IntroductionPeople who are homeless or vulnerably housed are subject to disproportionately high risks of physical and mental illness and are further disadvantaged by difficulties in access to services. Research has been conducted examining a wide range of issues in relation to end-of-life care for homeless and vulnerably housed people, however, a contemporary scoping review of this literature is lacking.ObjectivesTo understand the provision of palliative care for people who are homeless or vulnerably housed from the perspective of, and for the benefit of, all those who should be involved in its provision.DesignScoping review with thematic synthesis of qualitative and quantitative literature.Data sourcesMEDLINE, Embase, PsycINFO, Social Policy and Practice and CINAHL databases were searched, from inception to May 2020. Citation chasing and manual searching of grey literature were also employed.ResultsSixty-four studies, involving 2117 homeless and vulnerably housed people were included, with wide variation in methodology, population and perspective. The thematic synthesis identified three themes around: experiences, beliefs and wishes; relationships; and end-of-life care.ConclusionDiscussion highlighted gaps in the evidence base, especially around people experiencing different types of homelessness. Existing evidence advocates for service providers to offer needs-based and non-judgemental care, for organisations to use existing assets in co-producing services, and for researchers to address gaps in the evidence base, and to work with providers in transforming existing knowledge into evaluable action.
eg renal function and weight), are important for safe prescribing.These results have influenced the content of a regional guideline to enable healthcare professionals to make effective, evidence-based and patient-centred decisions about anticoagulation in patients with a life-limiting illness.
Warren, et al., 2021, Nursing Times. 117: 34) and developed for the Palliative and End of Life Care module as part of the Post Qualifying programme.Evidence shows us that people with learning disabilities experience extensive health inequalities which impacts on mortality (Heslop et al., 2013; NIHR, 2020). In addition, the quality of palliative care received by this group can contribute to poorer outcomes that are often avoidable (Hospice UK, 2021). Using suitable methods of communication to impart information in a format that allows for deeper understanding opens potential for greater quality of life and expectancy (Heslop et al., 2013; NIHR 2020). Aim To practice the skill of 'Breaking Bad News' to people with learning disabilities, by using actors in simulated patient scenarios. Methods On MS Teams in small groups, with a facilitator, to engage all learners in an interactive, authentic and safe experience with an actor. Varied scenarios were used to demonstrate breaking bad news to a person with learning disabilities. Results Reflective evaluative feedback from students demonstrate a deeper confidence in breaking bad news. This included a perceived lessening of anxiety when involved in discussing Breaking Bad News in practice generally after being involved with simulation. Confirmation of online simulation as a valuable practical skills-based learning experience. Conclusion This is now embedded in the Post Qualifying Introduction to Palliative and End of Life Care module and is applicable to a wider workforce approach including practitioners both generalist and those working within Learning Disabilities and End of Life Care. This is a focus of co-author doctorate studies.
Conclusion There is clearly a need for greater awareness of the pharmacology in symptom control in end-stage liver disease. As a result of this study, peer-reviewed clinical standards and guidelines are being formulated for the management of specific symptoms related to end-stage liver disease to provide standardised care across the network.
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