Author(s) | Care setting | Aims | Method | Socioeconomic measure | Population | Key findings relating to review questions |
---|---|---|---|---|---|---|
Barclay et al., 2003 [48] Quality score 32 | GP services | Compare palliative care training of GPs in deprived south Wales valleys with rest of Wales. | Survey | Geographic regions | HCP | Access issues: How HCP assessed patients. Key findings: There was no evidence of a difference between GPs in terms of palliative care training in areas of high and low social deprivation at any of the four career stages. GPs in the more deprived region were older, longer qualified and more likely to be non-UK graduates. |
Cartwright, 1992 [41] Quality score 22 | Inpatient hospice services (specialist palliative care) GP and home nursing (generalist palliative care) | (i) Understand the impact of social differences in mortality on life before death; and (ii) examine the extent to which experiences differ between social groups in this time. | Survey | Social class (I-V) Definitions from 1980 Classification of Occupations. | Patients (proxy) | Access issues: Symptom burden, patient resources, patient awareness, patient need. Key findings: More middle class had good quality of life in last year. More working class reported problems with costs of keeping home warm, adapting house to needs. More working class had financial problems. No class difference in symptoms apart from more dry mouth reported by working class; no difference in awareness of dying or being able to find all information wanted. |
Clark, 1997 [49] Quality score 17 | Hospice at home | Describe the use of a hospice at home service. | Routine data | Area deprivation (Jarman index) | Patients | Access issues: Service capacity Key findings: Patients living in the more deprived areas received twice as many visits at home as those in the less deprived areas. Statistical significance not reported. |
Dixon, et al., 2015 [7] Quality score 31 | Community services (specialist and generalist palliative care) | Identify and explore systematic differences in access or outcomes, between geographical areas, settings or different groups of service-users. | Survey | Area deprivation (Index of Multiple Deprivation) | Patients (proxy) | Access issues: Satisfaction / unmet need for care Key findings: Families of deceased who lived in more deprived areas were statistically significantly less likely to say they received sufficient help and support, and to have received spiritual or emotional support. |
Fergus et al., 2010 Quality score 29 [50] | Out of hours (generalist palliative care) | Identify key issues relating to out of hours care for palliative care patients, carers and professionals. | Qualitative interviews | Area measures of: Income Unemploy-ment Social grade Household type Car ownership | Patients Carers HCP | Access issues: patient understanding, communication, relationship with healthcare providers, resistance to care, service organisation, gatekeeping. Key findings: The rigmarole of access made patients reluctant to access services. Some patients misunderstood the service, assuming transfer was automatic. Bad (stressful) experiences led to decision not to contact the service again and district nurses felt it hindered contact with GPs. There was a need for better communication and information sharing to improve decisions during out-of-hours care. |
Gatrell and Wood, 2012 [51] Quality score 34 | Inpatient hospice (specialist palliative care) | Visualise and understand geographic patterns of both the demand for, as well as the supply of, specialist inpatient hospices. | Spatial analysis | Area deprivation (Index of Multiple Deprivation) | Hospices | Access issues: Geographic accessibility Key findings: There are 5.35 million adults living in areas of England and Wales that have higher than average deprivation and demand (cancer deaths) but below average access to inpatient hospice. |
Hanratty et al., 2012 [52] Quality score 30 | End-of-life care (any) | Explore people’s experiences of transitions between healthcare settings at the end of life. | Qualitative interviews | Occupational class Disadvantaged areas (Spearmen areas) | Patients | Access issues: Communication, relationship with healthcare providers, patient attitudes, service organisation. Key findings: Most participants were from disadvantaged areas and the findings may reflect issues around socioeconomic experiences. Patients reported positive experiences with individuals but challenges negotiating transitions, particularly when system priorities were not aligned with patient priorities, in securing support across settings, and communication between HCP and patients. Authors noted that findings showed little or no variation with socioeconomic status. However, socioeconomic factors were not the focus of the study. |
