Ethnic Inequalities in Palliative Care Prescribing – A Rapid Systematic Review

Abstract

Context: Effective palliative care involves managing the many symptoms commonly experienced towards the end-of-life. Appropriate prescribing is key to this care, and ethnic inequalities may lead to unequal treatment and poorer outcomes for minority groups. Understanding these disparities is critical to ensuring equitable care. Objectives: To investigate ethnic inequalities in palliative care prescribing amongst adults residing in high-income countries. Methods: The review was registered with the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42023476977. We conducted searches across three electronic databases (MEDLINE, Embase, and CINAHL) from January 2000 to November 2023. Screening, data extraction and quality assessment were conducted independently by two reviewers. Quality was assessed using various JBI Critical Appraisal tools. Due to the heterogeneity of included studies, a narrative review was undertaken without a meta-analysis. Results: Out of 7880 references identified, 10 studies met the inclusion criteria, all conducted in the United States. Overall, five studies were deemed to be high quality and five were fair quality. The studies highlighted ethnic disparities in palliative care prescribing. Minority populations were less likely to receive pain management medications, particularly opioids, compared to non-Hispanic whites. Increased age, female gender, lower socioeconomic status, and place of residence were also related to differences in prescribing practices. Conclusions: This rapid systematic review suggests that there are ethnic inequalities in palliative care symptom management prescribing, highlighting a possible gap in care for ethnic minority patients. Research beyond the USA is needed to understand if there are international disparities in palliative care prescribing.