Access to hospice care and socioeconomic position : A multiple case study

French, Madeleine and Preston, Nancy and Keegan, Thomas and Giorgi, Emanuele (2021) Access to hospice care and socioeconomic position : A multiple case study. PhD thesis, Lancaster University.

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Abstract

Background: There have long been concerns that some people who could benefit from hospice care do not access it, including those living in socioeconomically disadvantaged circumstances. There is uncertainty about the extent of socioeconomic inequities in accessing hospice care in UK settings, and little evidence about the factors influencing access. Aim: This study examines how socioeconomic position is related to access to hospice care in the UK. It aims to explore the association between hospice referrals and area social deprivation, and the factors influencing how healthcare professionals generate, and respond to, hospice referrals in the context of social deprivation. Methods: Taking a multiple case study approach, this study includes analysis of data from hospice referral records and interviews with healthcare professionals caring for people at the end of life. Generalised linear modelling and thematic analysis are used to explore access to hospice care in three different cases, each located in North West England, before comparing findings in a cross-case analysis. Findings: The relationship between social deprivation and access to hospice care in each case was underpinned by how hospices adapted to the local organisational and population context. Social deprivation was not statistically significantly associated with hospice referral rates, but healthcare professionals described challenges and tensions when supporting some patients in the most socially deprived areas. Good working relationships with hospitals may have facilitated hospice referrals of patients from the most socially deprived areas. Conclusion: Hospice care in the UK can be organised in ways that facilitate referrals of patients from the most socially deprived areas. This study encourages an understanding of equitable access that goes beyond referrals to consider how access to hospice and other end-of-life care is continuously generated through interactions between healthcare professionals and patients.