Factors shaping Eastern European communities’ access to and engagement with palliative and end-of-life care: a scoping review

Background
Persistent inequalities in access to and engagement with palliative and end-of-life care remain a significant challenge for many ethnic minority and migrant populations across the United Kingdom, despite sustained policy commitments to delivering equitable, person-centred care. With an ageing population and growing prevalence of chronic, life-limiting conditions, demand for palliative and end-of-life care continues to increase, making the reduction of inequalities in access an increasingly urgent healthcare priority. Migrant communities often encounter distinct barriers to accessing and engaging with palliative and end-of-life care services, including challenges related to language, communication and cultural differences. These issues are particularly relevant for Eastern European populations, who constitute one of the largest migrant populations in the United Kingdom, yet their experiences of palliative and end-of-life care remain underexplored. Existing research frequently aggregates ethnic minority populations, obscuring factors that shape engagement within specific communities and limiting opportunities to develop more equitable, person-centred care. To address this evidence gap, this review explored both barriers and facilitators influencing Eastern European populations’ access to and engagement with palliative and end-of-life care, addressing the question: What factors influence Eastern European populations’ access to and engagement with palliative and end-of-life care services?

Methods
This scoping review followed the Arksey and O’Malley framework, with additional guidance from the Joanna Briggs Institute and was reported in accordance with PRISMA-ScR. The review searched multiple databases and grey literature sources. Studies were screened using predefined Population, Concept, Context eligibility criteria and synthesised the data using a combined Socio-EcologicalModel and Systems Approach framework.

Results
Forty-one papers met the inclusion criteria, covering Eastern European populations across diverse international settings. Both barriers and facilitators to access and engagement were identified across all levels of the Socio-Ecological Model, including individual beliefs and knowledge, interpersonal relationships, organisational practices, community norms, and wider structural and policy influences. These factors were shown to interact in complex ways, shaping individuals’ experiences of palliative and end-of-life care.

Conclusions
Access to and engagement with palliative and end-of-life care among Eastern European populations is shaped by interconnected individual, interpersonal, organisational and structural influences. Addressing these multi-level factors is essential for developing and delivering person-centred care in practice and to inform policy and service development.