Assessing research methodologies used to evaluate inequalities in end-of-life cancer care research: a scoping review protocol.

INTRODUCTION: To provide equitable cancer care at the end of life, it is essential to first understand the evidence underpinning the existence of unequal cancer outcomes. Study design, measurement and analytical decisions made by researchers are a function of their social systems, academic training, values and biases, which influence both the findings and interpretation of whether inequalities or inequities exist. Methodological choices can lead to results with different implications for research and policy priorities, including where supplementary programmes and services are offered and for whom. The objective of this scoping review is to provide an overview of the methods, including study design, measures and statistical approaches, used in quantitative and qualitative observational studies of health equity in end-of-life cancer care, and to consider how these methods align with recommended approaches for studying health equity questions. METHODS AND ANALYSIS: This scoping review follows Arksey and O'Malley's expanded framework for scoping reviews. We will systematically search Medline, Embase, CINAHL and PsycINFO electronic databases for quantitative and qualitative studies that examined equity stratifiers in relation to end-of-life cancer care and/or outcomes published in English or French between 2010 and 2021. Two authors will independently review all titles, abstracts and full texts to determine which studies meet the inclusion criteria. Data from included full-text articles will be extracted into a data form that will be developed and piloted by the research team. Extracted information will be summarised quantitatively and qualitatively. ETHICS AND DISSEMINATION: No ethics approval is required for this scoping review. Results will be disseminated to researchers examining questions of health equity in cancer care through scientific publication and presentation at relevant conferences.

Access to cancer care among Indigenous peoples in Canada: A scoping review.

The inequities in access to healthcare documented and experienced by Indigenous peoples in Canada are startling given Canada's publicly funded and 'equally accessible' healthcare system, however little is known about access to cancer care, and barriers to accessing cancer care in particular. We conducted a scoping review to identify what is known about barriers to accessing cancer care among Indigenous peoples in Canada (including barriers to accessing cancer services, and barriers to receiving optimal care once those services were accessed), and to identify where along the cancer continuum (screening, diagnosis, treatment, etc.) these barriers are located. We searched SCOPUS, EBSCOhost, Google Scholar, Ovid MEDLINE and Ovid EMBASE for studies published between 1996 and 2019 that examined access to cancer care for Indigenous peoples in Canada; 36 studies were included in our analysis. Our review indicates that Indigenous peoples face barriers to accessing care at the individual level (factors at the level of the individual patient or healthcare provider (HCP) that impede access to cancer care), at the systems level (factors stemming from the healthcare system and its structure), and at the structural level (factors that are embedded within and systematically produced political, historical, social or economic structures). While barriers to accessing cancer care were found throughout the trajectory, there remains a disproportionate focus on access to cancer screening. Moreover, some barriers to accessing cancer care, such as racism, discrimination and lack of culturally safe care, although rooted in structural factors, were inconsistently framed as individual and/or systems factors. This suggests that while there is growing awareness of the impact that racism and discrimination have on access to cancer care at the individual level for example, there remains a lack of understanding of how these issues are linked with systemic and structural issues.