Supportive and palliative care of adults with respiratory problems experiencing structural vulnerability from homelessness, prison or other criminal justice system involvement

Gardener, A Carole; Kuhn, Isla; Micklewright, Kerry; Farquhar, Morag

doi:10.1097/spc.0000000000000511

Cited by 2 publications

(2 citation statements)

References 29 publications

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“…However, palliative care is often not provided for persons experiencing homelessness, or only to an insufficient degree. Moreover, the provision of palliative care is complicated by the characteristics of this population [14,18,21,22].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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Background Palliative care provision for persons experiencing homelessness is often poor. A threefold consultation service intervention was expected to increase knowledge of palliative care and multidisciplinary collaboration, and improve palliative care for this population. This intervention comprised: 1) consultation of social service professionals by palliative care specialists and vice versa; 2) multidisciplinary meetings with these professionals; and 3) training and education of these professionals. We aimed to evaluate the implementation process and its barriers and facilitators of this service implemented within social services and healthcare organizations in three Dutch regions. Methods A process evaluation using structured questionnaires among consultants, semi-structured individual and group interviews among professionals involved, and (research) diaries. Qualitative data were analysed using thematic analysis. The process evaluation was structured using the Reach, Adoption, Implementation and Maintenance dimensions of the RE-AIM framework. Results All three regions adopted all three activities of the intervention, with differences between the three regions in the start, timing and frequency. During the 21-month implementation period there were 34 consultations, 22 multidisciplinary meetings and 9 training sessions. The professionals reached were mainly social service professionals. Facilitators for adoption of the service were a perceived need for improving palliative care provision and previous acquaintance with other professionals involved, while professionals’ limited skills in recognizing, discussing and prioritizing palliative care hindered adoption. Implementation was facilitated by a consultant’s expertise in advising professionals and working with persons experiencing homelessness, and hindered by COVID-19 circumstances, staff shortages and lack of knowledge of palliative care in social service facilities. Embedding the service in regular, properly funded meetings was expected to facilitate maintenance, while the limited number of persons involved in this small-scale service was expected to be an obstacle. Conclusions A threefold intervention aimed at improving palliative care for persons experiencing homelessness is evaluated as being most usable when tailored to specific regions, with bedside and telephone consultations and a combination of palliative care consultants and teams of social service professionals. It is recommended to further implement this region-tailored intervention with palliative care consultants in the lead, and to raise awareness and to remove fear of palliative care provision.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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“…They identify key priorities to improve the delivery of respiratory health care pathways supporting prevention, harm reduction, and responsive care that are more inclusive of people living with severe mental illness. Similarly, Gardener et al [7] consider recent work in relation to structurally vulnerable populations, focusing on those experiencing homelessness or aspects of the criminal justice system. Again, the notable lack of research dedicated to supportive and palliative care for this group was remarkable, with the majority of papers focused on disease prevalence.…”

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confidence: 99%