British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
BMC Public Health. 2012 May 17;12:312. doi: 10.1186/1471-2458-12-312.
Homeless and marginally housed persons who use alcohol and/or illicit drugs often have end-of-life care needs that go unmet due to barriers that they face to accessing end-of-life care services. Many homeless and marginally housed persons who use these substances must therefore rely upon alternate sources of end-of-life care and support. This article explores the role of harm reduction services in end-of-life care services delivery to homeless and marginally housed persons who use alcohol and/or illicit drugs.
A qualitative case study design was used to explore end-of-life care services delivery to homeless and marginally housed persons in six Canadian cities. A key objective was to explore the role of harm reduction services. 54 health and social services professionals participated in semi-structured qualitative interviews. All participants reported that they provided care and support to this population at end-of-life.
Harm reduction services (e.g., syringe exchange programs, managed alcohol programs, etc.) were identified as a critical point-of-entry to and source of end-of-life care and support for homeless and marginally housed persons who use alcohol and/or illicit drugs. Where possible, harm reduction services facilitated referrals to end-of-life care services for this population. Harm reduction services also provided end-of-life care and support when members of this population were unable or unwilling to access end-of-life care services, thereby improving quality-of-life and increasing self-determination regarding place-of-death.
While partnerships between harm reduction programs and end-of-life care services are identified as one way to improve access, it is noted that more comprehensive harm reduction services might be needed in end-of-life care settings if they are to engage this underserved population.
无家可归和住房不稳定的酗酒者和/或吸毒者在临终关怀方面的需求往往得不到满足，这是因为他们在获得临终关怀服务方面存在障碍。因此，许多使用这些物质的无家可归者和住房不稳定者必须依靠其他临终关怀和支持来源。本文探讨了减少伤害服务在为酗酒者和/或吸毒的无家可归和住房不稳定者提供临终关怀服务方面的作用。
采用定性案例研究设计，探讨了加拿大六个城市中无家可归和住房不稳定者的临终关怀服务提供情况。一个主要目标是探讨减少伤害服务的作用。54 名卫生和社会服务专业人员参加了半结构化定性访谈。所有参与者都报告说，他们在临终时为这一人群提供护理和支持。
减少伤害服务（例如，注射器交换计划、管理酒精计划等）被确定为酗酒者和/或吸毒的无家可归和住房不稳定者获得临终关怀和支持的关键切入点和来源。在可能的情况下，减少伤害服务为这一人群提供了临终关怀服务的转介。当这些人群成员无法或不愿意获得临终关怀服务时，减少伤害服务还提供临终关怀和支持，从而提高了生活质量，并增加了对死亡地点的自主决定。
虽然减少伤害计划和临终关怀服务之间的伙伴关系被确定为改善获得途径的一种方式，但如果要使这些服务不足的人群参与进来，则可能需要在临终关怀环境中提供更全面的减少伤害服务。
