Equity of access to palliative care: a scoping review
Bibliographic record
Abstract
BACKGROUND: 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. OBJECTIVE: 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. METHODS: The PubMed, Web of Science, and Embase databases were searched for English-language articles published since 2017. ELIGIBILITY CRITERIA: 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. RESULTS: 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. CONCLUSION: 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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.037 | 0.156 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.006 | 0.007 |
| Bibliometrics | 0.027 | 0.026 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.007 | 0.007 |
| Open science | 0.003 | 0.005 |
| Research integrity | 0.004 | 0.003 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".