Homerton Hospital study shows gender and ethnicity inequity in palliative care

A Homerton Hospital study has concluded that there is an “urgent need” for further research into its findings showing that Black, Asian and minority ethnic patients, and in particular women, have had to wait longer for palliative care than white patients, both before and during the pandemic.

The research was conducted by the Homerton’s palliative care team, looking at the first 60 Covid-positive inpatients referred to its service between 1 March and 23 April of this year, alongside the 60 inpatients referred in a similar period last year.

The results showed that the time of referral to palliative care, which provides specialised support for people with life-limiting conditions, became longer for Black, Asian and minority ethnic patients during the pandemic, with a mean difference of 3.94 days to how long white patients had to wait. Pre-Covid, the mean difference was 0.27 days.

Claude Chidiac, the Homerton’s lead nurse for palliative care, said: “We found that Black, Asian, and minority ethnic patients tended to be referred later to palliative care compared to white ethnic patients, especially during COVID-19.

“This is an important finding for us to learn from and do more to understand why this is happening. Ethnic health inequalities are widely documented globally, but our findings suggest that Covid-19 may exacerbate those experiences.

“Therefore, we need to understand the ‘why’ and come up with effective solutions to set up equitable, responsive, flexible and integrated services.”

The study, the first comparative investigation of its kind into referrals to a palliative care service before and during the pandemic, is a local reflection of widely-reported findings showing that Black, Asian and ethnic minority groups have suffered disproportionately from the pandemic’s impact.

Data presented by the Homerton in the Palliative Medicine Journal also suggested that women from minority ethnic groups are referred later than men, with the report adding: “Evidence suggests that women are less likely to receive pain medications and are more likely to present with advanced illness, assume a caregiver role and experience a palliative care referral compared to men.”

Chidiac’s team also calls for further research into gender bias and palliative care from an intersectional lens, with the study arguing that this would help understand how categories such as gender and ethnicity intersect “to reveal interconnecting systems of privilege and oppression at the macro socio-structural level”.

The report further argues for early referral to palliative care in Covid-19 and focused education into recognising dying among healthcare professionals, due to the fact that the study shows that many patients were referred for symptom control instead of terminal care.

Reasons given by the study for the “suboptimal” end-of-life care received by Black, Asian and minority ethnic people include lower access to services, lack of cultural sensitivity among healthcare providers, a language barrier, previous negative experiences, or conflicting values between the person’s family or religion and palliative care itself.

Chidiac added: “Our findings showed that patients with Covid-19 have lower comorbidity scores, yet they have higher prevalence of symptoms, are less able to carry on ordinary daily activities, and deteriorate and die quicker.

“Therefore, early involvement of palliative care in Covid-19 is essential.

“It is important to be aware that palliative care does not only mean end of life care and may be beneficial to people at different stages of their illness.

“Much of Covid-19 care is about managing symptoms like breathlessness and anxiety, supporting families at a very difficult time, and maximising the use of available resources; all of which are the expertise of palliative care. So, involving palliative care in the wider COVID-19 planning response is important to ensure that we are delivering the best possible care.”