Sex and gender in palliative and end-of-life care: A service evaluation and qualitative analysis

Understanding Sex and Gender in End-of-Life Care

This study looks at how sex (whether someone is male or female) and gender (how someone sees and expresses themselves) can affect care at the end of life. People experience palliative care—care given to people with serious illness to make them comfortable—in different ways. The researchers wanted to know if being male, female, or identifying differently changes how people get or feel about this care.

What the Study Looked At

The study had two parts:

1. Data review: The researchers looked at information already collected by hospices and nursing teams in the UK from 2019 to 2022. They studied 90,614 cases to see if there were any differences based on sex.

2. Staff interviews: They talked to hospice and nursing staff in Scotland and Wales. These workers shared their thoughts on how gender affects care and how they collect information about patients.

Key Questions the Study Asked

• Are there differences between men and women in why they are referred for palliative care, how long they live after referral, and where they prefer to die?

• Do hospice and nursing staff believe gender affects the experiences of patients and caregivers?

Main Findings from the Data

• About half the patients were male and nearly half were female. Gender identity (how people see themselves) was missing in 25% of the cases.

• Most people were White British and had cancer.

• Many records had missing information about sexuality, religion, and gender identity.

• Both men and women most often wanted to die at home. Around 62% were able to die in the place they wanted.

• Women lived slightly longer than men after being referred for care (about two more days).

• No big differences were found in why people were referred to care or where they died.

What Staff Said in Interviews

Even though the numbers didn’t show big differences, staff noticed things in their day-to-day work.

1. Referrals:

   • Some staff said men are often referred later because they are cared for at home longer, usually by women like wives or daughters.

   • Others said men are referred earlier because they may be more alone and need more help.

   • Some felt men delay asking for help, even when they need it, while women may be more likely to ask for support.

2. Caregivers:

   • Staff said women are usually the main caregivers, even when there are brothers or husbands available.

   • Women were seen as more open to taking time off work and asking for help.

   • Men were described as feeling shame or pride that stops them from asking for support.

3. Other Factors (Intersectionality):

   • Staff said many things affect how someone experiences care, not just gender. Age, race, culture, money, location, and personality also matter.

   • Younger men, especially those with children, may ask for help more than older men.

   • Staff noted that people from different ethnic backgrounds often have less access to good palliative care.

4. Lack of Diversity:

   • Most patients were white, straight, and cisgender (their gender matches their birth sex).

   • Staff were unsure or uncomfortable asking about gender identity and pronouns. They worried about offending people by using the wrong words.

   • Some felt they needed more training to talk about personal things like gender, sexuality, and relationships in a kind and respectful way.

What This Means

This study shows that sex and gender may not change how people use palliative care, but they can affect how people feel and what kind of help they get. For example, women might carry more of the burden when caring for someone who is dying, while men might wait too long to ask for help.

Staff said it’s important to see each patient as a whole person. That means understanding their gender, culture, background, and what matters most to them.

What Needs to Change

• More complete and respectful data collection is needed—especially on gender identity, sexuality, and race.

• Staff need help learning how to ask about these topics in a sensitive way.

• Care services must be open and welcoming to all people, no matter their gender or background.

• More research is needed to understand how gender and other factors combine to shape the end-of-life experience.

Final Thoughts

While the numbers didn’t show big differences between men and women, the stories from staff showed that gender and other factors do affect how people and their families experience care at the end of life. The study encourages more training, better data collection, and a stronger focus on treating every person with respect and understanding.

Source: F Hudson, B., Edwards, B., Wagstaff, E., & White, N. (2025). Sex and gender in palliative and end-of-life care: A service evaluation and qualitative analysis. Palliative Care and Social Practice, 19, 26323524251344310.