Palliative Care for People Who Use Substances During Communicable Disease Epidemics and Pandemics: A Scoping Review

ABSTRACT

Background/aims: Communicable disease epidemics and pandemics magnify the health inequities experienced by marginalized populations. Given the pre-existing inequities to palliative care access for people with life-limiting illnesses who use substances, it is important to understand the impact of communicable disease epidemics and pandemics COVID-19 on this population. A scoping review was conducted to answer the research question, “what is known about communicable disease epidemics and pandemics, palliative care and people who use substances?” Methods: We conducted a scoping review of seven bibliographic databases from the inception of each database to April 2021. We also performed a grey literature search to identify the publications not indexed in the bibliographic databases in August 2020 and June 2021. We extracted quantitative data using a standardized data extraction form and summarized it using descriptive statistics. Additionally, we conducted thematic qualitative analyses and presented our findings as narrative summaries. Results: Included in our review were 54 records published between 1988 and 2021, of which 18 (33.3%) were peer-reviewed articles. The majority of reported populations were people with advanced HIV (n = 39, 72.2%) who use alcohol (n = 25, 46.3%) during HIV (n = 40, 74.1%) and COVID-19 (n = 15, 27.8%) outbreaks. Palliative care outcomes were heterogeneous but fell into four themes 1) intervention (e.g., symptom management), 2) access (e.g., financial barriers), 3) clinical program (e.g., interdisciplinary collaboration), and 4) policy/guideline (e.g., drug regulations). Conclusions: Strategies and interventions can be implemented during communicable disease outbreaks to promote equitable access to palliative care by people who use substances.