Inequity in palliative care and bereavement support: an umbrella review of the evidence

Introduction Inequitable, unfair or unjust service provision pervades palliative and bereavement care globally within and across countries. There is growing research into the needs of population groups known to experience inequity. This paper presents an evidence synthesis of systematic reviews examining inequities in palliative care and bereavement support for adults, to identify the key facilitators, barriers, and structural determinants of inequity across population groups, and to develop evidence-informed recommendations for policy, education, research, and practice. Methods Joanna Briggs Institute Umbrella review methodology was used. Searches were conducted across six electronic databases (CINAHL, Medline, PsycINFO, Scopus, Embase, and Cochrane Collaborative Database of Systematic Reviews) from January 2012 to November 2023 and updated the search in May 2025. Joanna Briggs Institute critical appraisal tools were used for quality assessment. Results Forty-eight reviews were included. Only 1 review focused exclusively on bereavement, a further 2 studies included it within a broader scope. Barriers and facilitators to equity were identified at individual, population-specific, and system-wide levels. Common structural determinants across all groups included low socioeconomic status, limited health literacy, geographical and structural impediments, cultural and language dissonance, and individual vulnerability due to interconnected personal characteristics. Key recommendations to improve equity included enhancing cultural competence, inclusive communication, intersectional awareness, person-centred care, shared decision-making, and community engagement. Discussion Inequity in palliative care and bereavement support reflect collective and shared experiences. The structural determinants of inequity that transcend population groups may be useful in identifying, assessing and measuring inequity in palliative care and bereavement support and aid the commissioning, delivery and evaluation of inclusive services.