Invited Editorials

Specialist palliative care services response to ethnic minority groups with COVID-19: equal but inequitable—an observational study

“…Structural racism is present if processes and organisational structures facilitate delivery of healthcare in a way that impacts one ethnic group more than another. 26 Specifically, within the responses, we found patterns suggesting structural racism (eg, organisations' policies on restricted visiting despite the cultural and religious significance of this to some groups; policies that prevented compulsory after-death rituals; the disproportionate impact of visiting policies on communication for people from ethnic minority groups). Structural racism is present if organisations do not assess the impact of their policies and practices and mitigate or put safeguards in place when policies are found to adversely affect certain ethnic groups.…”

“…6 Our data suggest that COVID-19 has not broken down these barriers, a number of which may be deeply entrenched within the specialty. 26 Hospital teams were more likely to have cared for these patients and families. Only 23% of responding hospice inpatient and 30% of home palliative care teams had cared for dying patients with COVID-19 from ethnic minority groups.…”

Does ethnicity affect pain management for people with advanced disease? A mixed methods cross-national systematic review of ‘very high’ Human Development Index English-speaking countries

“…Palliative care has traditionally not engaged with issues around ethnicity, race and racism. According to Gunaratnam, this may be due to the historic and continued development of palliative care by charismatic largely White leaders [ 138 , 139 ]. This review only found two USA papers engaging with racial and ethnic stereotypes [ 98 , 106 ], and two USA paper explicitly examining the racial and ethnic dynamics of palliative care services [ 114 , 122 ] The wider literature from the UK has highlighted the lack of research in this area and the poorer palliative care provision for those from Black, Asian and ethnically diverse groups [ 83 , 140 – 142 ].…”

“…The evidence indicates issues with communication between doctor and patient, and high levels of unmet pain management need across many different ethnic groups. Partnership working is an important part of taking anti-racist action within palliative care [ 138 ]. It is crucial for creating approaches to challenging conversations about pain management that are ground-up, and centred around different diverse perspectives.…”

“…However, changes to clinical practice and research have been slow, and few of the reports’ recommendations have been implemented [ 30 – 33 ]. A recent editorial in Palliative Medicine has addressed racism within UK palliative care, calling for; a recognition of racial and minority ethnic disadvantage, an understanding of racism, better data on ethnicity, and anti-racist action through partnership [ 138 ]. Similarly, a recent American article asks pain physicians to do more to tackle racism in pain management, the authors recommend strategies to reduce implicit bias and create a culture of safety within palliative care [ 143 ].…”