Factors influencing accessibility of palliative care: a systematic review and meta-analysis

Palliative care is essential for enhancing quality of life in patients with life-threatening illnesses. However, its accessibility remains inconsistent across populations and regions. This review systematically examines and quantifies factors influencing accessibility of palliative care. We conducted a comprehensive literature search in PubMed, Web of Science, CINAHL, Embase, the Cochrane Library, CNKI, Wanfang, and VIP databases, covering the period from January 2014 to July 2024. The search aimed to identify observational studies on factors influencing accessibility of palliative care. Keywords related to accessibility were derived from the five dimensions defined by Penchansky and Thomas: availability, accessibility, accommodation, affordability, and acceptability. Study quality was assessed using the Joanna Briggs Institute (JBI) tools, and a meta-analysis was conducted using Review Manager 5.3. A total of 20 studies were included in the analysis, with 15 using a retrospective design with secondary data analysis, two employing a cross-sectional design, and three using a cohort design. There were no studies on availability, one study on accessibility, two studies on affordability, one study on accommodation, and sixteen studies on acceptability. The influencing factor for accessibility is geographic location. The influencing factors for affordability and accommodation are mainly demographic characteristics, including race, religion, and employment status. The most influential factors for acceptability are categorized as sociodemographic, healthcare service, disease-related factors. Meta-analysis results indicated that female gender (OR = 1.18, 95% CI: 1.14–1.23), higher income level (OR = 1.11, 95% CI: 1.08–1.14), and larger hospital bed capacity (OR = 1.22, 95% CI: 1.14–1.32) facilitated accessibility to palliative care (P < 0.05). Conversely, residing in rural areas (OR = 0.80, 95% CI: 0.67–0.95) and being of African descent (OR = 0.78, 95% CI: 0.68–0.90) were barriers to accessibility (P < 0.05). This review highlights a relationship between key sociodemographic characteristics, healthcare service, disease-related factors and the accessibility of palliative care. However, the limited number of studies focusing on specific dimensions, such as availability, affordability, accessibility, and accommodation, creates gaps in understanding. Further research is needed to clarify the underlying mechanisms and potential causality of these associations. Recognizing the significant implications of limited accessibility of palliative care can help identify underserved populations and develop targeted interventions to improve the access to the service for these groups. • Adopting a Comprehensive Framework to Evaluate Accessibility of Palliative Care: This study applies the Healthcare Supply-Demand Adaptation Model by Penchansky and Thomas. It considers five dimensions of accessibility: availability, accessibility, affordability, acceptability, and accommodation. This approach provides a holistic view of palliative care access. • Exploring Barriers and Facilitators to Accessibility of Palliative Care: Key facilitators of palliative care accessibility include female gender, higher income, and larger hospital bed capacity. Barriers include rural residency and African descent. These findings offer new insights into accessibility patterns. • Detecting Imbalance in the Number of Studies Across Five Dimensions: Acceptability is the most frequently discussed dimension in the literature. However, other dimensions, such as availability, affordability, accessibility, and accommodation, remain underexplored. This imbalance highlights an important gap in current research and emphasizes the need for deeper investigation into these underrepresented areas. • Conducting Multi-Level Analysis of Influencing Factors: This study integrates meso-level factors, such as healthcare institutions, and micro-level factors, such as sociodemographic and cultural influences. This approach provides a more nuanced understanding of palliative care accessibility, addressing both systemic and individual barriers