Challenges and recommendations in increasing homeless persons' access to palliative care: an international systematic review

Abstract

Background: The UK Department of Health strives to provide palliative care at the time of need for everyone, regardless of “wherever the person may beâ€, “irrespective of social economic deprivationâ€. This goal has not been reached for homeless people who face numerous multifaceted challenges, including accessing health care. Given the complexities of this population, qualitative research exploring perspectives of homeless people and care providers is key to understanding the difficulties in provision of palliative care to this vulnerable group. This review of qualitative literature identifies challenges to and recommendations for the provision of palliative care for homeless people. Methods: A comprehensive literature search identified primary qualitative research papers exploring the perspectives regarding palliative care of homeless people and/or those working with them. 1715 articles were identified. Two reviewers completed all key review processes. Using thematic synthesis, core themes relating to the provision of palliative care from the perspectives of homeless people and care providers were identified. Findings: Twelve articles were eligible for review. Challenges and recommendations for the provision of palliative care for homeless people encompassed three core themes: 1) the unique circumstances of homeless people, 2) the structure of health care systems and 3) limitations of temporary accommodation systems. The importance of the development of trusting relationships and flexible, joined-up services were highlighted. Discussion: Increasing awareness, compassion and flexibility in the provision of high quality palliative care for homeless people may help to promote dignity and choice for this under-served population as they reach the end of their lives.