Coverdale Megan Rose, Murtagh Fliss
Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Kingston upon Hull, UK
Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Kingston upon Hull, UK.
BMJ Support Palliat Care. 2024 Dec 19;14(e3):e2411-e2422. doi: 10.1136/spcare-2024-004883.
Homeless adults experience a significant symptom burden when living with a life-limiting illness and nearing the end of life. This increases the inequalities that homeless adults face while coping with a loss of rootedness in the world. There is a lack of palliative and end of life care provision specifically adapted to meet their needs, exacerbating their illness and worsening the quality of their remaining life.
To identify interventions and models of care used to address the palliative and end of life care needs of homeless adults, and to determine their effectiveness.
Standard systematic reviewing methods were followed, searching from 1 January 2000 the databases: Ovid MEDLINE, EMBASE, SCOPUS, Web of Science, CINAHL and PsycInfo. Results were reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and described using a narrative synthesis. Study quality was assessed using Hawker's Quality Assessment Tool.
Nine studies primarily focused on: education and palliative training for support staff; advance care planning; a social model for hospice care; and the creation of new roles to provide extra support to homeless adults through health navigators, homeless champions or palliative outreach teams. The voices of those experiencing homelessness were rarely included.
We identified key components of care to optimise the support for homeless adults needing palliative and end of life care: advocacy; multidisciplinary working; professional education; and care in the community. Future research must include the perspectives of those who are homeless.
无家可归的成年人在身患绝症且生命接近尾声时，会承受巨大的症状负担。这加剧了他们在应对失去世界根基感时所面临的不平等。专门为满足他们的需求而提供的姑息治疗和临终关怀严重不足，这加剧了他们的病情，恶化了他们剩余生命的质量。
确定用于满足无家可归成年人姑息治疗和临终关怀需求的干预措施和护理模式，并确定其有效性。
遵循标准的系统评价方法，检索2000年1月1日以来的数据库：Ovid MEDLINE、EMBASE、SCOPUS、Web of Science、CINAHL和PsycInfo。按照系统评价和Meta分析的首选报告项目指南报告结果，并采用叙述性综合法进行描述。使用霍克质量评估工具评估研究质量。
九项研究主要集中在：对支持人员的教育和姑息治疗培训；预先护理计划；临终关怀的社会模式；以及通过健康导航员、无家可归者倡导者或姑息治疗外展团队设立新角色，为无家可归的成年人提供额外支持。无家可归者的声音很少被纳入研究。
我们确定了护理的关键组成部分，以优化对需要姑息治疗和临终关怀的无家可归成年人的支持：宣传；多学科合作；专业教育；以及社区护理。未来的研究必须纳入无家可归者的观点。
