Palliative and Supportive Care

Special Section: Vulnerability and Palliative Care

Palliative care for vulnerable populations

Deborah Stienstraa1 c1 and Harvey Max Chochinova2

a1 Disability Studies, University of Manitoba, Winnipeg, Canada

a2 Department of Psychiatry, University of Manitoba, and Manitoba Palliative Care Research Unit, Cancer Care Manitoba, Winnipeg, Canada

Abstract

Objective: The purpose of this article is to identify how inclusive and accessible palliative care can be achieved for all, including those labelled as vulnerable populations.

Method: Drawing on a review of existing literature as well the research of the Vulnerable Persons and End-of-Life New Emerging Team (VP-NET), this article reflects on what changes can be made within palliative care to make it more inclusive.

Results: Experiences of marginalization often result, intentionally or unintentionally, in differential treatment in healthcare. This increased vulnerability may result from attitudes of healthcare providers or from barriers as a result of “normal” care practices and policies that may exclude or stigmatize certain populations. This may include identifying when palliative care is necessary, who receives palliative care and where, and what is necessary to complement palliative care.

Significance of results: Inclusive and accessible palliative care can become possible through building on the existing strengths in palliative care, as well as addressing existing barriers. This may include treating the whole person and that person's support team, including paid support workers, as part of the unit of care. It involves ensuring physically accessible hospice and palliative care locations, as well as thinking creatively about how to include those excluded in traditional locations. Inclusive palliative care also ensures coordination with other care services. Addressing the barriers to access, and inclusion of those who have been excluded within existing palliative care services, will ensure better palliative and end-of-life care for everyone.

(Received April 11 2011)

(Accepted June 23 2011)

Correspondence:

c1 Address correspondence and reprint requests to: Deborah Stienstra, Disability Studies, 128 Education Building, University of Manitoba, Winnipeg, MB Canada R3T 2N2. E-mail: harvey.chochinov@cancercare.mb.ca