Dying in the margins: understanding palliative care and socioeconomic deprivation in the developed world

J Pain Symptom Manage. 2011 Jul;42(1):105-18. doi: 10.1016/j.jpainsymman.2010.10.265. Epub 2011 Mar 12.


Context: Individuals from low socioeconomic (SE) groups have less resources and poorer health outcomes. Understanding the nature of access to appropriate end-of-life care services for this group is important.

Objectives: To evaluate the literature in the developed world for barriers to access for low SE groups.

Methods: Electronic databases searched in the review included MEDLINE (1996-2010), CINAHL (1996-2010), PsychINFO (2000-2010), Cochrane Library (2010), and EMBASE (1996-2010). Publications were searched for key terms "socioeconomic disadvantage," "socioeconomic," "poverty," "poor" paired with "end-of-life care," "palliative care," "dying," and "terminal Illness." Articles were analyzed using existing descriptions for dimensions of access to health services, which include availability, affordability, acceptability, and geographical access.

Results: A total of 67 articles were identified for the literature review. Literature describing end-of-life care and low SE status was limited. Findings from the review were summarized under the headings for dimensions of access.

Conclusion: Low SE groups experience barriers to access in palliative care services. Identification and evaluation of interventions aimed at reducing this disparity is required.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Health Services Accessibility*
  • Humans
  • Palliative Care*
  • Poverty*
  • Social Class*
  • Socioeconomic Factors
  • Terminal Care
  • United States