Walshe Catherine, Todd Chris, Caress Ann, Chew-Graham Carolyn
School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, United Kingdom.
J Pain Symptom Manage. 2009 May;37(5):884-912. doi: 10.1016/j.jpainsymman.2008.05.004. Epub 2008 Dec 21.
Policies state that access to palliative care should be provided according to principles of equity. Such principles would include the absence of disparities in access to health care that are systematically associated with social advantage. A review of the literature a decade ago identified that patients with different characteristics used community palliative care services in variable ways that appeared inequitable. The objective of this literature review was to review recent literature to identify whether such variability remains. Searching included the use of electronic databases, scrutinizing bibliographies, and hand searching journals. Articles were included if they were published after 1997 (the date of the previous review) up to the beginning of 2008, and if they reported any data that investigated the characteristics of adult patients in relation to their relative utilization of community palliative care services, with reference to a comparator population. Forty-eight studies met the inclusion criteria. Patients still access community palliative care services in variable ways. Those who are older, male, from ethnic minority populations, not married, without a home carer, are socioeconomically disadvantaged, and who do not have cancer are all less likely to access community palliative care services. These studies do not identify the reasons for such variable access, or whether such variability is warranted with reference to clinical need or other factors. Studies tend to focus on access to specialist palliative care services without looking at the complexities of service use. Studies need to move beyond description of utilization patterns, and examine whether such patterns are inequitable, and what is happening in the referral or other processes that may result in such patterns.
政策规定，应根据公平原则提供姑息治疗服务。这些原则包括在获得医疗保健方面不存在与社会优势系统相关的差异。十年前的一项文献综述发现，具有不同特征的患者以不同方式使用社区姑息治疗服务，这似乎存在不公平现象。这篇文献综述的目的是回顾近期文献，以确定这种差异是否仍然存在。检索包括使用电子数据库、仔细审查参考文献以及手工检索期刊。如果文章发表于1997年（上次综述的时间）之后至2008年初，并且报告了任何调查成年患者特征与其社区姑息治疗服务相对利用率相关的数据，并提及了一个对照人群，则纳入这些文章。48项研究符合纳入标准。患者仍然以不同方式获得社区姑息治疗服务。年龄较大、男性、来自少数民族、未婚、没有家庭照顾者、社会经济处于不利地位以及没有患癌症的患者，获得社区姑息治疗服务的可能性都较小。这些研究没有确定这种不同获得情况的原因，也没有确定这种差异是否基于临床需求或其他因素是合理的。研究往往侧重于获得专科姑息治疗服务，而没有考虑服务使用的复杂性。研究需要超越对使用模式的描述，审查这些模式是否不公平，以及在转诊或其他可能导致这些模式的过程中发生了什么。
