Equity of access to palliative care: a scoping review
Abstract Background Palliative care (PC) has the potential to alleviate suffering and enhance quality of life for patients with serious progressive diseases; however, access to PC remains unequal across different populations. Objective This scoping review aimed to systematically examine the literatu...
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| Format: | Article |
| Language: | English |
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BMC
2024-11-01
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| Series: | International Journal for Equity in Health |
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| Online Access: | https://doi.org/10.1186/s12939-024-02321-1 |
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| author | Gonçalo Sítima Carlos Galhardo-Branco Paulo Reis-Pina |
| author_facet | Gonçalo Sítima Carlos Galhardo-Branco Paulo Reis-Pina |
| author_sort | Gonçalo Sítima |
| collection | DOAJ |
| description | Abstract Background Palliative care (PC) has the potential to alleviate suffering and enhance quality of life for patients with serious progressive diseases; however, access to PC remains unequal across different populations. Objective This scoping review aimed to systematically examine the literature on: (1) the primary contributors to inequity in accessing PC; (2) the key barriers to achieving equitable access to PC; (3) the essential recommendations for addressing these issues. Methods The PubMed, Web of Science, and Embase databases were searched for English-language articles published since 2017. Eligibility criteria: Population- people with chronic, progressive, life-threatening, or limiting diseases. Interventions- any PC intervention, including teams, services, programs, or strategies implemented in both hospital and community settings. Outcomes- equity in access to PC. Study Design- any. The PRISMA (extension for scoping reviews) recommendations were followed. Results Fourteen studies were included: half originated from North America (USA, n = 5; Canada, n = 2) and the other half from Europe (UK, n = 4; Spain, n = 1) and Australia (n = 2). Most studies focused on ethnic/racial discrimination (n = 4) or geographical discrepancies (n = 4). The remaining studies addressed PC in low- or middle-income countries (n = 2), gender discrepancies (n = 1), informal caregiving (n = 1), socioeconomic inequities (n = 2), and barriers to accessing PC (n = 1). Barriers to equitable access to PC include difficulties in identifying patients nearing the end of life, the “survival imperative,” the “normalization of dying,” misconceptions, mistrust, limited information about PC and end-of-life care, and a fragmented care system. Conversely, enablers of equitable access to PC encompass proper patient evaluation and workforce education, addressing basic survival needs and social determinants of equity, and promoting intersectoral collaboration, community advocacy, and engagement. Conclusion Achieving equity in PC is a complex endeavor requiring strong commitment and action at both policy and governmental levels. Additionally, it calls for sustained efforts in clinical practice, workforce planning, capacity building, community engagement, and research investment to implement and assess public health approaches to PC. Future research should aim to provide more comprehensive and generalizable insights into the determinants of equitable access, as well as the enablers and barriers to PC and end-of-life care. |
| format | Article |
| id | doaj-art-3ad87362efca405198a9a9de05b9907b |
| institution | DOAJ |
| issn | 1475-9276 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal for Equity in Health |
| spelling | doaj-art-3ad87362efca405198a9a9de05b9907b2025-08-20T02:51:46ZengBMCInternational Journal for Equity in Health1475-92762024-11-0123111810.1186/s12939-024-02321-1Equity of access to palliative care: a scoping reviewGonçalo Sítima0Carlos Galhardo-Branco1Paulo Reis-Pina2Faculty of Medicine, University of LisbonAmadora/Sintra Local Health Unit EPEFaculty of Medicine, University of LisbonAbstract Background Palliative care (PC) has the potential to alleviate suffering and enhance quality of life for patients with serious progressive diseases; however, access to PC remains unequal across different populations. Objective This scoping review aimed to systematically examine the literature on: (1) the primary contributors to inequity in accessing PC; (2) the key barriers to achieving equitable access to PC; (3) the essential recommendations for addressing these issues. Methods The PubMed, Web of Science, and Embase databases were searched for English-language articles published since 2017. Eligibility criteria: Population- people with chronic, progressive, life-threatening, or limiting diseases. Interventions- any PC intervention, including teams, services, programs, or strategies implemented in both hospital and community settings. Outcomes- equity in access to PC. Study Design- any. The PRISMA (extension for scoping reviews) recommendations were followed. Results Fourteen studies were included: half originated from North America (USA, n = 5; Canada, n = 2) and the other half from Europe (UK, n = 4; Spain, n = 1) and Australia (n = 2). Most studies focused on ethnic/racial discrimination (n = 4) or geographical discrepancies (n = 4). The remaining studies addressed PC in low- or middle-income countries (n = 2), gender discrepancies (n = 1), informal caregiving (n = 1), socioeconomic inequities (n = 2), and barriers to accessing PC (n = 1). Barriers to equitable access to PC include difficulties in identifying patients nearing the end of life, the “survival imperative,” the “normalization of dying,” misconceptions, mistrust, limited information about PC and end-of-life care, and a fragmented care system. Conversely, enablers of equitable access to PC encompass proper patient evaluation and workforce education, addressing basic survival needs and social determinants of equity, and promoting intersectoral collaboration, community advocacy, and engagement. Conclusion Achieving equity in PC is a complex endeavor requiring strong commitment and action at both policy and governmental levels. Additionally, it calls for sustained efforts in clinical practice, workforce planning, capacity building, community engagement, and research investment to implement and assess public health approaches to PC. Future research should aim to provide more comprehensive and generalizable insights into the determinants of equitable access, as well as the enablers and barriers to PC and end-of-life care.https://doi.org/10.1186/s12939-024-02321-1End-of-life careHealth disparateMinority and vulnerable populationsHealth equityHealth services accessibilityPalliative care |
| spellingShingle | Gonçalo Sítima Carlos Galhardo-Branco Paulo Reis-Pina Equity of access to palliative care: a scoping review International Journal for Equity in Health End-of-life care Health disparate Minority and vulnerable populations Health equity Health services accessibility Palliative care |
| title | Equity of access to palliative care: a scoping review |
| title_full | Equity of access to palliative care: a scoping review |
| title_fullStr | Equity of access to palliative care: a scoping review |
| title_full_unstemmed | Equity of access to palliative care: a scoping review |
| title_short | Equity of access to palliative care: a scoping review |
| title_sort | equity of access to palliative care a scoping review |
| topic | End-of-life care Health disparate Minority and vulnerable populations Health equity Health services accessibility Palliative care |
| url | https://doi.org/10.1186/s12939-024-02321-1 |
| work_keys_str_mv | AT goncalositima equityofaccesstopalliativecareascopingreview AT carlosgalhardobranco equityofaccesstopalliativecareascopingreview AT pauloreispina equityofaccesstopalliativecareascopingreview |