Table 1.

Action guidance on addressing racist and casteist policy and power structures that impact access to palliative care and pain relief

Aim	Action (across the serious illness continuum)
Redistribute power	► Transform decision-making processes that drive health systems, including PC, to be inclusive of, partnered with and driven by marginalised and racialised communities
	► Disincentivise interpersonal practices at the point of PC provision that perpetuate imbalanced power dynamics
	► Recognise and disassemble legacy-oriented positioning of policy-makers, providers and other stakeholders who currently hold a disproportionate level of power
	► Invest in sustainable community-based partnerships led by racially minoritised populations that honour them as the experts in their needs, preferences, goals and care delivery
	► Support recruitment, education and inclusion of interdisciplinary PC specialists from minoritised communities to promote patient-clinician ethnic, racial and cultural concordance and to diversify the health and social care clinical workforce
Adopt antiracist and anticasteist policies	► Prioritise training of individuals from marginalised and racialised communities in PC research and scholarship to effectively decolonise definitions of suffering and recentre its alleviation based on the lived experiences of BIPOC
	► Develop and execute ethical, empirical, and implementation frameworks for PC grounded by antiracist and anticasteist ideas and ideals
	► Create pathways for naming and dismantling interpersonal, institutional, systemic, and structural racism and repairing relational integrity in given contexts
	► Ensure clinicians are equipped with training in cultural humility and competence to support the provision of culturally safe PC for BIPOC and their family caregivers during serious illness, dying and death and bereavement
	► Fund community-based participatory approaches to enable social justice, foster long-term collaboration and mutual trust, address community-specific PC needs, and guide PC science through the lens of community values, preferences, goals and priorities

BIPOC, Black, Indigenous and People of Colour; PC, palliative care.