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 s, Social Services s, 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.
Highlights
People 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
Study eligibility criteria Original peer-reviewed, English language publications of studies that reported using qualitative research methods to explore views regarding palliative care for homeless people were eligible for inclusion
Results of data synthesis The views of both homeless people, and those working to support them are represented in the results and data from all studies fed into each theme
Summary
People 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. People who are homeless or vulnerably housed include individuals living on the street, sofa surfing, using temporary accommodation systems or hostels. They are referred to, for ease of reading, as homeless people in this paper and are a disadvantaged group who experience higher and different rates of morbidity and mortality than the housed population [1,2,3]. Their patterns of health care usage differ.
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