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54 Barriers to accessing and delivering hospice care services for diverse communities: a rapid review
  1. Ishrat Islam,
  2. Elin Baddeley,
  3. Delyth Morris,
  4. Annmarie Nelson and
  5. Stephanie Sivell
  1. Cardiff University, UK


Introduction Diverse communities - people with dementia, intellectual disabilities (ID) and religious beliefs, have lower rates in accessing palliative and hospice care services (Johnson, 2013). Healthcare providers also encounter problems in delivering appropriate services to these communities (Koffman, 2014).

Aim To identify the barriers to accessing and delivering hospice care services for diverse communities.

Method A rapid review was conducted using a systematic search protocol. The search yielded 95 relevant titles from which 34 were screened for data extraction and 23 met the inclusion criteria. Thematic approach was used for data analysis.

Results The overall barriers identified were mainly physical, psycho-social and economic. People with dementia were challenged by the uncertainty of their survival time. Their lack of awareness of service facilities, availability and financial circumstances hindered them accessing hospice care. Difficulties associated with prognostication; communication; inadequate medical interventions; and appropriateness of palliative care intervention were the main barriers for those providing palliative care to this group. For individuals with ID, social, emotional and cognitive issues (patient understanding, capacity to consent etc.) were the main factors affecting palliative care provision. The main barriers for services providers were lack of guidelines and support, access to general healthcare facilities and internal staffing issues. For those with specific religious beliefs, unwillingness to involve outsiders, being well supported by their religious community, distrust of medical establishments and unawareness of the need and availability of services were the main barriers. Lack of diversity among health care staff and resource constraints were barriers to service delivery.

Conclusions Addressing specific needs of diverse communities would encourage better utilisation of hospice care.

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