Gender Disparities in End of Life Care

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Traditional gender norms and expectations may disproportionately impact in-home palliative care received by women and a shift towards more care in the home may disproportionately burden women.

A recent scoping review by Wong and Phillips (2022) evaluated the literature describing gender disparities in end-of-life (EOL) care to explore relevant themes to inform future research and practice.

The authors define gender as a social construct related to opportunities and constraints arising from sex roles in contrast to sex as the biology of being a man or woman.

The scoping review included articles published in English between 2010 and 2021.  Articles not focusing on EOL care or gender roles were excluded.  Additionally, articles that focused on healthcare providers or researchers were excluded as the focus was patients and their families.  A total of 15 articles met the inclusion criteria.

Thematic analysis was used to synthesis data into themes.  From this process, six themes emerged:

  1. Living Situation: Studies appraised showed women were less likely married, more likely to be widowed and more likely to be living alone at the end of life.
  2. Symptom Experience: Women consistently reported more pain, fatigue, and nausea, despite this difference not being evident in medical charts or documentation
  3. Care Context: Women received medical care primarily from generalists such as family physicians, whereas men were more likely to have specialists involved.
  4. Care Preferences: More women tended to have a ‘do not resuscitate’ order in place and, compared with men, fewer received care in an ICU.
  5. Caregiving: Female caregivers experienced more mental and physical strain, had lower self-esteem and suffered greater fatigue.
  6. Coping Strategies: Women were more able to express needs and ask for help, while men tried to be strong and independent rather than voice symptoms or feelings.

The authors concluded that gender disparities in EOL caregiving and care receiving disadvantage both men and women, but in different ways.  Further, the role of palliative care professionals to challenge these gender disparities by building awareness of personal biases was highlighted.

Source: Wong, A. D., & Phillips, S. P. (2022).  Gender Disparities in End of Life Care: A Scoping Review.  Journal of Palliative Care, 08258597221120707.