School of Clinical Medicine, University of Cambridge, Cambridge, Cambridgeshire, UK.
Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK.
BMJ Support Palliat Care. 2022 Jun;12(2):142-151. doi: 10.1136/bmjspcare-2020-002719. Epub 2021 Feb 19.
Inequalities in access to hospice care is a source of considerable concern; white, middle-class, middle-aged patients with cancer have traditionally been over-represented in hospice populations.
To identify from the literature the demographic characteristics of those who access hospice care more often, focusing on: diagnosis, age, gender, marital status, ethnicity, geography and socioeconomic status.
Systematic literature review and narrative synthesis.
Searches of Medline, PsycINFO, CINAHL, Web of Science, Assia and Embase databases from January 1987 to end September 2019 were conducted. Inclusion criteria were peer-reviewed studies of adult patients in the UK, Australia, New Zealand and Canada, receiving inpatient, day, outpatient and community hospice care. Of the 45 937 titles retrieved, 130 met the inclusion criteria. Narrative synthesis of extracted data was conducted.
An extensive literature search demonstrates persistent inequalities in hospice care provision: patients without cancer, the oldest old, ethnic minorities and those living in rural or deprived areas are under-represented in hospice populations. The effect of gender and marital status is inconsistent. There is a limited literature concerning hospice service access for the LGBTQ+ community, homeless people and those living with HIV/AIDS, diabetes and cystic fibrosis.
Barriers of prognostic uncertainty, institutional cultures, particular needs of certain groups and lack of public awareness of hospice services remain substantial challenges to the hospice movement in ensuring equitable access for all.
临终关怀服务获取方面的不平等是一个令人深感关切的问题；传统上，白人、中产阶级、中年癌症患者在临终关怀人群中占比过高。
从文献中确定更常获得临终关怀服务的人群的人口统计学特征，重点关注：诊断、年龄、性别、婚姻状况、种族、地理位置和社会经济地位。
系统文献回顾和叙述性综合。
对 Medline、PsycINFO、CINAHL、Web of Science、Assia 和 Embase 数据库进行了 1987 年 1 月至 2019 年 9 月底的检索。纳入标准为在英国、澳大利亚、新西兰和加拿大接受住院、日间、门诊和社区临终关怀服务的成人患者的同行评审研究。从 45937 篇标题中，有 130 篇符合纳入标准。对提取数据进行叙述性综合。
广泛的文献检索表明临终关怀服务提供方面存在持续的不平等现象：没有癌症的患者、最年长的老年人、少数族裔以及居住在农村或贫困地区的患者在临终关怀人群中代表性不足。性别和婚姻状况的影响不一致。关于 LGBTQ+群体、无家可归者以及患有艾滋病、糖尿病和囊性纤维化的人获得临终关怀服务的文献有限。
预后不确定性、机构文化、某些群体的特殊需求以及公众对临终关怀服务的认识不足等障碍仍然是临终关怀运动在确保所有人公平获得服务方面面临的巨大挑战。
