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

Abstract

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

• Cancer
• Migrant patients
• Decision-making
• Place of death
• End-of-Life
• Palliative care