PP-33 The privilege of being listened to: a different perspective on social disadvantage and privilege at the end-of-life

<h3>Introduction</h3> Disparities in access to quality palliative and end-of-life care continue to persist based on ethnicity, disability, poverty, gender and sexuality. Work to explain or address this health inequity focuses on characteristics of the individual experiencing the disadvantage or structural factors. This has led us to overlook the role of relationships and conversations between health professionals, patients and families. Yet, research with people who are disadvantaged consistently reports frustration and distress associated with not being listened to or taken seriously by healthcare providers. <h3>Aims</h3> To explore how professionals’ acknowledgment of patient and family expertise shapes their care, and access to treatments and services. <h3>Methods</h3> Using examples from the literature and Cognitive Authority Theory, we examine the implications of health professionals’ judgements of expertise for care access, experience, involvement and appropriateness. <h3>Results</h3> We explain how people who are socially disadvantaged have fewer resources to exploit during consultations with health professionals and this means they find it more difficult to have their voices heard, their choices prioritised by others, and to express their expertise. We explore the role of unconscious bias in reinforcing existing health inequities as well as discuss how social privilege shapes experience of palliative and end-of-life care and plays an important role in maintaining health inequity. <h3>Conclusion</h3> Although there are important international and cultural differences in decision-making models, preferences for involvement in care, and availability of resources; the desire to be acknowledged and listened to transcends cultural borders and impacts care experience and access. We provide avenues to expose and describe epistemic injustice associated with a failure to recognise patient and family/caregiver expertise. <h3>Impact</h3> We make tangible recommendations for how Cognitive Authority Theory can be used to question practice and design research to address some of the limiting factors experienced by those who are structurally vulnerable. <h3>Reference</h3> Hunt KJ, May CR. Managing expectations: cognitive authority and experienced control in complex healthcare processes. <i>BMC health services research</i> 2017;<b>17</b>:1–13.