Table 2 Challenges and recommendations for Enhancing Equitable Access to Palliative Care and End-of-life services
Identified problems | Working out recommendations |
|---|---|
Racial discrimination | • Understanding and respecting the unique and intersecting cultural, social, and linguistic backgrounds of patients and families is essential for appreciating diverse perspectives and preferences regarding health, care, and illness. • The PC team should be sensitive to varying preferences for life-sustaining treatment and concerns about advance care planning among patients and families. • Social indicators, as well as cultural and linguistic backgrounds, care preferences, and perceptions, should be incorporated into all biopsychosocial assessments and treatment plans. This inclusion will help highlight the distinct needs of patients and families for the entire PC team. • The PC team must recognize the unique barriers that racial and ethnic minority families face in accessing palliative and EOL care. They should employ culturally sensitive and competent practices and advocacy to help reduce healthcare disparities. • PC team members should advocate for cultural sensitivity and foster open communication, understanding, and empathy among patients, family members, and PC team members across various systems and settings. • PC team members can advocate for increased research funding to support the collection and analysis of data on racial and ethnic disparities in care, identify ongoing research gaps, and evaluate interventions aimed at reducing these disparities. • To address inequity, it is recommended to enhance engagement between services and communities and to recruit staff from minority groups. |
Gender discrimination | • PC professionals can play a crucial role in reducing gender disparities by cultivating awareness of their personal biases. This self-awareness can enhance their ability to support patients and families and initiate important discussions about care that challenge unequal gender expectations. |
Informal caregivers discrepancies | • Providing financial support for informal caregivers through benefits is a clear and effective strategy for alleviating financial burdens associated with caregiving. |
Geographic discrepancies | • PC models must be re-envisioned to engage individuals in their communities. • Decentralizing inpatient palliative and EOL care services from urban centers can help alleviate geographic access challenges in rural areas. This can be achieved by introducing non-institutionalized services, such as hospice-at-home programs, and by leveraging technology-enhanced care options, including telehealth services and video conferencing. |
Socioeconomic discrepancies | • Healthcare providers need to enhance their capacity to recognize and address the impacts of social determinants of health in their delivery of PC. They must also prioritize building trust and respect while working with specific population groups. • To advocate for equitable access to high-quality PC for underserved populations, PC team members should develop and promote policies that address treatment-related financial hardships. Additionally, these policies should extend optimal support to individuals requiring temporary or long-term care, along with their families and caregivers. • There is a pressing need for more PC research to examine and articulate structural vulnerabilities. This research should focus on addressing existing inequities and the underlying power structures that reinforce them. |
Health care accessibility | • A supportive policy and political environment is essential for advancing equity-focused PC. • Achieving equity-focused PC also necessitates meaningful community engagement and empowerment, along with the identification and action on social determinants of health inequity—those non-health-related factors that underpin poor access to and utilization of services. |
Difficulties in low-income countries | • The Ministry of Health should incorporate PC training for all internal medicine residents and integrate PC into the management of chronic noncommunicable diseases (e.g., in Rwanda). • The Ministry of Health should also plan to train home-based care practitioners to provide both noncommunicable disease management and PC in home settings (e.g., in Rwanda). |