Methods for overcoming barriers in palliative care for ethnic/racial minorities: a systematic review

Abstract

ObjectivesEthnic/racial minority groups are less likely to discuss issues involving end-of-life treatment preferences and utilize palliative care or hospice services. Some barriers may be differences in language, religion, lower levels of health literacy, or less access to healthcare services and information. The purpose of this article is to conduct a systematic review on interventional studies that investigated methods to overcome the barriers faced by ethnic/racial minorities when accessing end-of-life services, including completing advanced directives, accepting palliative care, and enrolling in hospice.MethodsLiterature searches using four standard scientific search engines were conducted to retrieve articles detailing original research in an interventional trial design. All studies were conducted in an outpatient setting, including primary care visits, home visits, and dialysis centers. Target populations were those identified from ethnic or racial minorities.ResultsNine articles were selected to be included in the final review. All were full-text English language articles, with target populations including African Americans, Hispanic or Latinos, and Asian or Pacific Islanders. Measured outcomes involved level of comfort in discussing and knowledge of palliative care services, desire for aggressive care at the end-of-life, completion of advance directives, and rate of enrollment in hospice.Significance of ResultsThree main avenues of interventions included methods to enhance patient education, increase access to healthcare, or improve communication to establish better rapport with target population. Studies indicate that traditional delivery of healthcare services may be insufficient to recruit patients from ethnic/racial minorities, and outcomes can be improved by implementing tailored interventions to overcome barriers.

Disparities in Palliative and Hospice Care and Completion of Advance Care Planning and Directives Among Non-Hispanic Blacks: A Scoping Review of Recent Literature

“…68 Conducting a comprehensive examination of published research for overcoming barriers in palliative care for minority populations, Mayeda and Ward (2019) argued that traditional delivery of healthcare services may be insufficient and that urgent interventions are needed to overcome the barriers faced by underserved minority populations when accessing end-of-life services, including completing advance care directives, accepting palliative care, and enrolling in hospice. 29 Matsuyama and colleagues (2011) posed the interesting question, "Will patients want hospice or palliative care if they do not know what it is?" 97 They reasoned that awareness of service availability is a prerequisite to accessing services.…”

“…After searching almost fourthly-thousand citations, 284 articles were included in our study, of which 147 were manuscripts that directly addressed end-of-life and hospice care, palliative care, as well as advance care planning and directives that include non-Hispanic Blacks. 4 …”

“… 68 Conducting a comprehensive examination of published research for overcoming barriers in palliative care for minority populations, Mayeda and Ward (2019) argued that traditional delivery of healthcare services may be insufficient and that urgent interventions are needed to overcome the barriers faced by underserved minority populations when accessing end-of-life services, including completing advance care directives, accepting palliative care, and enrolling in hospice. 29 …”

“…Innovative interventions are urgently needed to overcome the barriers faced by the underserved non-Hispanic Black community when accessing end-of-life services, completing advance care directives, accepting palliative care, and enrolling in hospice programs. 29 We obviously need additional theory-based interventions that address the knowledge, education, attitudes, motivations, skills, and resources of non-Hispanic Blacks in order to modify their utilization of end-of-life care. Finally, systematic and in-depth reviews are needed to document effectiveness of recent interventions.…”

The Premise and Development of CHECK IN—Check-In for Exchange of Clinical and Key Information to Enhance Palliative Care Discussions for Patients With Limited English Proficiency

“…A large proportion of these minority groups also have LEP and therefore are at risk of disparities during serious illness. [16][17][18] Furthermore, even when comprehensive services are available, such as during hospitalization, palliative care in hospitals can still be sub-optimal with protracted intensive care and prolonged use of life-sustaining therapies. [19][20][21] Patients with LEP are less likely to adopt comfort care measures orders and do-not-resuscitate orders despite imminent death.…”