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Butler H, Gott M, Prebble DK, Fortune DS, Robinson DJ. Palliative care research utilising intersectionality: a scoping review. BMC Palliat Care 2023; 22:189. [PMID: 38012662 PMCID: PMC10683236 DOI: 10.1186/s12904-023-01310-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/14/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Access to palliative care is recognised as a human right, yet clear disparities exist. There have been recent appeals to examine people's contexts and interactions with social systems which for many, adversely influence their utilisation of palliative care. Intersectionality provides a way to understand these drivers of inequity and ultimately advocate for change. AIM To identify and describe published studies utilising intersectionality in relation to need, access and experience of palliative care. DESIGN A scoping review. DATA SOURCES Medline, PsycINFO, CINAHL and Google Scholar databases and a manual search were undertaken for studies published up to January 2023. Included studies were evidence based articles where palliative or end of life care was the focus and intersectionality was identified and/or applied to the research that was undertaken. RESULTS Ten published studies were included. An analytic framework was developed to identify the extent that intersectionality was utilised in each study. A wide range of different groups were researched across the studies, with most focusing on aspects of their participant's identity in relation to palliative care access and experience. Common topics of power, heterogeneity of people within the health system and barriers to palliative care were illuminated across the studies. CONCLUSIONS Very limited research to date has utilised intersectionality to understand access, utilisation and experience of palliative care. This scoping review demonstrates intersectionality can provide a way to illuminate rich understandings of inequity in palliative care. It is imperative that future palliative research incorporates an intersectionality focus to further clarify the needs and experiences of structurally marginalised groups.
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Affiliation(s)
- Helen Butler
- School of Nursing, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand.
| | - Merryn Gott
- School of Nursing, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Doctor Kate Prebble
- School of Nursing, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Doctor Sarah Fortune
- School of Population Health, University of Auckland, 28 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Doctor Jackie Robinson
- School of Nursing, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
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Allana S, Norris C, Hussain A, Clark A. A scoping review and intersectionality-based analysis of heart failure telehealth interventions for vulnerable populations. J Adv Nurs 2023; 79:4097-4111. [PMID: 37409794 DOI: 10.1111/jan.15756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 05/28/2023] [Accepted: 06/15/2023] [Indexed: 07/07/2023]
Abstract
AIMS To map the existing body of heart failure (HF) telehealth interventions for vulnerable populations, and to conduct an intersectionality-based analysis utilizing a structured checklist. DESIGN A scoping review and intersectionality-based analysis. DATA SOURCES The search was conducted in March 2022 in the following databases: MEDLINE, CINAHL, Scopus and the Cochrane Central Register of Controlled Trials, ProQuest Dissertations and Theses Global. REVIEW METHODS First, the titles and abstracts were screened, and then the entire articles were screened against the inclusion criteria. Two of the investigators screened the articles independently in Covidence. The studies included and excluded at various stages of screening were depicted through a PRISMA flow diagram. The quality of the included studies was assessed based on the mixed methods appraisal tool (MMAT). Each study was read thoroughly and the intersectionality-based checklist by Ghasemi et al. (2021) was applied, whereby a yes/no response was marked for each question on the checklist and the relevant supporting data were extracted. RESULTS A total of 22 studies were included in this review. About 42.2% of the responses indicated that studies incorporated the principles of intersectionality at the 'problem identification' stage, followed by 42.9% and 29.44% responses indicating incorporation of these principles at the 'design and implementation' and 'evaluation' stages respectively. CONCLUSIONS The findings suggest that the research around HF telehealth interventions for vulnerable populations is not adequately grounded in appropriate theoretical underpinning. The principles of intersectionality have been applied mostly to the problem identification and the intervention development and implementation stages, and not so much at the evaluation stage. Future research must fill the identified gaps in this area of research. NO PATIENT OR PUBLIC CONTRIBUTION Since this was a scoping, there was no patient contribution to this work; however, based on this study's findings, we are undertaking patient-centred studies with patient contribution.
