Gender disparities in end-of-life care: A scoping review of patient, caregiver and care provider perspectives in low-and middle-income countries.

Abstract

Background: The term "end-of-life" care refers to the physical, social, spiritual, and emotional assistance provided to people near the end of their lives. Throughout history, gender has profoundly impacted many of the decisions people make. Studies have shown an increased demand for palliative care worldwide, which varies significantly among low-and middle-income countries. Achieving universal health coverage requires everyone to have access to health care where and when they need it, irrespective of gender. This scoping review aims to map the evidence available on the gender disparities in end-of-life care in low-and middle-income countries, considering the perspectives of patients, caregivers, and care providers.

Methodology: A comprehensive search was done for the review in the following databases: PubMed, Embase, Scopus, Web of Science, ProQuest, and Cumulative Index to Nursing and Allied Health Literature. The World Health Organization's definition of gender was the inclusion standard. Studies conducted in low-and middle-income countries were included. Only articles published between 2005 and 2024 were retained. Articles on sexual minorities were excluded.

Results: Eight articles were selected for the review and the descriptive analysis was done, followed by a thematic analysis to synthesize the available data into themes. The themes identified based on the patient's perspectives were end-of-life preferences, challenges, and perceptions towards caregiving. Care provider perspectives included attitude toward euthanasia and perception towards care provision, while caregiver perspectives involved perceptions of caregiving and challenges. Gender disparities were evident across all perspectives, with women being disproportionately affected.

Conclusion: The review identified significant gender disparities in different aspects of end-of-life care. Women often experience a greater caregiving burden and higher risks of emotional, physical, and sexual violence, while men encounter societal stigma in caregiving roles. Addressing these disparities is required to ensure equitable and inclusive EOL care. Further research should be done in this direction to identify the influence of gender on end-of-life care and how it interacts with other factors like culture, religion, socio-economic status, and education to inform policies that promote gender-sensitive end-of-life care.