Equity of Access to Palliative Care: A Scoping Review

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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