Faculty of Medicine, University of Lisbon, Avenida Professor Egas Moniz, Lisbon, 1649-028, Portugal.
Amadora/Sintra Local Health Unit EPE, Amadora, Estremadura, Portugal.
Int J Equity Health. 2024 Nov 25;23(1):248. doi: 10.1186/s12939-024-02321-1.
Palliative care (PC) has the potential to alleviate suffering and enhance quality of life for patients with serious progressive diseases; however, access to PC remains unequal across different populations.
This scoping review aimed to systematically examine the literature on: (1) the primary contributors to inequity in accessing PC; (2) the key barriers to achieving equitable access to PC; (3) the essential recommendations for addressing these issues.
The PubMed, Web of Science, and Embase databases were searched for English-language articles published since 2017.
Population- people with chronic, progressive, life-threatening, or limiting diseases. Interventions- any PC intervention, including teams, services, programs, or strategies implemented in both hospital and community settings. Outcomes- equity in access to PC. Study Design- any. The PRISMA (extension for scoping reviews) recommendations were followed.
Fourteen studies were included: half originated from North America (USA, n = 5; Canada, n = 2) and the other half from Europe (UK, n = 4; Spain, n = 1) and Australia (n = 2). Most studies focused on ethnic/racial discrimination (n = 4) or geographical discrepancies (n = 4). The remaining studies addressed PC in low- or middle-income countries (n = 2), gender discrepancies (n = 1), informal caregiving (n = 1), socioeconomic inequities (n = 2), and barriers to accessing PC (n = 1). Barriers to equitable access to PC include difficulties in identifying patients nearing the end of life, the "survival imperative," the "normalization of dying," misconceptions, mistrust, limited information about PC and end-of-life care, and a fragmented care system. Conversely, enablers of equitable access to PC encompass proper patient evaluation and workforce education, addressing basic survival needs and social determinants of equity, and promoting intersectoral collaboration, community advocacy, and engagement.
Achieving equity in PC is a complex endeavor requiring strong commitment and action at both policy and governmental levels. Additionally, it calls for sustained efforts in clinical practice, workforce planning, capacity building, community engagement, and research investment to implement and assess public health approaches to PC. Future research should aim to provide more comprehensive and generalizable insights into the determinants of equitable access, as well as the enablers and barriers to PC and end-of-life care.
姑息治疗（PC）有可能减轻患有严重进行性疾病患者的痛苦并提高其生活质量；然而，不同人群获得 PC 的机会仍然不平等。
本范围综述旨在系统地研究以下方面的文献：（1）获得 PC 机会不均等的主要原因；（2）实现公平获得 PC 的主要障碍；（3）解决这些问题的基本建议。
检索了 2017 年以来发表的英文文献，包括 PubMed、Web of Science 和 Embase 数据库。
人群-患有慢性、进行性、威胁生命或限制生命疾病的人。干预措施-任何 PC 干预措施，包括在医院和社区环境中实施的团队、服务、计划或策略。结局- PC 获得公平性。研究设计-任何。遵循了 PRISMA（扩展范围综述）建议。
纳入了 14 项研究：其中一半来自北美（美国，n=5；加拿大，n=2），另一半来自欧洲（英国，n=4；西班牙，n=1）和澳大利亚（n=2）。大多数研究关注种族/民族歧视（n=4）或地理差异（n=4）。其余研究涉及低收入或中等收入国家的 PC（n=2）、性别差异（n=1）、非正规照护（n=1）、社会经济不平等（n=2）以及获得 PC 的障碍（n=1）。公平获得 PC 的障碍包括难以识别接近生命终点的患者、“生存冲动”、“死亡正常化”、误解、不信任、对 PC 和临终关怀的信息有限以及护理系统碎片化。相反，公平获得 PC 的促进因素包括对患者进行适当的评估和劳动力教育、解决基本的生存需求和公平的社会决定因素，以及促进部门间合作、社区宣传和参与。
实现 PC 的公平性是一项复杂的工作，需要在政策和政府层面上做出坚定的承诺并采取行动。此外，还需要在临床实践、劳动力规划、能力建设、社区参与和研究投资方面做出持续努力，以实施和评估针对 PC 的公共卫生方法。未来的研究应旨在更全面和更普遍地了解公平获得的决定因素，以及 PC 和临终关怀的促进因素和障碍。
