A Call to Action to Address Disparities in Palliative Care Access: A Conceptual Framework for Individualizing Care Needs

Sociodemographic Disparities in Access to Hospice and Palliative Care: An Integrative Review

“…However, it is naïve to assume that addressing system-level issues will fix patient-and provider-level obstacles-the humanity operating within the system itself. 3 The domain of Approachability, or patients' ability to perceive information, is arguably the most basic component on the spectrum of service access, and may be a driver of health inequities if services are not conveniently tailored to meet patient needs. Per the health care accessibility framework, Approachability should involve gaining patients' trust through transparently delivering information akin to health beliefs and health literacy levels.…”

“…1,2 Both hospice and palliative care involve a multidisciplinary approach and philosophy of care that prioritizes quality of life for patients and families experiencing symptoms related to 1 Johns Hopkins University School of Nursing, Baltimore, MD, USA serious illness. 3 The evidence base for hospice and palliative care has grown, demonstrating the benefits for improving quality of life, reducing aggressive medical intervention, and easing economic burden by minimizing hospitalizations and utilization of the intensive care unit (ICU) at the end of life. 1,2 However, it is projected more than 60% of Americans die without hospice services annually, 4 and only 17% of hospitals with 50 beds or more in rural communities have palliative care available.…”

“…9,10 This tendency has significant implications in that it preserves adverse stereotypes of many specific groups, which can lead to greater provider bias in care delivery. 3 Furthermore, existing metrics of assessment lack potential for intersectionality, perpetuating traditional perspectives regarding application of hospice and palliative care. 11,12 Very few studies have outlined interventions or recommendations for mitigating inequities in access for those individuals "situated on lower rungs of social hierarchies of power," such as individuals with low-income or without a permanent residence.…”

“…7,11 Health is a fundamental right, and as such, research, policy, and clinical practice must remediate health disparities from a position of equity and social justice. 3,13 To do so, the distribution of structural barriers and challenges faced by a particular group must first be identified and understood. Therefore, the evidence gathered in this review may be useful for researchers and providers to tailor care based on individual patient needs and will serve as a foundation for design of targeted interventions to reduce disparities in hospice and palliative care access going forward.…”

Integration of Palliative Care Into All Serious Illness Care as A Human Right

“…Black, Latinx, Native American and Indigenous, and other people of color have been disproportionately affected by COVID-19 in terms of both mental health consequences and severe illness. Palliative care health equity frameworkspromote assessment of the social and moral determinants of health, as well as systemic injustices, to tailor services to the individual, context, and culture at hand 6,7. Other marginalized populations, such as lesbian, gay, bisexual, transgender, and other sexual and gender minority persons and their families of choice, require greater attention to inclusive palliative care practices during COVID-19 that foster trust, transparency, and value-concordant care delivery 8.…”