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Intersectionality factors and equitable end-of-life experiences: rapid review
  1. Briony F Hudson1,2,
  2. Fiona Taylor3,
  3. Rini Jones2,
  4. Devi Rani Sagar2,
  5. Ruth Driscoll2,
  6. Dominic Carter4,
  7. Sam Royston2 and
  8. Alison Penny5,6
  1. 1 Marie Curie Palliative Care Research Department, University College London, London, UK
  2. 2 Marie Curie, London, UK
  3. 3 School of Health Sciences, University of Surrey, Guildford, UK
  4. 4 Hospice UK, London, UK
  5. 5 National Children's Bureau, London, UK
  6. 6 National Bereavement Alliance, London, UK
  1. Correspondence to Dr Briony F Hudson; b.hudson{at}ucl.ac.uk

Abstract

Background Efforts to minimise inequity in palliative and end-of-life care (PEoLC) are well-researched. This is frequently explained by differences related to singular factors. The concept of intersectionality recognises that the combination of variables exacerbates disparities.

Objective To identify and review what is known about intersectionality’s impact on experiences of PEoLC, including advance care planning (ACP).

Methods A rapid review with a narrative summary of peer-reviewed articles. Six electronic databases were searched for studies explicitly exploring the role of intersectionality in the experience of PEoLC and ACP for people with life-limiting or terminal illnesses, published in the last 10 years.

Results Identifying eligible papers was challenging. Of the 3738 papers found, only seven were eligible. Of the seven included papers, four explored the impact of intersectionality on access to and attitudes towards ACP. Two studies involved access to PEoLC and one considered quality of care received in the last year of life.

Conclusions Understanding intersectionality is crucial for delivering personalised approaches to care and support. The relationship between intersecting factors and end-of-life experiences is complex and there is currently a paucity of studies considering this. The majority of existing literature addresses a narrow range of variables. Additionally, the lack of guidance on the application of intersectionality in research, makes it difficult to compare and synthesise findings. Further diverse action-orientated research is necessary to produce impactful evidence to inform future policy with the aim of reducing inequity in PEoLC.

  • advance care planning
  • advance directives

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Footnotes

  • X @brionyhudson

  • Contributors BFH conceptualised the scope of the research and together with FT planned the research. FT screened titles, abstracts and full texts and undertook data extraction and study evaluation. BFH and DRS reviewed a selection of the studies across different categories. FT led writing the manuscript. All authors provided important feedback in shaping the research and manuscript, and all authors approved the manuscript.

  • Funding This work was funded through the VCSE Health and Wellbeing Alliance, jointly managed and funded by Department of Health and Social Care, NHS England and UK Health Security Agency. For more information, please visit: https://www.england.nhs.uk/hwalliance/. BFH, DRS, RJ, RD, FT and SR’s time was funded by Marie Curie.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.