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Hill L, Baruah R, Beattie JM, Bistola V, Castiello T, Celutkienė J, Di Stolfo G, Geller TP, Lambrinou E, Mindham R, McIlfatrick S, Strömberg A, Jaarsma T. Culture, ethnicity, and socio-economic status as determinants of the management of patients with advanced heart failure who need palliative care: A clinical consensus statement from the Heart Failure Association (HFA) of the ESC, the ESC Patient Forum, and the European Association of Palliative Care. Eur J Heart Fail 2023; 25:1481-1492. [PMID: 37477052 DOI: 10.1002/ejhf.2973] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 06/29/2023] [Accepted: 07/09/2023] [Indexed: 07/22/2023] Open
Abstract
The delivery of effective healthcare entails the configuration and resourcing of health economies to address the burden of disease, including acute and chronic heart failure, that affects local populations. Increasing migration is leading to more multicultural and ethnically diverse societies worldwide, with migration research suggesting that minority populations are often subject to discrimination, socio-economic disadvantage, and inequity of access to optimal clinical support. Within these contexts, the provision of person-centred care requires medical and nursing staff to be aware of and become adept in navigating the nuances of cultural diversity, and how that can impact some individuals and families entrusted to their care. This paper will examine current evidence, provide practical guidance, and signpost professionals on developing cultural competence within the setting of patients with advanced heart failure who may benefit from palliative care.
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Affiliation(s)
- Loreena Hill
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
- College of Nursing and Midwifery, Mohammed Bin Rashid University, Dubai, United Arab Emirates
| | - Resham Baruah
- Chelsea and Westminster NHS Foundation Trust, London, UK
| | - James M Beattie
- Cicely Saunders Institute, King's College London, London, UK
| | - Vasiliki Bistola
- National and Kapodistrian University of Athens, Department of Cardiology, Heart Failure Unit, Attikon University Hospital, Athens, Greece
| | - Teresa Castiello
- Department of Cardiovascular Imaging, King's College London, Croydon Health Service London, London, UK
| | - Jelena Celutkienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Giuseppe Di Stolfo
- Cardiovascular Department, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Tal Prager Geller
- Palliative care centre DOROT medical centre Netanya, Netanya, Israel
| | | | - Richard Mindham
- United Kingdom European Society of Cardiology Patient Forum, Sophia Antipolis, France
| | - Sonja McIlfatrick
- Institute of Nursing and Health Research, Ulster University, Belfast, UK
| | - Anna Strömberg
- Department of Health, Medicine and Health Sciences, Linköping University, Linköping, Sweden
- Department of Cardiology, Linköping University, Linköping, Sweden
| | - Tiny Jaarsma
- Department of Health, Medicine and Health Sciences, Linköping University, Linköping, Sweden
- Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
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Moving Women Veterans' Health Research Forward: a Special Supplement. J Gen Intern Med 2022; 37:665-667. [PMID: 36042081 PMCID: PMC9427162 DOI: 10.1007/s11606-022-07606-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Hosman FL, Engels S, den Ruijter HM, Exalto LG. Call to Action for Enhanced Equity: Racial/Ethnic Diversity and Sex Differences in Stroke Symptoms. Front Cardiovasc Med 2022; 9:874239. [PMID: 35592405 PMCID: PMC9110690 DOI: 10.3389/fcvm.2022.874239] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/04/2022] [Indexed: 01/02/2023] Open
Abstract
BackgroundFundamental aspects of human identity may play a role in the presentation of stroke symptoms and, consequently, stroke recognition. Strokes must be recognized and treated expeditiously, as delays result in poorer outcomes. It is known that sex plays a role in the presentation of symptoms, such that non-traditional symptoms are more commonly observed among women. However, factors such as geographical location and race/ethnicity, and the interactions between these various factors, need to be considered. This will provide an intersectional approach.MethodsA systematic review and meta-analysis of the literature was conducted to investigate differences in the presentation of stroke symptoms between sexes. Using PubMed and Embase, a search involving the components sex, symptoms and stroke was completed and yielded 26 full-text manuscripts.ResultsOur findings indicate that there is substantial overlap in stroke symptom presentation in men and women. Nonetheless, some differences in the clinical manifestations of stroke were observed. In addition, it was discovered that only three studies were conducted outside of North America and Europe. Furthermore, only two studies reported symptoms based on both sex and racial/ethnic group.ConclusionThese findings indicate a research gap and call for increased research in order to uncover the possible interactions between sex and race/ethnicity in an intersectional approach. Resultantly, stroke recognition could be improved and greater equity in healthcare can be achieved.
