Palliative care needs and models of care for people who use drugs and/or alcohol: A mixed methods systematic review

Abstract

Background: Providing palliative care for individuals who use alcohol and/or drugs poses a multi-faceted challenge. In addition to clinical and social needs, individuals may endure mental health problems, co-morbidities and homelessness, thus requiring a multi-disciplinary, flexible approach to care. Aim: To identify the palliative care needs and models of care for people who use drugs and/or alcohol. Design: A mixed-methods systematic review was conducted using the JBI Manual for Evidence Synthesis. Data Sources: Six databases were searched to identify relevant studies. Full text review and quality appraisal were completed independently and in-duplicate by two reviewers with conflicts resolved by a third reviewer. Qualitative and quantitative data were tabulated together using narrative synthesis, then categorised according to outcomes of interest, with similar and divergent findings reported accordingly. Results: Thirteen studies were included, nine qualitative and four quantitative, using a range of data collection methods, across various settings. The difficulties for individuals who use alcohol and/or drugs as well as their formal and informal carers, in relation to end-of-life care were examined, revealing access, care and skills issues. Three themes emerged which could underpin the development of a model of care: interpersonal/organisational relationships; holistic care; and collaborating with other services and training. Conclusion: Despite end-of-life needs of this population being different to others, challenges include creating inclusive policies, sensitising staff to distinctive individual needs and training exchanges for staff working in both drug and alcohol services and palliative care.

Association between opioid use disorder and palliative care: a cohort study using linked health administrative data in Ontario, Canada

“…Stigma toward people who have substance use disorders can contribute to late referrals and missed opportunities to receive palliative care in the community. 46 …”

Palliative care for people who use drugs during communicable disease epidemics and pandemics: A scoping review on access, policies, and programs and guidelines

“…In pre-pandemic planning, this creates an opportunity for focused education, training, and capacity building for hospital- and community-based clinicians in providing high quality compassionate trauma-informed care 83 as well as building relationships within and across services and sectors. 4 , 81 Regarding “Space,” proactive planning can include dedicated spaces that integrate harm reduction services such as supervised consumption sites within palliative care contexts. 84 In some cases, these spaces may need to be mobile to meet people who are receiving palliative care but not admitted to a structure like a hospice.…”

“…2 They are also at high risk of life-limiting illnesses such as Acquired Immunodeficiency Syndrome (AIDS), cancers, pulmonary diseases, and liver cirrhosis, 3 and can benefit from palliative care. 4 Previous research has identified how palliative care tends to deprioritize the needs of populations who are “doubly vulnerable”—people who require palliative care and are disadvantaged in terms of the social determinants of health. 5 Many people who use drugs have unique end-of-life care needs, and encounter barriers in having these needs addressed.…”

“…Recent knowledge syntheses suggest there is limited evidence to provide guidance for providing palliative care for this population, but these reviews did not account for epidemics and pandemics. 4 , 25 To address this gap, we conducted a scoping review to identify and map available and emerging evidence in this area.…”

Implementation of a threefold intervention to improve palliative care for persons experiencing homelessness: a process evaluation using the RE-AIM framework

“…Further, this process evaluation showed that efforts must also be made in the financial field: multidisciplinary care also needs multidisciplinary, structural funding to achieve long-term improvements in the palliative care for this population. However, since both the population and interventions regarding palliative care are understudied yet, evidence-based models of improving palliative care hardly exist [16,32]. We recommend further research evidence-based interventions and evaluating the processes.…”