Kessler et al., 2005 [53] Quality score 26 | Hospice GP services | (i) Clarify the relationship between social class and place of death; and (ii) explore carer anxiety and barriers to control for people of a lower socioeconomic position receiving palliative care. | Qualitative interviews | Social class (I-V). Taken from Standard Occupational Classification. | Patients Carers | Access issues: Patient attitudes and awareness, relationship with healthcare providers; patient resources, information seeking Key findings: Disadvantaged social class associated with having relatives close by and more available, expressing less desire for information, and passively receiving information. Families often relied on their most forceful members, particularly children of higher social class, to help negotiate barriers to accessing care. No evidence of class differences in anxiety or attitudes towards hospice or awareness of death. |
Koffman et al., 2007 [54] Quality score 31 | Any palliative care Macmillan cancer (specialist palliative care) | (i) explore the awareness of palliative care and related services among UK cancer patients; and (ii) analyse the relationship between demographic factors and patients’ knowledge-base | Survey | Area deprivation (Index of Multiple Deprivation) | Patients | Access issues: Patient awareness and understanding. Key findings: Patients in the least deprived areas were 8.4 times as likely to recognise the term palliative care and 7 times as likely to correctly understand the role of Macmillan nurses, than those in the most deprived areas. |
Rees-Roberts, M. et al. 2019 [55] Quality score 31 | Specialist palliative care (community services) | To describe and compare the features of hospice at home services in England and understand key enablers to service provision | Survey | Area deprivation (details not provided) | Hospices | Access issues: Geographic accessibility Key findings: 7.1% of hospice at home services are provided in predominantly deprived areas, 15.7% in predominantly affluent areas, and 77.1% in mixed deprivation areas. |
Seale, et al., 1997 [56] Quality score 28 | NA (death awareness) | Report the prevalence of different awareness contexts and explore the causes of differences. | Survey | Social class (I -V). No reference or details given. | Patients (proxy) | Access issues: Patient awareness. Key findings: Being in a higher (I and II) social class increased the odds of someone dying in full open awareness by 2.66 times, compared to being in classes IV and V. This remained statistically significant for just cancer decedents but not non-cancer decedents. Those who died in an open awareness context were more likely to have died in a hospice. |
Spruyt, 1999 [57] Quality score 22 | Community-based care (all palliative care) | Increase understanding of the Bangladeshi community’s experiences of palliative care in East London. | Qualitative interviews Routine data | Not formally measured but local area described as deprived and disadvantaged. | Carers | Access issues: Communication, healthcare costs, healthcare quality Key findings: Issues with finances and re-housing influenced carers’ experiences of supporting patients and their impression of the quality of formal healthcare services. |
Walsh and Laudicella, 2017 [58] Quality score 30 | End-of-life care (hospital) | (i) examine whether there is a socioeconomic gradient in end-of-life healthcare costs; and (ii) whether any observed disparities are underpinned by greater use of emergency admission amongst patients in a more disadvantaged socioeconomic position. | Economic analysis | Area income deprivation (Indices of Deprivation: Income Deprivation Domain) | Patients | Access issues: Healthcare resources and costs Key findings: End-of-life healthcare costs in England are highest amongst cancer patients who live in more income deprived areas, largely due to the higher use of emergency service by these patients. The most deprived groups have longer stays in hospital after an emergency admission. |
Wilson, 2009 [59] Quality score 26 | Nurses (specialist palliative care) District nurses (generalist palliative care) | (i) explore whether the lifestyle factors of a patient influences nurses’ pain management decisions; and (ii) explore if post basic education and experience of pain and pain management in the clinical setting influences nurses’ attitudes in relation to pain. | Survey | Occupation | HCP | Access issues: How HCP assessed patients, stigmatising attitudes Key findings: Generalist nurses were significantly less likely to recognise the pain described by businessman than a construction worker with a history of drink driving. |
Wood et al., 2004 Quality score 28 [60] | Inpatient hospice (specialist palliative care) | Assess the extent to which those living in particular wards in North West England have equity of access to adult inpatient hospice services. | Spatial analysis | Area deprivation | Hospices | Access issues: Geographic accessibility Key findings: 41% of wards in the North West where access was poor and demand relatively high were relatively highly deprived. |