Accounts of carers' satisfaction with health care at the end of life: a comparison of first generation black Caribbeans and white patients with advanced disease

While much research has described experiences at the end of life, no studie s have explored the black Caribbean perspective. This paper compares the fi nal year of life of first generation black Caribbeans and white patients wi th advanced disease in an inner London health authority, focusing on their satisfaction with service provision in both primary care and acute settings using face-to face interviews with carers of deceased patients. Of the 106 black Caribbean patients and 110 white deceased patients identified as dyi ng during the study period 50 interviews per ethnic group were conducted wi th family members or close friends, a response rate of 47% and 45%. Even th ough examples of excellent and good care were cited, a larger proportion of negative satisfaction ratings of health care was recorded among respondent s representing black Caribbean patients. This was true for all health care settings, particularly primary care, but less so for specialist palliative care nurses. However, few black Caribbean patients accessed specialist pall iative care nurses or hospices. Qualitative data provided a deeper insight into the black Caribbean experience care at the end of life. We recommend t hat where examples of best practice in palliative care and culturally sensi tive provision are evident they be extended to more health care professiona ls through education and training. Access to specialist palliative care ser vices needs to be improved.