Identity and equity in palliative care: An integrative review of intersectional research.

Abstract

Palliative care aims to relieve the suffering of patients and their families with life-threatening illness. Interrelated identities such as ethnicity, gender and socioeconomic status influence patients' experiences and challenge equity within palliative care. Intersectionality considers how multiple identities of a person intersect, shaping experiences, access to care and treatment preferences. This review aims to investigate how intersectionality is defined and operationalized within palliative care, which intersecting identities are described in current literature and how intersectionality affects palliative care access, accessibility and quality. An integrative review was executed using the model of Whittemore and Knafl according to a previously published protocol (PROSPERO: CRD420251090929). The search was conducted in Medline, Embase, PsychINFO and CINAHL. Studies explicitly defining or examining intersecting identities were included. Critical quality appraisal of included literature was conducted using the Johns Hopkins Nursing Evidence-Based Practice model. Ninety studies defining intersectionality or describing intersecting identities within palliative care were included. This review highlights the substantial variation in how intersectionality is described, defined, applied and understood in terms of its consequences. It shows that intersectional disparities (e.g. LGBTQI+-identity, gender, ethnicity, and socioeconomic status) contribute to reduced access to palliative care, lower quality of end-of-life care and dissatisfactory end-of-life experiences. This review represents a crucial step in mapping knowledge about intersectionality in palliative care and the complexity it entails. It shows how rigid care pathways, gendered expectations, and social contexts shape both the palliative care system and providers' interactions with marginalized patients.