From Albania to Zambia: travel back to country of origin as a goal of care for terminally ill patients.

Background: With unprecedented levels of international migration, physicians in the United States may care for terminally ill patients who have strong connections to their country of origin and such patients may desire to return in the final stages of life.

Objective: In this study, we analyzed how often terminally ill patients cited travel to country of origin as a goal of care, how often travel occurred, and factors associated with successful travel.

Design: A retrospective chart review from January 1, 2005 through May 1, 2007.

Setting/subjects: All foreign-born patients seen by a palliative care consultation service, including inpatient and outpatient consultations, in an urban safety-net health system in the United States.

Measurements: We determined whether patients expressed a desire to travel to their country of origin and the factors, including demographics and functional status associated with travel.

Results: Of 336 foreign-born patients, 129 (38%) expressed a desire to travel to their country of origin; 60 (47%) successfully returned to 24 unique countries. Countries to which the largest number of patients returned were Mexico (n=14), Poland (n=11), and the Philippines (n=7). Although patients with the best functional status were most likely to travel successfully, 16 (31%) who wanted to travel despite having the worst functional status (Eastern Cooperative Oncology Group [ECOG] score indicating confinement to bed or chair) traveled successfully. There were no deaths en route or flight diversions due to medical crisis; all trips were made on regularly scheduled commercial airline flights.

Conclusions: A substantial proportion of patients in our cohort expressed a desire to return to their country of origin. We facilitated successful travel for nearly half of these patients. Our findings identify the need to include travel back to country of origin in the framework of planning care for terminally ill patients.