A comparison of conceptual frameworks to examine health inequities in End-of-Life care

Abstract

Aims: To discuss existing conceptual frameworks that can be applied to the examination of health inequities in end-of-life care and related health outcomes. We used the Fawcett and Desanto-Madeya evaluation technique modified by the National Institute on Minority Health and Health Disparities Research Framework to include individual, interpersonal, community, and societal levels of influence.

Design: Discussion paper.

Data sources: We performed a systematic review of PubMed, CINAHL and Embase for conceptual frameworks of health inequities in end-of-life care and health outcomes published as of February 2022.

Implications for nursing: There is a strong need for research that can address multiple factors influencing end-of-life care inequities and health outcomes. To mitigate the complex nature of social determinants of health and structural inequities, researchers, clinicians, educators and administrators should have solid conceptualizations of these multi-level factors. Based on sound and comprehensive frameworks, nurses with interdisciplinary partnerships can promote health equity with a broader health care scope through addressing social determinants of health.

Conclusion: We identified and reviewed three frameworks. We concluded all three frameworks have the potential for use in the examination of health inequities in end-of-life care and health outcomes. However, the Conceptual Framework of Minority Access to End-of-Life Care was more applicable to diverse studies and settings when adapted to include fundamental characteristics such as sex and gender.

Impact: Despite the substantial rise in end-of-life care delivery, health inequities persist in end-of-life care access and utilization. Though some studies have been conducted to promote health equity by addressing social determinants of health, progress is hampered by their complex and multi-faceted nature. Through a concrete conceptual framework, researchers can comprehensively examine multi-level factors influencing health inequities in end-of-life care.

No patient or public contribution: This discussion paper focused on reviewing existing evidence.

Keywords: conceptual frameworks; end-of-life care; health inequities; nursing/nurses; social determinants of health; theoretical models.

FIGURE 1

PRISMA 2020 flow diagram. Note. Page et al. (2021).

FIGURE 2

A conceptual framework of minority access to end-of-life care. Note. This model shows access to end-of-life care with patient, system, and societal-level barriers and health care-level mediators. From “Racial/Ethnic Minority Access to End-of-Life Care: A Conceptual Framework,” by J. Laguna, S. Enguidanos, M. Siciliano, & A. Coulourides-Kogan, 2012, Home Health Care Services Quarterly, 31(1), p. 66. (https://doi.org/10.1080/01621424.2011.641922).

FIGURE 3

A conceptual framework for the role of healthcare service factors in place of death. Note. This model presents the impact of healthcare services on the place of death. From “A Population-Based Conceptual Framework for Evaluating the Role of Healthcare Services in Place of Death,” by W. Gao, S. Huque, M. Morgan, & I. J. Higginson, 2018, Healthcare, 6(3), p. 3. (https://doi.org/10.3390/healthcare6030107).

FIGURE 4

An adapted conceptual model integrating palliative Care in Serious Illness and Multiple Chronic Conditions. Note. This model was adapted from a conceptual model of the role of clinical complexity in the care of patients with multiple chronic conditions. From “An Adapted Conceptual Model Integrating Palliative Care in Serious Illness and Multiple Chronic Conditions,” by K. P. Murali, G. Yu, J. D. Merriman, A. S. Kelley, & A. A. Brody, 2020, The American journal of hospice & palliative care, 37(12), p. 1091. (https://doi.org/10.1177/1049909120928353).