目标:多年来,医疗保健中的种族和族裔差异问题一直是一个重大问题。它包括各个方面,包括疾病预防,诊断,管理,和报废(EOL)护理。研究发现,及时干预姑息治疗可以改善EOL护理并降低医疗成本。这篇综述旨在详细介绍医疗保健差异对姑息治疗的影响,临终关怀注册,以及面临EOL的严重疾病患者的EOL护理。它解决了在造成这些差异中起作用的因素,并描述了可以减少提供EOL护理方面的差异的具体干预措施。
方法:作者搜索,PubMedCentral,Medline,和PubMed数据库使用种族差异和临终/姑息治疗组合。共确定了57项研究。所有文章都进行了审查,并综合现有证据,确定受种族差异影响的EOL护理关键领域及其影响因素.
■几个病人,提供者,机构层面的因素可能是导致EOL护理差异的原因,包括健康素养,获得护理,对医疗系统的不信任,健康的社会决定因素(SDH),医学种族主义,文化和宗教习俗,在EOL的沟通。少数族裔患者经历的EOL护理差异是医疗保健系统中系统和制度化种族主义猖ramp的延伸。供应商必须在多个方面努力解决这种不平等和不公正,首先是关于EOL护理差异的认可和对话。
结论:沟通中的差异,姑息治疗和临终关怀的利用,症状管理必须根除。所有患有严重疾病的患者和家庭,无论其种族或族裔背景如何,都应获得姑息治疗和临终关怀。
OBJECTIVE: The issue of racial and ethnic disparities in healthcare has been a significant concern for many years. It encompasses various aspects, including disease prevention, diagnosis, management, and end-of-life (EOL) care. Research has found that timely intervention with palliative care can result in better EOL care and reduced healthcare costs. This
review aims to detail the role of healthcare disparities impacting palliative care,
hospice enrollment, and EOL care in patients with serious illnesses who are facing EOL. It addresses the factors that play a role in creating these disparities and describes specific interventions that may reduce disparities in the provision of EOL care.
METHODS: Authors searched, PubMed Central, Medline, and PubMed databases using Racial Disparity and End-of-Life/Palliative Care combinations. A total of 57 studies were identified. All articles were reviewed, and the available evidence was synthesized and to identify key domains in EOL care impacted by racial disparities and the factors contributing to them.
UNASSIGNED: Several patient, provider, and institutional level factors may be responsible for disparities seen in EOL care, including health literacy, access to care, mistrust of the healthcare system, social determinants of health (SDH), medical racism, cultural and religious customs, and communication at EOL. Disparities in EOL care experienced by minority patients is an extension of the systemic and institutionalized racism rampant in the healthcare system. Providers must work on multiple fronts to address this inequity and injustice, the first of which is recognition and conversation regarding disparities in EOL care.
CONCLUSIONS: Disparities in communication, palliative and
hospice care utilization, and symptom management must be eradicated. Palliative care and
hospice should be made accessible for all patients and families experiencing severe illness regardless of their racial or ethnic background.