Increasing Access—A Qualitative Study of Homelessness and Palliative Care in a Major Urban Center

Krakowsky, Yonah; Gofine, Mirriam; Brown, Pnina; Danziger, Jana; Knowles, Holly

doi:10.1177/1049909112448925

Cited by 38 publications

(70 citation statements)

References 3 publications

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“…Health and social care professionals were recruited from a range of services in Canada, North America and Australia and had varying degrees of experience in working with homeless people [9, 34–38]. …”

Section: Resultsmentioning

confidence: 99%

“…Often shaped by discrimination, disrespect [6] and disempowerment [42]. As a result, expectations and conceptualisation of health care, including of palliative care, described by homeless people appear different to those perhaps commonly shared by the housed population [6, 33, 34, 36, 40]. This contributes to the difficulty homeless people had in trusting or engaging with health and social services [6, 9, 34–37, 39] as outlined in the quote below:

“There is a lot of shame….low self-esteem, horrific histories of trauma and abuse, mistrust of caregivers.

…”

Section: Resultsmentioning

confidence: 99%

“…The lack of and uptake if available of palliative care options in mainstream healthcare for homeless people seems a result of multiple issues including their complex health needs [6, 35, 36], and substance and alcohol misuse [35, 36], being uncomfortable in institutional settings [34], and thereby general avoidance of medical services and personnel [6, 34, 36], and subsequently late presentation to services [6, 9, 35, 37].

“The health care system has failed that population…When trying to access care in the mainstream, they experience discrimination and disrespect and poor care”- Health care professional [37]

…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

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

Hudson

Flemming

Shulman³

et al. 2016

BMC Palliat Care

103

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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.

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Section: Resultsmentioning

confidence: 99%

“There is a lot of shame….low self-esteem, horrific histories of trauma and abuse, mistrust of caregivers.

…”

Section: Resultsmentioning

confidence: 99%

“The health care system has failed that population…When trying to access care in the mainstream, they experience discrimination and disrespect and poor care”- Health care professional [37]

…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

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

Hudson

Flemming

Shulman³

et al. 2016

BMC Palliat Care

103

View full text Add to dashboard Cite

show abstract

“…A recent report noted that upward of 50% of homeless people do not have a primary care physician, which results in a higher use of hospital emergency departments as the primary care location for this population 16 . It was noted that acute health care utilization for homeless people can be 3-4 times that of the general population, with visits by homeless individuals to the emergency department accounting for 25% of the total volume in some large urban centres.…”

Section: Quantifying the Problem: Demographic And Epidemiologic Datamentioning

confidence: 99%

“…Programs offering evidence of reduced risk and harms have identified a need for supervised drug consumption services 2 , enhanced cultural competence training to all palliative care staff involved 2 , and a recognition that staff working regularly with people who are homeless do not have experience or training in end-of-life issues 5,16 .…”

Section: Overcoming Barriers: Promising Models and Supportive Researchmentioning

confidence: 99%

Palliative Care as a Public Health Issue: Understanding Disparities in Access to Palliative Care for the Homeless Population Living in Toronto, Based on a Policy Analysis

et al. 2017

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Even in a developed country such as Canada, there are disparities in just access to adequate health care-and, more specifically, palliative care. That inequality is most notable in an underserved group such as the homeless population. Even the word "homeless" has become both a negative descriptor and a stereotype in our society. We posit that the provision of hospice palliative care is structured on several problematic assumptions: an expectation that patients will have an informal support network (family and friends), a stable and secure residence, a predictive terminal illness trajectory, and reasonable access to health care. Those assumptions create structural inequality within the system.Homeless individuals have considerable experience with death and dying, and qualitative research has shown them to hold the expectation that their death will be both sudden and violent. Here, we look at the current data concerning known disparities in access to good palliative care services experienced by the homeless population, based on a stakeholder analysis of the available literature. That information, coupled with the use of a public health ethics decision-making tool, such as the Good Decision Making in Real Time framework, is used to explore the common ethics challenges that can arise in public health interventions aimed at the provision of end-of-life care to homeless adults. A broad exploration of the system that underlies our care is critical to the proper and appropriate provision of care for homeless individuals.

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PROTOCOL: A comprehensive review of prioritized interventions to improve the health and wellbeing of persons with lived experience of homelessness

Pottie

Mathew

Mendonca

et al. 2019

Campbell Systematic Reviews

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Worldwide, over 1.8 billion people lack adequate housing and almost 25% of the world's urban population reside in informal accommodation (United Nations Human Rights Council, 2019). "People with a lived experience of homelessness" is a term coined to describe individuals who are, have been, or at risk of becoming homeless. This population lacks stable, permanent, appropriate housing, or may be without immediate prospect, means and ability to acquire it. Such physical living situations can include emergency shelters or provisional accommodations (Canadian Observatory on Homelessness, 2017). This population continues to grow, giving rise to a major international clinical and public health priority. Homelessness is strongly associated with high levels of morbidity (Hwang, Wilkins, Tjepkema, O'Campo, & Dunn, 2009) and mortality (Nordentoft & Wandall-Holm, 2003). People with lived experience of homelessness are at an increased risk for acute illnesses, such as traumatic injury

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Increasing Access—A Qualitative Study of Homelessness and Palliative Care in a Major Urban Center

Cited by 38 publications

References 3 publications

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

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

Palliative Care as a Public Health Issue: Understanding Disparities in Access to Palliative Care for the Homeless Population Living in Toronto, Based on a Policy Analysis

PROTOCOL: A comprehensive review of prioritized interventions to improve the health and wellbeing of persons with lived experience of homelessness

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