Bearing Witness: Exploring the End-of-Life Needs of Homeless Persons and Barriers to Appropriate Care

West, Keri J.; B, Wrobel; Pallotta, Stefania; A, Coatsworth

doi:10.1177/0030222818801150

Cited by 18 publications

(22 citation statements)

References 62 publications

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“…1 Socially vulnerable individuals are often unable to access health care, including medication coverage and/or access to affordable, appropriate housing. 9 , 10 The CAMPP addresses these gaps, providing relevant and important care as evident in the findings.…”

Section: Discussionmentioning

confidence: 98%

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Extending Palliative Approaches to Care Beyond the Mainstream Health Care System: An Evaluation of a Small Mobile Palliative Care Team in Calgary, Alberta, Canada

Petruik

Colgan

2022

Palliative Medicine Reports

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Background: People experiencing houselessness (PH) endure worse health outcomes than their housed counterparts and often have inadequate care when nearing end of life. Innovative palliative care approaches are necessary when considering socially vulnerable populations. Aim: Evaluate the implementation and early outcomes of the Calgary Allied Mobile Palliative Program (CAMPP) after the first four years of servicing people experiencing extreme social marginality. Setting/Participants: Participants include CAMPP clients and service providers (SPs) who work adjacently to CAMPP in the social services/health sectors. Design: This is a mixed-methods evaluation, including an SP survey ( n = 31); client interviews ( n = 5); collection of program metrics; and case note reviews. Results: The CAMPP has served 128 clients to date. The CAMPP supported clients by connecting them to 62 services, programs, agencies, and/or resources totaling 485 connections. The most referred-to resource was for social support in the community for PH at 61 referrals. The second was for transportation with 57 referrals, followed by referrals to palliative and Home Care programs ( n = 53 referrals). Another common referral was for food assistance with 30 referrals. The survey showed that 97% of SPs agreed that CAMPP is “an essential service in the area of palliative care.” Twenty-six of 30 (87%) “Strongly Agreed” or “Agreed” that their knowledge in working with people with life-limiting illnesses has improved since working with CAMPP. The SPs suggested that the team should focus on referral clarity and improved communication with the wider health care team. Finally, clients reported high levels of satisfaction with CAMPP services. Clients also reported challenges navigating the complexity of care in the social/health services sector. Conclusions: The CAMPP bridges the gap in care between health/social services. The CAMPP connects clients to community resources and is effective in adapting to client needs. This evaluation provides four recommendations to improve and build on the existing program.

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Section: Discussionmentioning

confidence: 98%

“…These connections are crucial for PH with life-limiting illness since traditional models of palliative care are largely inaccessible to them. 9 In Canada's universal health system, universality does not ensure health equity 3 and the CAMPP team addresses this by providing community-based care and liaising with other SPs. 3 …”

Section: Discussionmentioning

confidence: 99%

Extending Palliative Approaches to Care Beyond the Mainstream Health Care System: An Evaluation of a Small Mobile Palliative Care Team in Calgary, Alberta, Canada

Petruik

Colgan

2022

Palliative Medicine Reports

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“…Ondanks een significant lagere levensverwachting en gelijkaardige verwachtingen rond levenseindezorg als bij de algemene bevolking, dreigen personen met een ernstige (persisterende) psychiatrische aandoening toch niet dezelfde kwaliteit van zorg aangeboden te krijgen (5,11,21). De oorzaken uit de literatuur zijn wederom heel divers: verkokering van de zorg, (zelf)stigma, storend gedrag zoals verbale en fysieke agressie, dwalen, roepen, verzamelwoede, enz., onvoldoende middelen voor gespecialiseerde zorg zoals opleidingsmogelijkheden en gemeenschapswerking, laatdetectie, het ontbreken van een netwerk, communicatieproblemen en financiële beperkingen (5,11,12,14,15,(22)(23)(24)(25). Psychiatrische voorzieningen in België krijgen, in tegenstelling tot algemene ziekenhuizen, geen specifiek budget voor het uitbouwen van een team voor palliatieve ondersteuning.…”

Section: Besprekingunclassified

Omgaan met zorgweigering bij een persoon met een ernstige psychiatrische aandoening en een levensbedreigende ziekte: een casusbespreking

