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]