more likely to have delayed access to and inadequate palliative end-of-life care. If palliative care is a human right, it is imperative that further research be conducted and policies put in place to better serve this vulnerable population at end-of-life. Keywords Undocumented immigrants · Palliative care · End-of-life · Access to care · Scoping review Introduction Throughout history, individuals living in underprivileged countries have sought improved quality of life through immigration [1]. It has been estimated that approximately 30–40 million immigrants worldwide live precariously with- out documentation [2]. Of this estimate, roughly 11.5 mil- lion live in the United States, 1.9–3.8 million live in the European Union, and 500,000 live in Canada [2, 3]. Canada accepted almost 300,000 immigrants and refugees in 2016, one of the highest amongst Organisation for Economic Co- operation and Development (OECD) countries [4]. The current discussion uses the phrase “undocumented immi- grants” to refer to all individuals without legal status. This term encompasses the thousands of immigrants who enter Canada legally on various forms of provisional visas (such as interim refugee claimants, caregivers, and temporary workers), and then overstay these limitations [5, 6]. Of those who enter on temporary visas, 60% maintain underpaid and risky jobs prone to exploitation [7–9]. Undocumented immi- grants often sufer from various forms of trauma and stress surrounding immigration, both relating to their country of origin and unstable status post-arrival. Although these particular challenges often place signifcant strain on their physical health [7, 9], they face extensive and largely unac- knowledged barriers to healthcare access. Restricted healthcare is a serious and widespread issue among undocumented groups globally. For example, undoc- umented Mexican immigrants in the United States are 27% less likely to have visited a healthcare provider in the past year than their documented counterparts [10]. In the Neth- erlands, over half of undocumented women report hav- ing healthcare needs left unmet [11]. Policies vary widely between countries, but undocumented patients are often only eligible for emergency care [5]. In reality, however, exten- sive barriers restrict the provision of good quality emergency care to those in need. Limited profciency in the national language, little understanding of the health system, fear of being reported to authorities, and mistrust in health care * Lisa Seto Nielsen lisaseto@yorku.ca 1 School of Nursing, Faculty of Health, York University, Toronto, Canada 2 School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong 3 Daphne Cockwell School of Nursing, Ryerson University, Toronto, Canada 4 Sunnybrook Hospital, Toronto, Canada