1 Pathway Charity, London, UK.
2 Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK.
Palliat Med. 2018 Jan;32(1):36-45. doi: 10.1177/0269216317717101. Epub 2017 Jul 3.
Being homeless or vulnerably housed is associated with death at a young age, frequently related to medical problems complicated by drug or alcohol dependence. Homeless people experience high symptom burden at the end of life, yet palliative care service use is limited.
To explore the views and experiences of current and formerly homeless people, frontline homelessness staff (from hostels, day centres and outreach teams) and health- and social-care providers, regarding challenges to supporting homeless people with advanced ill health, and to make suggestions for improving care.
Thematic analysis of data collected using focus groups and interviews.
Single homeless people ( n = 28), formerly homeless people ( n = 10), health- and social-care providers ( n = 48), hostel staff ( n = 30) and outreach staff ( n = 10).
This research documents growing concern that many homeless people are dying in unsupported, unacceptable situations. It highlights the complexities of identifying who is palliative and lack of appropriate places of care for people who are homeless with high support needs, particularly in combination with substance misuse issues.
Due to the lack of alternatives, homeless people with advanced ill health often remain in hostels. Conflict between the recovery-focused nature of many services and the realities of health and illness for often young homeless people result in a lack of person-centred care. Greater multidisciplinary working, extended in-reach into hostels from health and social services and training for all professional groups along with more access to appropriate supported accommodation are required to improve care for homeless people with advanced ill health.
无家可归或住房不稳定与年轻时死亡有关，通常与药物或酒精依赖引起的医疗问题有关。无家可归者在生命末期承受着高症状负担，但姑息治疗服务的使用有限。
探讨当前和以前的无家可归者、无家可归者一线工作人员（来自收容所、日间中心和外展团队）以及卫生和社会保健提供者对支持患有晚期疾病的无家可归者所面临的挑战的看法和经验，并提出改善护理的建议。
使用焦点小组和访谈收集的数据的主题分析。
单身无家可归者（n=28）、以前的无家可归者（n=10）、卫生和社会保健提供者（n=48）、收容所工作人员（n=30）和外展工作人员（n=10）。
这项研究记录了人们越来越关注的问题，即许多无家可归者在无人支持、无法接受的情况下死亡。它强调了确定谁是姑息治疗对象以及为有高支持需求的无家可归者提供适当的护理场所的复杂性，特别是在与药物滥用问题相结合的情况下。
由于缺乏替代方案，患有晚期疾病的无家可归者往往仍留在收容所。许多服务以康复为重点的性质与年轻无家可归者的健康和疾病现实之间的冲突，导致缺乏以患者为中心的护理。需要加强多学科合作，扩大卫生和社会服务部门向收容所的延伸服务，并对所有专业群体进行培训，同时增加获得适当的支持性住房的机会，以改善对患有晚期疾病的无家可归者的护理。
