Access to palliative care: the primacy of public health partnerships and community participation

Abstract

Access to Palliative Care, is especially pertinent given the unprecedented effects of COVID-19. In support of this theme, we propose a re-imagining of palliative-care access to promote more equitable outcomes through public-health partnerships that prioritise community development and participation in end-of-life care.Palliative care is widely recognised as a public-health concern, with both structural and social determinants of health affecting health inequalities for disadvantaged populations across high-income and low-income countries. 1,2 For low-income countries, palliative care development has become a key focus to promote equitable access, with the International Palliative Care Initiative producing a roadmap to guide development and expansion of palliative-care provision in resourceconstrained countries. 3 However, disadvantaged groups are also found in resource-rich countries-Indigenous peoples, LGBTQI+ communities, and those incarcerated or homeless, in particular. A review of hospice-patient care in the UK, Australia, New Zealand, and Canada found that older people (aged ≥85 years), ethnic minorities, people with non-cancer illnesses, and people living in rural locations or areas of social deprivation had unequal access to palliative care. 4 We declare no competing interests.

Identifying Paths Forward: Expanding Palliative Care to Low-Income Patients in California

“…This strategy is in keeping with the preference, expressed by participants in other research for how primary care providers should introduce and refer patients to palliative care. 28 At the same time, drafting and implementing a public health communication strategy would bode equally well, 29,30 including through the use of patient role model stories that have shown to be effective in improving knowledge about palliative care. 31 Additionally, patients seem to have a high level of confidence in their primary care physicians' decision-making on their behalf, as well as entrusting their care to other healthcare professionals they come into contact with, thus strengthening the argument for involving healthcare professionals in expanding HBPC services to this population.…”

Public health palliative care interventions that enable communities to support people who are dying and their carers: a scoping review of studies that assess person-centered outcomes

“…for people with palliative care needs within their networks and neighborhoods (13,14). The identification and harnessing of community-specific assets with recognition of shared concerns may better reflect and serve the needs and wishes of ethnically and socially diverse populations than traditional service responses alone (10).…”

Social Model Hospice Residential Care Homes: Whom Do They Really Serve?

“…The provision of equitable care at the end-of-life, especially for marginalized populations, is a serious public health issue requiring community action and involvement. 1 Home deaths in the U.S. have been increasing, but institutions including hospitals and nursing facilities remain the most common place of death 2 despite the fact that most individuals express a desire to die at home. 3,4 The home as a place of death has been shown to promote well-being for both the dying and their caregivers when support is available.…”