Sociodemographic Disparities in Access to Hospice and Palliative Care: An Integrative Review.
Katie E Nelson, Rebecca Wright, Anna Peeler and 2 others
PMID 33423532WHAT IT FOUND
Hospice and palliative care access differed by race, ethnicity, income, insurance, age, sex, disease, and location.
Patients and families reported lack of knowledge, poor translator use, medical jargon, and culturally insensitive communication.
Key findings
01Low socioeconomic status was associated with high-intensity interventions, hospital admissions, and ICU stays in the last 30 days of life in 5 studies, and with less palliative care or hospice engagement in 4 studies.
02Patients and caregivers reported lack of knowledge and misconceptions about hospice and palliative care options, and communication barriers were a common theme across qualitative and mixed-methods studies.
03Only 15% of included studies described approachability, which concerns whether patients can perceive information about services.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The included studies were mostly non-experimental, so they show patterns of service use, not the cause of a disparity. Socially disadvantaged populations, mainly non-White individuals, were underrepresented in the samples, especially in studies comparing race or ethnicity. Many studies sampled patients only, so caregiver and provider perspectives were not fully represented. Qualitative samples were small, so themes are not generalizable to all patients or families. The search may have missed relevant studies, and the review included only U.S. articles published between 2010 and 2020. Outcome measures varied widely, and service utilization was often used as a proxy for access.
Declared interests
The authors declared no potential conflicts of interest for the article.
The easy way to misread this
Do not read this review as evidence that any hospice or palliative care access intervention works. The included studies were mostly non-experimental and measured who received services, not whether a program caused better access.