Health Care Disparities in Palliative Care
This article looks at how unconscious bias and health disparities limit palliative care access, with strategies to improve equity and support better patient outcomes.
Author: Lauren Wells, PharmD Candidate Class of 2026
Editor: Kristen Linduaer, PharmD, BCPS, AAHIVP
Have you ever heard, seen, or experienced bias in the health care workplace? Every day, unconscious bias is portrayed. However, we must ensure we know how to mitigate this limitation to provide proper treatment plans. According to the World Health Organization, 56.8 million people need palliative care a year and only 14% of this population receives it. Palliative care is a medical support that relieves symptoms, pain, and emotional distress experienced by those with serious illness. These illnesses can include, but are not limited to, cancer, advanced heart disease, and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). Despite the benefits of palliative care (eg, better symptom management, longer life expectancy, less anxiety and depression, etc.), the service is not offered to all populations across the United States.
The gap between care is vividly expansive with looking at health care disparities and the impact on underrepresented groups. Health care disparities are related to an uneven distribution of social and economic resources. This limitation is found to result in decreased health outcomes and quality of life.
It has been shown that African Americans and Indigenous Americans often suffer through high mortality rates, poor health outcomes, and earlier disease onset than white Americans. In palliative care, examples of these disparities are inappropriate pain management, less timely care, language barriers, cultural differences, mistrust in health care systems, and unconscious bias from providers.
- high mortality rates,
- poor health outcome, and
- earlier disease onset
...compared to white Americans.
Call to Action
By 2025, there will be an increase in underrepresented adults aged 65 and older. As pharmacists, physicians, and other health care providers, we must address the inequalities in this population. There are effective strategies in place to enhance educational knowledge. First, providing educational interventions that focus on communication skills and cultural awareness will improve health care providers' knowledge and skills. Additionally, offering patient advocates and navigators would enable the patient to learn and seek palliative services. Secondly, the health team should consider what the patients’ goals are and how to accomplish that. The 4M framework - What Matters, Medication, Mentation, and Mobility - focuses on the core issues that should assist with decision making in elderly adults. The framework is designed to have a balance between the provider, family, and patients. Also, patients should always be screened for social determinants of health barriers using any of these tools: Accountable Health Communities Health Related Social Needs Screening Tool or Protocol for Responding to & Assessing Patients’ Assets, Risks & Experiences. These tools will guide decisions about plans for non-clinical health factors.
Palliative care is an interprofessional service of physicians, nurses, pharmacists, social workers, and spiritual providers to ensure the patients’ well-being is covered in all aspects. Every team member plays a role in optimizing care and doing the best possible for quality of life. Evidence shows that a team-based approach for palliative services decreased readmission rates. Pharmacists are key clinical players on the team focusing on symptom management, adjusting medications, and counseling family members as needed. Certain locations rely on pharmacists to be a part of discharge documents which allows for avoiding discrepancies and ensure safety.
Overall, palliative care is a growing service for patients, and the health care team must be vital members to ensure optimal care is provided, and disparities/barriers are addressed. Patients rely on the team to provide the utmost respect, knowledge, and guidance for their health. Unconscious bias can be addressed and mitigated by using the tools above. The health care system should move towards an inclusive environment.
About the Author
References
- Institute for Healthcare Improvement. (2020, July). Age-Friendly Health Systems: Guide to using the 4Ms in the care of older adults. The John A. Hartford Foundation; American Hospital Association; Catholic Health Association of the United States. https://www.americangeriatrics.org/sites/default/files/inlinefiles/IHIAgeFriendlyHealthSystems_GuidetoUsing4MsCare.pdf
- Johnson KS. Racial and ethnic disparities in palliative care. J Palliat Med. 2013;16(11):1329–1334. https://pmc.ncbi.nlm.nih.gov/articles/PMC3822363/.
- National Association of Community Health Centers. (n.d.). PRAPARE®: Protocol for Responding to and Assessing Patients’ Assets, Risks & Experiences. https://prapare.org/
- Pornrattanakavee, P., Srichan, T., Seetalarom, K., Saichaemchan, S., Oer-areemitr, N., & Prasongsook, N. (2022). Impact of interprofessional collaborative practice in palliative care on outcomes for advanced cancer inpatients in a resource-limited setting. BMC Palliative Care, 21, 229. https://doi.org/10.1186/s12904-022-01121-0
- Wachterman MW, et al. Dying poor in the US—Disparities in end-of-life care. JAMA. 2021;325(5):443–444. https://jamanetwork.com/journals/jama/fullarticle/2775702.
- World Health Organization. Palliative care. World Health Organization; 2020. Available at: https://www.who.int/news-room/fact-sheets/detail/palliative-care.