Selected abstracts from the 4th international research seminar of the EAPC Reference Group on Public Health & Palliative Care, June 17-19, 2025. Palliat Care Soc Pract. 2025;19. doi:10.1177/26323524251366788
In the originally published version of this abstract book, one abstract was inadvertently omitted. The missing abstract given below has now been added.
Identifying Equity Gaps in Palliative Care Access: A Co-Design Process
Aynharan Sinnarajah1,2,3,4, Omar Abdel-Rahman5,4, Beverley Berg4, Michelle Peterson Fraser4, Pin Cai1, Sharon Watanabe5,4, Cara Bablitz4, Anna Santos Salas5, Simon Colgan1,4, Patricia Biondo1, Jessica Simon1,4
1University of Calgary, 2Queen’s University, 3Lakeridge Health, 4Alberta Health Services, 5University of Alberta
Background: As palliative care (PC) access increases over time, inequities continue, in use and timing of access across different factors.
Study Objectives: The overall study objective was to explore, using administrative data, differences in specialist PC (SPC) access and use, when looking at various equity factors, as directed by our co-design stakeholders.
Research approach: We used a co-design process whereby patients, providers, researchers (including equity researcher), health system leaders and policy makers informed the research questions, methods, data sources and analysis plans. All decedents who died from any chronic disease from 2013-2021 in Alberta were included in the sample. They were linked to health resource use in their last year of life, using administrative data. In this first phase, three equity factors were prioritized as exposures of interest: diagnoses (cancer vs non-cancer), rural-urban residence and socioeconomic factors (composite quintile index from least deprived to most deprived). Outcomes of interest were defined as use of SPC at any point before death (proportion) and timing of first use of SPC (median).
Relevance: During successive meetings, our co-design stakeholders identified 8 equity factors to explore: Income level, Socioeconomic marginalization index (Pampalon Index), Age, Sex, Housing status, Diagnosis, Rural-urban residence and Immigrant status. Across 166,301 decedents, SPC use was 37.1%, with 1st SPC use occurring a median of 33 days before death. SPC use was higher in cancer (70.2%) vs non-cancer (21.7%), occurring a median of 38 days vs 23 days before death respectively. Urban residents had more SPC use (45.1%) vs rural residents (17.0%) without difference in timing (32 days vs 34 days). The most deprived residents had lower SPC use (38.8%) vs least deprived (44.8%), but no difference in timing (32-33 days). However, the difference in SPC access between the most deprived vs least deprived were attenuated in the urban cancer cohort (83.4% vs 85.1%) and rural non-cancer cohort (8.1% vs 9.2%).
Conclusion: In a large publicly funded health system, there continues to be inequities in PC access in populations who live in rural areas, have non-cancer diagnoses and are most socioeconomically deprived. However, these differences are attenuated when looking at combinations of equity factors. Leaders and policy makers should carefully tailor interventions based on the intersections of diverse equity factors.
Originality: A co-design process ensured stakeholders were involved in research question development from the beginning, to make data collection and analysis relevant and acceptable for patients, clinicians, health system leaders and policy makers.
Relevance to conference theme: Equity and diversity factors identified within a co-design process should lead to more direct impact on health systems and policies, thereby promoting more compassionate and comprehensive care for all.
