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从文化安全到反种族主义:对缓和治疗中不平等问题的反思。

From Cultural Safety to Anti-Racism: Reflections on Addressing Inequities in Palliative Care.

机构信息

Department of Family & Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada.

Palliative Care Physician, Freeman Centre for the Advancement of Palliative Care, North York General Hospital, 4001 Leslie Street Ontario, North York, ON M2K 1E1, Canada.

出版信息

Curr Oncol. 2023 Aug 28;30(9):7920-7925. doi: 10.3390/curroncol30090575.

Abstract

The purpose of palliative care is to ease the suffering of individuals with a serious and often life-limiting illness throughout the course of their disease by providing holistic care that considers the physical, spiritual, and psychosocial dimensions of health and well-being. Research shows that a palliative approach to care is cost-effective for the healthcare system and results in improved quality of life for patients and their loved ones. However, it is well-documented in the literature that structurally vulnerable populations have greater difficulty accessing equitable and culturally safe palliative care. Several domains are identified as contributing factors to the disparities seen in the literature, including systemic racism, cultural differences around death and suffering, and language barriers. Although Canada has had a national palliative care framework since 2018, ongoing issues of access and equity continue to disproportionately impact certain groups, including racially marginalized, immigrant, and low-income communities. In this commentary, successes and ongoing gaps in providing culturally safe and anti-racist palliative care are explored. In these proposed interventions, we advocate for a palliative approach to care that is grounded in equity, justice, and human rights.

摘要

缓和医疗的目的是通过提供整体医疗服务来缓解患有严重且常常致命疾病的个体的痛苦,该服务考虑到健康和福祉的身体、精神和社会心理层面。研究表明,采用缓和医疗方法对医疗保健系统具有成本效益,并能提高患者及其亲人的生活质量。然而,文献中清楚地表明,结构上处于不利地位的人群在获得公平和文化安全的缓和医疗方面存在更大的困难。有几个领域被确定为导致文献中存在差异的因素,包括系统性种族主义、围绕死亡和痛苦的文化差异以及语言障碍。尽管加拿大自 2018 年以来就有一个国家缓和医疗框架,但持续存在的准入和平等问题继续不成比例地影响某些群体,包括边缘化的种族群体、移民和低收入社区。在这篇评论中,探讨了在提供文化安全和反种族主义缓和医疗方面的成功和持续存在的差距。在这些拟议的干预措施中,我们主张以公平、正义和人权为基础的关怀方法。

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