University of Michigan, Ann Arbor, MI.
J Clin Oncol. 2020 Mar 20;38(9):974-979. doi: 10.1200/JCO.19.02108. Epub 2020 Feb 5.
In the United States, racial and ethnic minorities and people with lower socioeconomic status (SES) face structural, health system, and interpersonal barriers to optimal health care, including palliative care. Much of the available data on palliative care in racial and ethnic minorities and people with lower SES have identified disparities according to race, ethnicity, and SES. Limitations to understanding disparities in palliative care include the fact that much of the available data are cross-sectional, drawn from administrative or claims data, or based on qualitative work in limited geographic areas. To advance our knowledge and achieve health equity with respect to palliative care in patient groups that have been understudied or that are known to receive disparate care, gaining a deeper understanding of the barriers to palliative care is necessary from patients, families, referring providers, and communities. In addition, cultural competency training for all members of the palliative care team and referring providers needs to be changed from being obligatory to being intentional and assessed continuously. Finally, concerted changes in coordination of care, payment structures, and policy are needed.
在美国，少数族裔和社会经济地位较低的人群面临着结构、医疗体系和人际障碍，这些障碍会影响他们获得最佳的医疗保健，包括姑息治疗。在少数族裔和社会经济地位较低的人群中，姑息治疗方面的大多数现有数据都根据种族、族裔和社会经济地位识别出了差异。对姑息治疗差异的理解存在局限，因为大部分可用数据都是横断面的，来源于行政或索赔数据，或基于有限地理区域内的定性工作。为了深入了解在研究不足或已知接受差异化护理的患者群体中，姑息治疗方面的知识和实现健康公平，需要从患者、家属、转诊提供者和社区中了解姑息治疗的障碍。此外，姑息治疗团队和转诊提供者的所有成员的文化能力培训需要从强制性转变为有目的的，并进行持续评估。最后，需要协调一致地改变护理协调、支付结构和政策。
