Hunt Katherine J, May Carl R
School of Health Sciences, University of Southampton, Southampton, UK.
Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
Palliat Med. 2025 Apr;39(4):448-459. doi: 10.1177/02692163251321713. Epub 2025 Feb 26.
There persist disparities in access to quality palliative and end-of-life care, often based on avoidable injustice. Research and theory to explain this health inequity focuses on structural or individual-based factors, overlooking important relational factors between health professionals, patients and families.
To apply Cognitive Authority Theory in palliative and end-of-life care to explain neglected relational drivers of inequity in access and experience.
Cognitive Authority Theory, a middle-range theory of power relations between individuals and authority over knowledge, was developed from empirical and review data. This paper demonstrates its utility in explaining an overlooked component of inequity in palliative care: interactions between health professionals and patients/caregivers.
Using examples from the palliative care literature, we characterise how people who are socially disadvantaged have fewer resources to exploit during consultations with health professionals which makes it difficult for them to have their voices heard, their choices prioritised by others, and to express their expertise. We examine the implications of health professionals' judgements of expertise for care access, experience, involvement and appropriateness. We offer a fresh perspective on the mechanisms by which stereotypes, bias and power imbalances between health professionals and patients reinforce existing health inequities, drawing on the role of social privilege in shaping inequity in palliative care.
This paper provides a new language to articulate relational drivers of inequity in palliative care. It explains how to use Cognitive Authority Theory to design and interpret research to determine how healthcare interactions reinforce both social privilege and social disadvantage at end-of-life.
在获得优质的姑息治疗和临终关怀方面，差距依然存在，这往往基于可避免的不公正现象。用以解释这种健康不平等现象的研究和理论聚焦于结构或个体层面的因素，而忽视了医疗专业人员、患者及其家庭之间重要的关系因素。
将认知权威理论应用于姑息治疗和临终关怀，以解释在获得服务和体验方面被忽视的不平等关系驱动因素。
认知权威理论是一种关于个体与知识权威之间权力关系的中程理论，它是从实证和综述数据中发展而来的。本文展示了其在解释姑息治疗不平等现象中一个被忽视的组成部分的效用：医疗专业人员与患者/照顾者之间的互动。
通过引用姑息治疗文献中的例子，我们描述了社会弱势群体在与医疗专业人员咨询过程中可利用的资源较少的情况，这使得他们难以让自己的声音被听到，难以让自己的选择被他人优先考虑，也难以表达自己的专业知识。我们研究了医疗专业人员对专业知识的判断对获得护理、体验、参与度和适宜性的影响。我们从社会特权在塑造姑息治疗不平等方面的作用出发，对医疗专业人员与患者之间的刻板印象、偏见和权力不平衡强化现有健康不平等的机制提供了新的视角。
本文提供了一种新的语言来阐述姑息治疗不平等的关系驱动因素。它解释了如何运用认知权威理论来设计和解释研究，以确定医疗互动如何在临终时强化社会特权和社会劣势。
