Inequities in conceptualisations of ‘family’ within national palliative and end-of-life care policies: Document analysis of policy guidance

BACKGROUND: Policy across public sectors has been criticised for its prioritisation of family-norm structures that exclude a wealth of family practices. Despite calls for equity in palliative and end-of-life care, there is evidence that bias against LGBTQ+ communities persists in clinical practice. Achieving equitable practice necessitates critical examination of how key policy guidance acknowledges diverse family structures and relationships. AIM: To identify explicit and implicit conceptualisations of 'family' in UK palliative and end-of-life care policies, consider whether and how definitions may reinforce family-norm discourse, and determine implications for clinical practice and policy. DESIGN: A critical discourse analysis of current UK policy guidance in palliative and end-of-life care was conducted. DATA SOURCES: National policy documents applicable to England, Scotland and Wales were identified through expert consultation and national organisations' webpages. Inclusion criteria were: palliative care specific documents, written or revised between 2019 and 2025. RESULTS: 19 documents were included, mainly published between 2015 and 2025. Results showed that palliative and end-of-life care policies reinforce exclusionary family-norm discourse through an emphasis on nuclear family structures. Some policies acknowledge family as existing in wider interdependent care networks, such as community, and the role of services in enabling these care networks. CONCLUSIONS: Policies' reinforcement of family-norm discourse may contribute to inequities identified in broader research. Policymakers should consider adopting a definition of family that centres family practices rather than genetic or legal relationship structures. Further research into community approaches to palliative and end-of-life care for LGBTQ+ and other marginalised groups is needed.