LGBTIQ + people in palliative and end-of-life care contexts in Switzerland: a scoping review

Despite being a high-income country with universal health insurance coverage, disparities persist for LGBTIQ + people's mental health, substance use, sexual health, and physical health in Switzerland. Less research attention and public health efforts have focused on their palliative and end-of-life care (PEOLC) needs. This scoping review's objective is to explore, describe, and map the evidence related to PEOLC contexts for LGBTIQ + people in Switzerland.

We conducted a scoping review in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews and adhered to PRISMA-ScR guidelines. Inclusion criteria were defined using the Population-Concept-Context framework. We systematically searched peer-reviewed and grey literature published in English, German, French, and Italian in databases including APA PsychInfo, CINAHL, Cochrane, Embase, Google Scholar, Medline Ovid ALL, ProQuest, Web of Science, and various Swiss institutional repositories. Screening and data extraction were facilitated using Covidence, with titles and abstracts independently reviewed by at least two authors. Extracted data were organized to identify themes regarding patients' (anticipated) PEOLC needs, social support networks, healthcare professional (HCP) competencies, and existing initiatives or policies in Switzerland.

Our search yielded 454 potential references, from which 35 were included after screening and eligibility assessments. The majority (n = 32, 91.4%) were grey literature sources, reflecting limited peer-reviewed empirical research. Nine references presented empirically collected data directly related to LGBTIQ + populations and their social support or HCP experiences in ageing, palliative, or end-of-life contexts. Findings highlighted significant health disparities, elevated chronic disease prevalence, and persistent fears of discrimination among ageing LGBTIQ + people, negatively impacting healthcare access and engagement. Social networks primarily composed of chosen families underscored vulnerabilities related to informal caregiving and decision-making in PEOLC contexts. HCPs were generally reported as lacking sufficient competencies and preparedness for providing culturally sensitive and inclusive care. Initiatives designed to promote awareness-building and inclusion remain fragmented, underscoring the need for coordinated efforts to address gaps in care provision for LGBTIQ + people in Switzerland.

A stronger empirical basis is needed to effectively respond to PEOLC needs for LGBTIQ + people in Switzerland. Collaborative research efforts will lay the groundwork to build trust and capacity between people, communities, and healthcare professionals.