Table 4.

Recommendations for improving services made in the reviews

○ Strategic planning of services to ensure equity of provision [27,28]

○ End-of-life care provision for non-malignant diseases [21,25]

○ Training regarding services and the referrals pathway for physicians who are not palliative care or cancer specialists [21,26-28]

○ Recruitment of staff from minority ethnic groups and the implementation of equal opportunity policies [21,25,29]

○ Provision of interpretation and advocacy services [25-28,30]*

○ Training of interpreters and advocates in EoL care issues [25]

○ Awareness raising of services among minority ethnic groups using appropriate methods [21,28,30]*

○ Provision of information concerning services in appropriate languages and formats [25-28]

○ Discussion of place of death preferences [25,30]*

○ Understanding that a preference for home care should not be assumed and that all options must be explained [29]

○ Support for carers [25]

○ Understanding of the EoL care needs in care homes [28,29]

○ Attendance of religious and spiritual needs, preferably by a multi-faith chaplaincy service [25]

○ The provision of space and time for religious practices to be carried out [30]*

○ The provision of special dietary requirements on a case by case basis [25]

○ Make care homes and hospices more welcoming [29,30]*

○ Involvement of minority ethnic groups in the planning of services and outreach [23,25,28]

○ Recognition that categorising people by ethnicity alone can lead to stereotyping [20,24,30]*

○ Recognition that cultural needs form only one part of an individual's EoL needs [19,20,24,28,30]*

○ Sensitivity regarding the involvement of patients' families in decision-making and disclosure [19,20,22,25]

○ Training in care that is sensitive to cultural difference [23-25,28,29,48]

○ Training in: communication issues (verbal and non-verbal) [19,24-26]; the use of interpreters [25]; awareness of the multiple disadvantages faced by minority ethnic groups [20,24,28]; information concerning 'attitudes, values, beliefs and norms' of minority ethnic groups [22]; and, countering the belief that services are unsuitable for minority ethnic groups [21,23]

○ Training at under-graduate and post-graduate level [25] and to both generalists and specialists [27]

○ Extra funding for training, interpretation and awareness raising [28]

○ Rigorous ethnic monitoring of service users and services reviewed using data [20,23,25,26,29,30]*

○ Tackling of racism[19,23,25,28]

* Recommendations made in the End-of-Life Care Strategy: Equality Impact Assessment [30].