Background: There is growing evidence of disparities in access to hospice and palliative care services to varying degrees by sociodemographic groups. Underlying factors contributing to access issues have received little systematic attention. Objective: To synthesize current literature on disparities in access to hospice and palliative care, highlight the range of sociodemographic groups affected by these inequities, characterize the domains of access addressed, and outline implications for research, policy, and clinical practice. Design: An integrative review comprised a systematic search of PubMed, Embase, and CINAHL databases, which was conducted from inception to March 2020 for studies outlining disparities in hospice and palliative care access in the United States. Data were analyzed using critical synthesis within the context of a health care accessibility conceptual framework. Included studies were appraised on methodological quality and quality of reporting. Results: Of the articles included, 80% employed non-experimental study designs. Study measures varied, but 70% of studies described differences in outcomes by race, ethnicity, or socioeconomic status. Others revealed disparate access based on variables such as age, gender, and geographic location. Overall synthesis highlighted evidence of disparities spanning 5 domains of access: Approachability, Acceptability, Availability, Affordability, and Appropriateness; 60% of studies primarily emphasized Acceptability, Affordability, and Appropriateness. Conclusions: This integrative review highlights the need to consider various stakeholder perspectives and attitudes at the individual, provider, and system levels going forward, to target and address access issues spanning all domains.

Background Although disproportionately affected by cardiovascular disease, Black adults remain underrepresented in clinical trials. The National Institutes of Health recommends that studies define goals for recruitment of underrepresented populations. However, the extent to which cardiovascular trials incorporate evidence‐based recruitment strategies in their protocols is understudied. Methods and Results We systematically reviewed National Institutes of Health‐funded cardiovascular clinical trials registered in ClinicalTrials.gov between 2000 and 2019. Based on publicly available or requested protocols, we focused on enrollment of Black adults as well as the following recruitment strategies: community‐based, electronic medical record‐based, and provider‐based recruitment. A total of 100 clinical trials focused on cardiovascular disease were included in our analysis, of which 62% had published protocols, and 46% of trials had enrolled populations that were <25% Black. In our analysis of available trial protocols, 21% of trials defined a recruitment target for underrepresented groups; however, only one study reported achieving its enrollment goal. While 13% of trial protocols referenced community‐based recruitment strategies, 5% explicitly mentioned involving community members in the trial design process. Defining recruitment targets was associated with higher enrollment of Black participants. Conclusions Black adults are underrepresented in National Institutes of Health‐funded cardiovascular trials, and the majority of these trials did not specify a Black enrollment target, did not meet targets, and largely did not report specific plans to enroll Black adults in their studies. Future interventions should target trial design and planning phases before study initiation to address these enrollment disparities.

No abstract

Background: Fiscal constraints, an ageing populations and the increasing burden of chronic conditions are stressing health systems internationally. Nurses are the linchpin of effective healthcare delivery and their success is dependent on adequate staffing models, which must align knowledge, skills and competencies with workload.Objectives: To compare measures of nursing workload in adult inpatient settings.Design, data sources and review method: A review of published studies characterising nursing workload measures was undertaken. Databases-PubMed and CINHALwere used to identify published studies. A description of the psychometric properties of each measure and its use in an inpatient setting was required for inclusion. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used to guide and report the review.Results: Of the 1,422 studies identified, 15 met the inclusion criteria. Nursing workload was measured in the intermediate care unit (n = 6), overall hospital (n = 7), emergency department (n = 1) and burn unit (n = 1) settings and also by mailed survey (n = 1). Eleven different workload measures were identified. The National Aeronautics and Space Administration Task Load Index (n = 3), Therapeutic Intervention Scoring System (n = 3) and Nursing Activities Score (n = 2) were the most common nursing workload measures identified with reported psychometric properties. Conclusion:Researchers, clinicians and hospital administrators should carefully identify and assess the psychometric properties of nursing workload measures before using these in routine practice.Relevance to clinical practice: Gaining a consensus on effective nursing workload measures is a crucial step in designing appropriate staffing models and policies, improving nurse productivity and well-being, as well as enhancing patient health outcomes in inpatient settings.

No abstract