Table 1 Overview of included studies on palliative and end of life care for Blacks in Canada

Chu et al. 2021 [13]

Ontario

To compare end-of-life care between recent immigrants and long-term residents

Cancer decedents including: 13,085 immigrants and 229,471 long-term residents ≥ 18 years at the time of death.

Number of Blacks: 1052

Retrospective, population-based

cohort study

between 2004 and 2015

• Black immigrants have 1.2 times greater risk for aggressive care at end of life than long term residents (OR: 1.20, 95% CI 0.94 to 1.53).

• Black immigrants are one of 3 ethnic groups that are least likely to access supportive care (ORs: 0.82, 95% CI 0.72 to 0.93;)

Nayfeh et al. 2021 [27]

Ontario

To measure satisfaction with the quality of inpatient end-of-life care

1,543 next-of-kin of recently deceased patients from various racial backgrounds

Number of Blacks: 25

Observational survey

• High level of satisfaction among family members of patients who died in the intensive care unit. Overall Satisfaction score was 8.30(2.09) of 10

• Satisfaction scores among black participants ranged from 8.00–9.00 of 10pionts

Quach et al. 2021 [28]

Ontario

To compare places of care among recent immigrants and long-standing residents in the last 90 days of life.

376 617 deceased individuals, ≥ 18

Number of Africans: 1299

Retrospective cohort study between January 2013, and December 2016.

• Immigrants from Africa used more acute care in the last 90days of life:

• Health care service use by immigrants from Africa were as follows: Subacute (6.70%), Acute (58.89%), Community (29.64%), Long-term care (4.77%).

• Immigrants from Africa more likely than other participants to receive palliative physician visit in the last 90 days of life [1.35 (1.18–1.53) (P <.0001)]

Yarnell et al. 2017 [29]

Ontario

To examine end-of-life care provided to immigrants in the last 6 months of their life.

967 013 decedents who immigrated to Canada between 1985 and 2015.

Number from the African region: 2,606

Population-based cohort study from April 1, 2004, to

March 31, 2015

• High relative risk of dying in ICU among decedents born in Africa: (95% CI, 1.70-2.00).

• Up to 482 (18%) participants of African origin died in the ICU.

• High experience of aggressive care at the end of life among recent immigrants from Africa.

Wanda et al. 2014 [32]

Nova Scotia

To examine the role of spirituality at the end of life.

14 participants between 35 to 72 years who were either Caribbean, Canadian Black or African family caregivers or spiritual leaders.

Qualitative

In-depth interviews and focus groups

• Role of pastors at end of life is seen as supportive.

• More support provided to church members at the end of life, compared to non-church members.

• Having faith in God was associated with more peaceful end-of-life experiences than those without faith.

• Need for improved healthcare provider awareness of the spiritual needs of African families.

• Need for holistic palliative care services: with end of life care plans that include spirituality and involves religious leaders.

Maddalena et al. 2013 [30]

Nova Scotia

To assess knowledge regarding options for palliative and end of life care.

6 African Canadian caregivers of a patient with a late-stage condition who has died within the last 5 years and no sooner than 6 months. Caregivers aged 50-70years

Qualitative: naturalistic inquiry and Participatory Action Research

• Limited knowledge of options for palliative care services.

• End of life considered a “family affair.”

• Preference for home care and expectation of close family members and community to provide care

• Lack of respite and bereavement care.

• Financial strain associated with the care of their ill family member

• Limited access to information about palliative care services

• Need to explore different ways of educating community members about palliative and end of life care services.

• Education on available palliative care provided to participants by palliative care team seen as very helpful and hope it continues.

• Concern about “strangers” getting in their homes to provide care.

• Positive experience with formal healthcare system

Maddalena et al. 2010 [31]

Nova Scotia

Examine the meanings that African Nova Scotians ascribe to their experiences of cancer, family caregiving, and use of complementary alternative medicine (CAM) at end of life.

7 African Canadian caregivers of someone who has died from cancer within the last 3 years and no sooner than 6 months.

Three case studies examined: Two African Nova Scotian families and one immigrant family from the Caribbean.

Three primary caregivers, and four secondary caregivers.

Qualitative: Case study with in-depth interviews

• Expectation that family members (primarily women) will assume the primary caregiving role in the home for their ill family members with chronic illness or at the end of life.

• Reluctance among participants to use conventional institution-based palliative and supportive care.

• Considerable hardships experienced while caregiving including financial burden.

• Primary caregivers of ill family members often assumed other caregiving roles within the family.

• Participants expressed limited knowledge of the supports available within the health system as well as how to access financial supports.

• Limited access to bereavement support services.

• Importance of spirituality to ill family members at the end of life.

• Resignation to fate and “God’s will”.

• Home remedies used such as cannabis for pain management, massage and prayer identified as Complimentary and Alternative Medicine.

• Use of complementary and alternative medicine due to fear of the health system or denial.