How is equity of care measured by specialist palliative care services? Results of a scoping review

Despite health equity being a focus of many organizations, the equity of palliative care outcomes is not routinely measured by many specialist palliative care (SPC) services. This scoping review aimed to identify measures used to assess equity in SPC delivery, to help programs identify measurement gaps and address inequities for underserved populations. Medline (Ovid), Embase (Ovid), CINAHL (EBSCOhost), and Cochrane Central Register of Controlled Trials (Ovid) were searched for English-language articles to May 2023. Inclusion criteria: original report pertaining to a SPC service or program, included adults > 18 years old, reported outcomes during or after receipt of SPC, and assessed the impact of one or more equity factors on the reported outcomes. Equity factors were assessed based on the PROGRESS-Plus framework. Two hundred and eighty-four records were included: just over half (54%) originated from the United States, with the remaining from Canada, Australia, the United Kingdom, and Taiwan. Place of death, patient symptoms, costs of care, and length of stay in a United States hospice social insurance program were the four most common SPC outcomes assessed for inequities. Gender/sex, age, disease type and ethnicity were the most common equity factors assessed in relation to SPC outcomes. Analysis of health administrative data was the most frequently reported measurement method for SPC and equity factors. Notably, many equity factors (e.g., sexual orientation, language spoken, homelessness, incarceration, substance use disorder) were rarely measured. Important gaps exist in how SPC services are measuring equity of care. Development of new measures with equity-deserving groups is needed to ensure that the indicators that shape SPC delivery in the coming years promote equity. Not applicable.