O-16 Intersectionality and palliative care – a rapid review

Abstract

Background

Intersectionality is a concept that recognises the interconnected disadvantage and marginalisation based on a person’s multiple characteristics and identities (Crenshaw. University of Chicago Legal Forum. 1989;1989(1); Hankivsky, Grace, Hunting, et al. Int J Equity Health. 2014;13(119)). We know that inequities in palliative care exist (Tobin, Rogers, Winterburn, et al. BMJ Support Palliat Care. 2022; 12(2), 142–151). Intersectionality provides an informative lens through which to explore how the multiple characteristics of a person may influence experiences towards the end of life (Estupiñán Fdez de Mesa, Marcu, Ream, et al. BMJ Open. 2023;13:e066637).

Aim

To examine and map the type and focus of research exploring intersectionality and access to palliative care, summarise existing literature and identify directions for future research.

Methods

Five online databases were searched for qualitative and quantitative studies, published in the last 10 years that explicitly explored the impact of intersectionality between two or more characteristics for people accessing palliative or end of life care or advance care planning (ACP).

Results

Seven eligible papers were identified. Evidence of intersectional impacts were found. Four studies explored the impact of intersectionality on access to and attitudes towards ACP (age and ethnicity; and sexuality, gender and age). Two explored intersectionality and access to care (age and sexuality; ethnicity and gender), one investigated intersectionality (ethnicity and gender) and quality of care in the last year of life. Inconsistent operationalisations of intersectionality complicated the identification of eligible papers.

Conclusions

There is limited evidence exploring the complicated interactions between the different elements of a person and their experiences towards the end of life. Studying intersectionality is complex and challenged by methodological issues and data limitations. A more robust definition of intersectionality, and an agreed theoretical framework will facilitate the sharing and translation of knowledge in this field. Improvements in the quantity and quality of data available, regarding characteristics linked to inequity would enable more nuanced analyses of intersectionality. Coproducing research and services with a diverse range of people could help identify intersections that defy existing analysis, and improve care and future research.