There are many inequities within palliative care, hospice care, and end-of-life care. This scoping review by Sítima, Galhardo-Branco, and Reis-Pina (2024) examines these inequities for people with chronic, progressive, life-threatening, or limiting diseases. The review explores the primary contributors, key barriers to achieving equitable access, and essential recommendations.
The researchers executed a systematic search of PubMed, Web of Science, and Embase databases for all English-language articles published since 2017. They included all palliative care, hospice care or end-of-life care interventions, in hospital and community settings, with the outcome being equitable access to care.
The research team identified 14 studies from the following countries: USA (5), Canada (2), UK (4), Spain (1) and Australia (2).
The main contributors identified to inequity included: racial discrimination, disparities among informal caregivers, geographic discrepancies, socioeconomic disparities, healthcare accessibility issues, and challenges in low-income countries. See below some recommendations to address these key contributors.
Contributor Identified | Recommendation(s) |
Racial discrimination | Understand diverse backgrounds, be sensitive to treatment preferences, and incorporate social and cultural factors. |
Gender discrimination | Foster awareness of personal biases. |
Informal caregiver discrepancies | Provide financial support through benefits. |
Geographic discrepancies | Decentralize palliative care services and introduce technology-enhanced care. |
Socioeconomic discrepancies | Recognize and address social determinants of health, build trust, and advocate for policies supporting underserved populations. |
Health care accessibility | Foster a supportive policy environment, engage communities, and identify social determinants of health inequity. |
Difficulties in low-income countries | Integrate palliative care training into medical curriculums and develop training programs for home-based care practitioners. |
The researchers also identified both barriers and enablers to achieving equitable access to palliative care services.
Barriers Identified
- Identification of patients: Difficulty in accurately identifying patients nearing the end of life.
- Survival imperative: Focus on prolonging life over palliative care.
- Normalization of dying: Reluctance to discuss death openly, leading to underutilization of palliative care.
- Misconceptions and mistrust: Misunderstandings about palliative care and mistrust in the healthcare system, particularly among marginalized groups.
- Fragmented care system: Poor communication and integration within the healthcare system, leading to gaps in service delivery.
Enablers Identified
- Proper patient evaluation: Systematic evaluations to identify those who may benefit from PC early.
- Workforce education: Training healthcare providers on the importance and benefits of palliative care.
- Addressing basic survival needs: Ensuring access to basic needs and addressing social determinants of health.
- Promoting intersectoral collaboration: Building partnerships between healthcare sectors, community organizations, and social services.
- Community engagement: Engaging communities in advocacy to promote awareness and understanding of PC services and challenging systemic barriers.
Source: Sítima G, Galhardo-Branco C, Reis-Pina P. Equity of access to palliative care: a scoping review. International journal for equity in health. 2024;23(1):248-18. doi:10.1186/s12939-024-02321-1
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