Challenges to access and provision of palliative care for people who are homeless: a systematic review of qualitative research

Abstract

BackgroundPeople who are homeless or vulnerably housed are a marginalized group who often experience high rates of morbidity and die young as a result of complex problems. Access to health care and support can be challenging, with access to palliative care even more so. This review presents a synthesis of published qualitative research exploring from the perspective of homeless people and those working to support them, current challenges to palliative care access and provision, in addition to suggestions for what may improve palliative care for this population.MethodsSystematic review of qualitative research analysed using thematic synthesis. PsycINFO, Medline, Sociological Abstracts, Social Services Abstracts, Science citations index and CINAHL were searched up to September 2016. Thematic synthesis involved a three-step inductive process to develop a deeper understanding of the challenges to and suggestions for the access and provision of palliative care for homeless people.ResultsThirteen qualitative articles, reporting nine studies were identified. The challenges to access and provision to palliative care were drawn from the data covering three broad areas, namely “the chaotic lifestyles sometimes associated with being homeless”, “the delivery of palliative care within a hostel for homeless people” and provision within “mainstream health care systems”. Obstacles were related to homeless persons competing day-to-day priorities, their experience of stigma in mainstream settings, the high burden on hostel staff in supporting residents at the end of life and inflexibility in mainstream health care systems. Suggestions for improving access to palliative care include building trust between homeless persons and health professionals, increasing collaboration between and flexibility within services, and providing more training and support for all professionals.ConclusionsThe provision of palliative care can be complicated for all populations, however delivering palliative care for people who are homeless is influenced by a potentially greater and more varied range of factors, on both individual and systemic levels, than providing palliative care for the housed population. Careful consideration and potentially great changes will be needed within health care systems to ensure homeless populations have equitable access to palliative care.

The Views of Homeless People and Health Care Professionals on Palliative Care and the Desirability of Setting Up a Consultation Service: A Focus Group Study

“…Data from the first two focus groups was discussed by two researchers, who decided that the interview guide worked well and needed no adjustment for the remaining focus groups. Transcripts were analysed following the principles of thematic analysis 24 . Before analysing, the transcripts were read and reread by two researchers for familiarization with the data.…”

The spiritual concerns of people experiencing homelessness at the end of life

“…In fact, they often die in difficult or degrading conditions, devoid of dignity, for example under bridges and in shop doorways, without access to specialist palliative care services (Care Quality Commission 2017). Some reasons for this have been documented and many barriers to access have been identified in the literature (Hudson et al 2016; Care Quality Commission 2017). However, exploration of these barriers is beyond the scope of this paper.…”

Cuidados paliativos en personas sin hogar

“…Hudson et al (2016a) reflexionan sobre las dificultades a la hora de aplicar los cuidados paliativos en un albergue para personas sin hogar. Pese a que los albergues no suelen estar adaptados para cubrir las necesidades paliativas, muchas personas sin hogar expresaron su deseo de permanecer en el albergue en caso de que su salud se deteriorara, en lugar de ser transferidos a un hospital.…”