Table 2 Investigation of included studies using the intersectionality research integration identification framework

Baskaran & Hauser (2022)

[50]

People who identify as LGBQTI + 

Group highly intersectional including LGBQTI + , gender, socio-economic status (SES), religion, culture, environment

Not articulated

Only identified as a theme in findings

Participants identified their various marginalised

identities as simultaneously oppressive. Recognised reductionist interventions don’t validate individual & group needs related to their “complex intersectionality” (p. 7)

Not identified

Urged discrimination & inequity to be seen as symptoms of social & structural injustice. Palliative care embodies, “whole person” & hospice care. Opportunity to palliate symptoms of inequity

Not identified

Dworzanowski-Venter, B. (2017) [51]

South

African black male caregivers

Class, race,

professional status, gender norm, SES

To understand lived experience of black male caregivers. Recognised socially created separation in gender norms related to work

Integrated in

theory framework research question, design, analysis & findings

Linked colonisation to understanding of masculinity. Recognised dominant masculinity hegemony is based on a values status of professional work & associated financial prowess. Sees conflict between abstract of masculinity & reality

Dynamic nature of

intersectionality which connects structured oppression & marginalization. An increase in status of one identity does not neutralize oppression in other identities

Recognised

revolutionary potential—real change only possible when intersecting oppressions are unmasked & challenged

In background & rationale. Identified all self-knowledge is shaped by contextual location. Reflexivity alone cannot ameliorate white privilege. Asks if white feminist authors be sufficiently disruptive

Giesbrecht et al. (2012) [52]

Female family caregivers

Emerged in coding & analysis. Included culture, gender, geography, life course stage, material resources

Compassionate Care Benefit (CCB) is an attempt to lessen family caregiver burden – limited uptake. Diversity is often ignored in health policy & patterns of inequity are not recognised

Part of a larger study, so not an original objective. Not included in research question (focus on diversity). Used critical diversity analysis informed by intersectionality

Conveyed women are not a homogenous group. This leads to a variety of caregiving experiences (including diversity in vulnerability & inequity). Caregiving results in gendered inequity & overlap with other social location factors

Considered simultaneous interactions between different aspects of social identity, as well as the impact of systems & processes of oppression & domination

Identified CCB is not working for some. Explored the differing social/physical locations which informed the under-utilization of the benefit. Intersectionality theory a foundation for pursuit of social justice & addressing inequity

Not articulated

Giesbrecht et al. (2018) [53]

People who experience structural vulnerability

Race/ethnicity, SES, mental health issues, disability

Accepted all people at the end-of-life experience vulnerability, this is significantly amplified for people who also experience structural vulnerability

Applied in analysis to understand how differing lived experiences shape access to care for structurally vulnerable populations

Concerned with simultaneous interactions between aspects of social difference & identity

Systemic forms of oppression (e.g., racism & ableism) interact in complex ways; includes equitable distribution of resources

To inform those in power ways of directly impacting policy, practice, & system change for equitable access to palliative care for most vulnerable population groups

Not discussed

Giesbrecht et al. (2015) [54]

Palliative family caregivers

Social networks, education, employment status, geographic location of residence, housing status, life course stage

Used case studies to show the unique lived experience of palliative family caregivers. Identified that the multiple variables connected & interacted in specific contexts as important

Secondary analysis from a larger study—not an original objective. Utilised as a lens to identify aspects of socio- environmental context

Acknowledged human lives can’t be reduced to a singular category/social location. Real lived experience is more complex. Family caregiver resilience, stress, burden & burnout is shaped by socio-environmental factors & experienced differently within this group

Explored concurrent interactions of unitary categories & social locations. The combined impacts of multiple social locations & structural processes create & perpetuate health inequities

Not explicit—provided commentary about heterogeneity (including socio-environmental aspects) for this group means nurses can enhance family caregivers’ individual capacities to be resilient & identify vulnerability

Not articulated

Hutson (2016)

[55]

People diagnosed with HIV/AIDS

HIV/AIDS diagnosis, sexual orientation, location of residence, religion, ethnicity

Not articulated

Only identified in findings

Participants intersecting identities seen as sources of stigma, discrimination & oppression. Often leads to social isolation. Author found difficulty identifying stigma relating to singular identity or characteristic e.g. if related to disease/sexuality/ethnicity

Not undertaken

Recognised importance for healthcare providers to understand pervasive nature of stigma & how this impacts on advance care planning & end-of-life care

Not discussed

Liu et al. (2020) [56]

Caregivers for people diagnosed with dementia

Caregiving, gender, race, ethnicity & other socio-demographic factors

To examine the dementia caregiving burden related to multiple ascribed identities & the multidimensionality of caregiving burdens

Integrated in research question, methodology, analysis & discussion

Multidimensional burdens for dementia caregivers aren’t experienced evenly by gender or by racial/ethnic groups. Influenced by differing experiences, interpretation of stressors & coping mechanisms

Identified intersectionality provides opportunity to assess the inter-connections relevant to use of power. Did not undertake power analysis within study

General statements made about need for policy change to reflect & address current inequities

Not articulated

Stajduhar et al. (2019) [57]

People who experience structural vulnerability

Group defined as highly intersectional

Barriers to palliative care likely amplified for people who are structurally vulnerable. Positionality for structurally vulnerable changes in response to external forces (e.g. policy reform)

In definition of structural vulnerability & analysis to explore the complex, concurrent & interdependent interactions between types of social difference & identity

Whilst living in poverty, people may also experience homelessness & racism, trauma, violence, social isolation, stigma related to mental health, cognitive impairment, substance use, behavioural & mobility issues, interactions with criminal-justice system &/or disability

Explored complex, simultaneous & interdependent interaction between types of social difference, identity & forms of systemic oppression (e.g. sexism, racism, ableism) at micro & macro scales

Critical theoretical perspectives of equity & social justice utilised

Engaged in reflexivity during the observations by research staff within the field notes, which included their thoughts about the observation itself, possible influences impacting on the observation & anything of note for future observations

Suntai et al. (2023) [58]

Black American People, women

Race & gender

Considers how race & gender interact to impact on quality of end of life care

Used as theoretical framework underpinning study. Analyses aimed to see intersectional effects

Recognised identity complexity in background. Considered income, post-secondary education in analyses. Not reflected on in discussion

Not identified

Found interpersonal discrimination as a factor in findings. Considered changes in healthcare that are needed – not explicit re social justice aims

Not discussed

Wilson et al. (2018) [59]

People who identify as LGB

Age, gender identity, sexual orientation

Not articulated within methodology

Issues of intersectionality articulated in abstract & discussion

Recognised significant heterogeneity in ageing people. Age, gender identity & sexual orientation seen as non-modifiable determinants. Emphasised need for the intersections of these identities to be further understood

Not identified

Understanding intersectionality is crucial to facilitate inclusive health systems that support positive aging experiences & good end-of-life care

Not discussed