Moureau¹,

Tansens²,

Desimpele³

et al. 2023

Tijdschr Geneesk

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Dealing with refusal of care by patients with a severe psychiatric disorder in combination with a life-threatening condition: a case report Providing good care for persons with a severe psychiatric disorder in combination with a life-threatening condition is a major challenge for health care providers. By means of a case report, the authors analyze the situation of a 65-year-old woman with Korsakov’s disease, depressive symptoms and aplastic anemia. She refuses to be examined and treated, despite many efforts on the part of the caregivers and relatives, as well as the seriousness of the situation. The team has to switch from a curative to a palliative approach in a short space of time. Various areas of tension are assessed: appraising the decision-making capacity of the person requesting care, dealing with refusal of care in a life-threatening situation, and involving and coordinating the various parties concerned, including the psychiatric and somatic care providers, administrator and family. The case uniquely illustrates the challenges described in international literature and recent local studies. The authors plead for the importance of the liaison function between psychiatric and somatic care and the central role of the general practitioner associated with the psychiatric facility. The careful clarification of the legal capacity of the patient who refuses life-saving care, the added value of ethical consultation in order to come to a supported approach and to channel moral distress, and the involvement of a palliative support team within a psychiatric setting are also crucial elements in the approach.

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“…In addition, such care suffers from ethical issues surrounding decision-making and lack of resources, care-coordination and appropriate care-settings. Hence, creativity, consultation and education are needed [29][30][31][32][33]. These issues might account for PC for patients with SUD as well.…”

Section: (Continued From Previous Page)mentioning

confidence: 99%

Palliative care for patients with substance use disorder and multiple problems: a qualitative study on experiences of healthcare professionals, volunteers and experts-by-experience

et al. 2020

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Background: There is little information about how healthcare professionals feel about providing palliative care for patients with a substance use disorder (SUD). Therefore, this study aims to explore: 1) the problems and needs experienced by healthcare professionals, volunteers and experts-by-experience (HCP/VE) during their work with patients with SUD in a palliative care trajectory and; 2) to make suggestions for improvements using the quality of care model by Donabedian (Structure, Process, Outcome).Methods: A qualitative study was conducted, consisting of six focus group interviews which consisted of HCP/VE working with patients with SUD in a palliative care phase. At the end of the focus group interviews, participants structured and summarized their experiences within a Strengths, Weaknesses, Opportunities and Threats (SWOT) framework. Interview transcripts (other than the SWOT) were analysed by the researchers following procedures from the Grounded Theory Approach ('Grounded Theory Lite'). SWOT-findings were not subjected to in-depth analysis.Results: HCP/VE stated that within the Structure of care, care networks are fragmented and HCP/VE often lack knowledge about patients' multiplicity of problems and the time to unravel these. Communication with this patient group appears limited. The actual care-giving Process requires HCP/VE a lot of creativity and time spent seeking for cooperation with other caregivers and appropriate care settings. The latter is often hindered by stigma. Since no formalized knowledge is available, care-delivery is often exclusively experience-based. Pain-medication is often ineffective due to active substance use. Finally, several Outcomes were brought forward: Firstly, a palliative care phase is often identified only at a late stage. Secondly, education and a (mobile) team of expertise are desired. Thirdly, care for the caregivers themselves is often de-prioritized.

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Bearing Witness: Exploring the End-of-Life Needs of Homeless Persons and Barriers to Appropriate Care

Cited by 18 publications

References 62 publications

Extending Palliative Approaches to Care Beyond the Mainstream Health Care System: An Evaluation of a Small Mobile Palliative Care Team in Calgary, Alberta, Canada

Extending Palliative Approaches to Care Beyond the Mainstream Health Care System: An Evaluation of a Small Mobile Palliative Care Team in Calgary, Alberta, Canada

Omgaan met zorgweigering bij een persoon met een ernstige psychiatrische aandoening en een levensbedreigende ziekte: een casusbespreking

Palliative care for patients with substance use disorder and multiple problems: a qualitative study on experiences of healthcare professionals, volunteers and experts-by-experience

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