A Multidimensional Narrative Review of Disparities in Hospice Care Use

Area of Science:

• Health Services Research
• Public Health
• End-of-Life Care

Background:

• Hospice care enhances quality of life and support for patients and families at the end of life.
• Significant disparities exist in hospice care utilization among racial/ethnic minorities, LGBTQ+ individuals, and socioeconomically disadvantaged groups.

Purpose of the Study:

• To examine disparities in hospice care use.
• To explore multilevel factors contributing to these disparities using the Social Ecological Model.
• To propose strategies for improving hospice care access and utilization.

Main Methods:

• A narrative review guided by the Social Ecological Model.
• Analysis of societal, structural, healthcare system, interpersonal, and individual factors influencing hospice care access.

Main Results:

• Hospice care disparities are influenced by historical context, policy, socioeconomic factors, clinician communication, and cultural beliefs.
• Interacting factors across multiple levels shape patterns of hospice care access and utilization.
• System-level solutions and enhanced clinician communication are vital for equitable hospice care.

Conclusions:

• Coordinated, multilevel interventions are essential to reduce hospice care disparities.
• Policy changes, healthcare system integration, community partnerships, and improved communication are critical.
• Ensuring equitable access to goal-concordant, high-quality hospice care for all seriously ill individuals is paramount.