Unmet Needs of Transgender and Gender-Diverse Adults With Serious Illness Receiving Hospice and Palliative Care: A Thematic Scoping Review

BackgroundTransgender and gender-diverse individuals experience higher mortality rates and elevated incidence of serious illness compared to cisgender populations. Despite these disparities, discrimination and stigma continue to create barriers to high-quality hospice and palliative care.AimsThis scoping review identified the unmet needs of gender-diverse adults receiving hospice and palliative care in the United States.MethodsFollowing PRISMA-ScR guidelines, we systematically searched seven databases between May and June 2025. Inclusion criteria required: English-language publications from US settings, exclusive focus on gender-diverse adults, and examination of unmet needs in serious illness, hospice, or palliative care contexts. Two reviewers independently screened titles, abstracts, and full texts.ResultsFive publications met eligibility criteria. A descriptive thematic analysis identified four categories of unmet needs: (1) competent healthcare professionals with gender-affirming training; (2) holistic, inclusive care delivery models; (3) family and chosen family engagement protocols; and (4) protective institutional policies and legal frameworks. Critical limitations include a small sample size; predominance of healthcare professional perspectives rather than transgender patient voices; reliance on descriptive and narrative-based approaches; and absence of intersectional analyses examining race, class, and disability.ConclusionsThis review exposes substantial under-resourcing of research on gender-diverse patients' end-of-life needs. Urgent priorities include systematic competency training for hospice and palliative care professionals, development of evidence-based clinical guidelines, advocacy for protective legal frameworks, and most critically, conducting robust qualitative and quantitative research centering transgender patients' lived experiences and priorities in serious illness care.