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Affiliation(s)
- Floortje L. Hosman
- Department of Neurology, University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Sabine Engels
- Department of Neurology, University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Hester M. den Ruijter
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Lieza G. Exalto
- Department of Neurology, University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
- *Correspondence: Lieza G. Exalto
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McKay B, Tseng NWH, Sheikh HI, Syed MK, Pakosh M, Caterini JE, Sharma A, Colella TJF, Konieczny KM, Connelly KA, Graham MM, McDonald M, Banks L, Randhawa VK. Sex, Race, and Age Differences of Cardiovascular Outcomes in Cardiac Resynchronization Therapy RCTs: A Systematic Review and Meta-analysis. CJC Open 2022; 3:S192-S201. [PMID: 34993449 PMCID: PMC8712541 DOI: 10.1016/j.cjco.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 09/07/2021] [Indexed: 11/05/2022] Open
Abstract
Background Cardiac resynchronization therapy (CRT) is beneficial in patients who have heart failure with reduced ejection fraction or arrhythmic events. However, most randomized controlled trials (RCTs) showing survival benefits primarily enrolled older white men. This study aims to evaluate CRT efficacy by sex, race, and age in RCTs. Methods Five electronic databases (CINAHL, Embase, Emcare, Medline, and PubMed) were searched from inception to July 12, 2021 for RCTs with CRT in adult patients. Data were analyzed for clinical outcomes including all-cause or cardiovascular (CV) death, worsening heart failure (HF), and HF hospitalization (HFH) according to sex, race, and age. Results Among six RCTs with up to moderate risk of bias, 54% (n = 3,630 of 6,682; mean age 64 years, 22% female, 8% black patients) had CRT device implantation. All-cause death (odds ratio [OR], 0.51; P = 0.053) was reduced in female versus male CRT patients, whereas CV death, HFH, or all-cause death with worsening HF or HFH did not differ significantly. No difference was seen in CRT patients for all-cause death and worsening HF (OR, 1.32; P = 0.46) among white vs black patients or for all-cause death and HFH (OR, 1.19; P = 0.55) among ≥ 65 versus < 65 years. Conclusions Whereas all-cause death was lower in female CRT patients, other reported outcomes did not significantly differ by sex, race, or age. Only 6 studies partially reported outcomes. Thus, enhanced reporting and analyses are required to overcome such paucity of data to evaluate the impact of these factors on clinical outcomes in distinct patient cohorts with CRT indication.
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Affiliation(s)
- Bradley McKay
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | | | - Hassan I Sheikh
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Mohammad K Syed
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Maureen Pakosh
- Library & Information Services, University Health Network, Toronto, Ontario, Canada
| | | | - Abhinav Sharma
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Tracey J F Colella
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.,Lawrence S. Bloomberg Faculty of Nursing, Faculty of Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Kaja M Konieczny
- Department of Cardiology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Kim A Connelly
- Department of Cardiology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Michelle M Graham
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Michael McDonald
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Laura Banks
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada.,KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Varinder Kaur Randhawa
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Johnston A, Tseung V, Dancey SR, Visintini SM, Coutinho T, Edwards JD. Use of Race, Ethnicity, and National Origin in Studies Assessing Cardiovascular Risk in Women With a History of Hypertensive Disorders of Pregnancy. CJC Open 2021; 3:S102-S117. [PMID: 34993440 PMCID: PMC8712581 DOI: 10.1016/j.cjco.2021.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/10/2021] [Indexed: 11/06/2022] Open
Abstract
Women with a history of hyperBtensive disorders of pregnancy (HDP) are at particularly high risk for cardiovascular disease (CVD) and CVD-related death, and certain racial and ethnic subpopulations are disproportionately affected by these conditions. We examined the use of race, ethnicity, and national origin in observational studies assessing CVD morbidity and mortality in women with a history of HDP. A total of 124 studies, published between 1976 and 2021, were reviewed. We found that white women were heavily overrepresented, encompassing 53% of all participants with HDP. There was limited and heterogeneous reporting of race and ethnicity information across studies and only 27 studies reported including race and/or ethnicity variables in at least 1 statistical analysis. Only 2 studies mentioned the use of these variables as a strength; several others (k = 18) reported a lack of diversity among participants as a study limitation. Just over half of included articles (k = 68) reported at least 1 sociodemographic variable other than race and ethnicity (eg, marital status and income); however, none investigated how they might have worked synergistically or antagonistically with race and/or ethnicity to influence participants' risk of CVD. These findings highlight significant areas for improvement in cardiovascular obstetrics research, including the need for more robust and standardized methods for collecting, reporting, and using sociodemographic information. Future studies of CVD risk in women with a history of HDP should explicitly examine racial and ethnic differences and use an intersectional approach.
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Affiliation(s)
- Amy Johnston
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Brain and Heart Nexus Research Program, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Victrine Tseung
- Brain and Heart Nexus Research Program, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Sonia R. Dancey
- School of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Sarah M. Visintini
- Berkman Library, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Thais Coutinho
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Canadian Women’s Heart Health Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jodi D. Edwards
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Brain and Heart Nexus Research Program, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- IC/ES, Ottawa, Ontario, Canada
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