Hubbell Sarah A
University of San Francisco School of Nursing and Health Professions, San Francisco, CA, USA.
Public Health Nurs. 2017 Sep;34(5):472-478. doi: 10.1111/phn.12333. Epub 2017 May 10.
Vulnerable populations in the United States experience disparities in access to advance care planning and may have significant unmet health care needs at the end of life, including unrelieved suffering. People who are homeless have increased morbidity and mortality risks, yet lack opportunities to communicate end-of-life preferences. This paper includes a narrative literature review of advance care planning interventions and qualitative investigations into end-of-life concerns among people experiencing homelessness. Trials of clinician-guided interventions with homeless individuals demonstrated effectiveness in achieving advance directive completion and surrogate decision-maker designation. End-of-life concerns among homeless persons included fears of dying alone, dying unnoticed, or remaining unidentified after death. Research participants also reported concerns regarding burial and notification of family members. Public health practitioners should facilitate advance care planning for people who are homeless by providing opportunities for education and discussion on care options and advance directives.
美国的弱势群体在获得预先护理计划方面存在差异，在生命末期可能有大量未得到满足的医疗保健需求，包括痛苦未得到缓解。无家可归者的发病率和死亡率风险增加，但缺乏表达临终偏好的机会。本文包括对预先护理计划干预措施的叙述性文献综述，以及对无家可归者临终关怀问题的定性调查。针对无家可归者的临床医生指导干预试验表明，在完成预先指示和指定替代决策者方面是有效的。无家可归者的临终关怀问题包括害怕孤独死去、死亡时无人注意或死后身份不明。研究参与者还报告了对埋葬和通知家庭成员的担忧。公共卫生从业者应通过提供有关护理选择和预先指示的教育和讨论机会，为无家可归者推动预先护理计划。
