Cognitive authority theory: reframing health inequity, disadvantage and privilege in palliative and end-of-life care
Cognitive authority theory: reframing health inequity, disadvantage and privilege in palliative and end-of-life care
Background: there persist disparities in access to quality palliative and end-of-life care, often based on avoidable injustice. Research and theory to explain this health inequity focuses on structural or individual-based factors, overlooking important relational factors between health professionals, patients and families.
Aim: to apply Cognitive Authority Theory in palliative and end-of-life care to explain neglected relational drivers of inequity in access and experience.
Methods: cognitive Authority Theory, a middle-range theory of power relations between individuals and authority over knowledge, was developed from empirical and review data. This paper demonstrates its utility in explaining an overlooked component of inequity in palliative care: interactions between health professionals and patients/caregivers.
Results: using examples from the palliative care literature, we characterise how people who are socially disadvantaged have fewer resources to exploit during consultations with health professionals which makes it difficult for them to have their voices heard, their choices prioritised by others, and to express their expertise. We examine the implications of health professionals’ judgements of expertise for care access, experience, involvement and appropriateness. We offer a fresh perspective on the mechanisms by which stereotypes, bias and power imbalances between health professionals and patients reinforce existing health inequities, drawing on the role of social privilege in shaping inequity in palliative care.
Conclusion: this paper provides a new language to articulate relational drivers of inequity in palliative care. It explains how to use Cognitive Authority Theory to design and interpret research to determine how healthcare interactions reinforce both social privilege and social disadvantage at end-of-life.
Cognitive Authority Theory, Theoretical models, health inequalities, health inequities, palliative care, social disadvantage in health, social privilege, unconscious bias
448-459
Hunt, Katherine J.
5eab8123-1157-4d4e-a7d9-5fd817218c6e
May, Carl R.
b72849ad-c1b0-41bd-a44b-d170aa78b953
April 2025
Hunt, Katherine J.
5eab8123-1157-4d4e-a7d9-5fd817218c6e
May, Carl R.
b72849ad-c1b0-41bd-a44b-d170aa78b953
Hunt, Katherine J. and May, Carl R.
(2025)
Cognitive authority theory: reframing health inequity, disadvantage and privilege in palliative and end-of-life care.
Palliative Medicine, 39 (4), .
(doi:10.1177/02692163251321713).
Abstract
Background: there persist disparities in access to quality palliative and end-of-life care, often based on avoidable injustice. Research and theory to explain this health inequity focuses on structural or individual-based factors, overlooking important relational factors between health professionals, patients and families.
Aim: to apply Cognitive Authority Theory in palliative and end-of-life care to explain neglected relational drivers of inequity in access and experience.
Methods: cognitive Authority Theory, a middle-range theory of power relations between individuals and authority over knowledge, was developed from empirical and review data. This paper demonstrates its utility in explaining an overlooked component of inequity in palliative care: interactions between health professionals and patients/caregivers.
Results: using examples from the palliative care literature, we characterise how people who are socially disadvantaged have fewer resources to exploit during consultations with health professionals which makes it difficult for them to have their voices heard, their choices prioritised by others, and to express their expertise. We examine the implications of health professionals’ judgements of expertise for care access, experience, involvement and appropriateness. We offer a fresh perspective on the mechanisms by which stereotypes, bias and power imbalances between health professionals and patients reinforce existing health inequities, drawing on the role of social privilege in shaping inequity in palliative care.
Conclusion: this paper provides a new language to articulate relational drivers of inequity in palliative care. It explains how to use Cognitive Authority Theory to design and interpret research to determine how healthcare interactions reinforce both social privilege and social disadvantage at end-of-life.
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hunt-may-2025-cognitive-authority-theory-reframing-health-inequity-disadvantage-and-privilege-in-palliative-and-end-of
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Accepted/In Press date: 28 January 2025
e-pub ahead of print date: 26 February 2025
Published date: April 2025
Keywords:
Cognitive Authority Theory, Theoretical models, health inequalities, health inequities, palliative care, social disadvantage in health, social privilege, unconscious bias
Identifiers
Local EPrints ID: 499470
URI: http://eprints.soton.ac.uk/id/eprint/499470
ISSN: 0269-2163
PURE UUID: 09e41087-32cd-45c7-b85b-56a9de6317fb
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Date deposited: 20 Mar 2025 18:18
Last modified: 11 Sep 2025 02:29
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Author:
Carl R. May
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