Gott Merryn, Williams Lisa, Wiles Janine, Black Stella, Moeke-Maxwell Tess, Robinson Jackie
Te Kura Tapuhi/The School of Nursing, Waipapa Taumata Rau/The University of Auckland, 85 Park Road, Auckland, Aotearoa New Zealand.
The School of Population Health, Waipapa Taumata Rau/The University of Auckland, Auckland, Aotearoa New Zealand.
BMC Palliat Care. 2024 Dec 2;23(1):275. doi: 10.1186/s12904-024-01598-x.
People experiencing homelessness access specialist palliative care late in their illness trajectory, if at all. There is also little evidence they receive generalist palliative care or are given opportunities to engage in Advance Care Planning. This qualitative study describes the central role of key workers in supporting access to healthcare in homeless communities and identifies implications for improving palliative care provision.
Qualitative data were collected via focus groups and individual interviews with staff working for a key provider of support and housing/accommodation for people experiencing homelessness in an urban area of Aotearoa New Zealand.
The ability to provide palliative care for people experiencing homelessness is dependent upon supporting engagement with mainstream health services. It is here that we identified the key worker role as central due to the complex and expert work they undertake to facilitate healthcare access for their clients. As a result of the high burden of chronic conditions this community experiences, most of this work related to support managing serious conditions, as well as death and dying. Key workers often went 'above and beyond' to support their clients in engaging with mainstream health services, during outpatient appointments, hospital admissions and in emergency department settings. They felt clinicians in these settings did not recognise the knowledge they held about the person, or their skills in terms of providing trauma informed care. The inflexibility of current care provision, as well as people experiencing homelessness feeling stigmatised, and neither valued nor respected in these settings, also created barriers to receiving care.
New models of palliative care are required which recognise the central role of non-health care key support staff and engage them more actively in supporting people experiencing homelessness when they interact with mainstream health services. Such models will need to be responsive to the nature and complexity of palliative care need in this population and facilitate support for people who typically do not see healthcare spaces as safe. The trusted relationships key workers have developed over time are crucial resources for identifying palliative care need and supporting access to palliative care for people experiencing homelessness.
无家可归者在其疾病发展轨迹的晚期才获得专科姑息治疗，即便能获得也是极少数情况。也几乎没有证据表明他们接受了全科姑息治疗，或者有机会参与预先护理规划。这项定性研究描述了关键工作者在支持无家可归社区获得医疗保健方面的核心作用，并确定了对改善姑息治疗服务的启示。
通过焦点小组和对在新西兰奥塔哥一个城市地区为无家可归者提供支持和住房/住宿的主要服务提供者的工作人员进行个人访谈收集定性数据。
为无家可归者提供姑息治疗的能力取决于支持他们与主流医疗服务机构接触。正是在这方面，我们确定关键工作者的角色至关重要，因为他们为客户提供医疗保健服务所开展的工作复杂且专业。由于这个社区慢性病负担沉重，这项工作大多与支持管理严重疾病以及死亡相关事宜有关。在门诊预约、住院和急诊科环境中，关键工作者经常“竭尽全力”支持他们的客户与主流医疗服务机构接触。他们觉得这些环境中的临床医生没有认识到他们所掌握的关于患者的知识，也没有认可他们在提供创伤知情护理方面的技能。当前护理服务的僵化，以及无家可归者在这些环境中感到受辱，既未得到重视也未受到尊重，也造成了接受护理的障碍。
需要新的姑息治疗模式，承认非医疗关键支持人员的核心作用，并在他们与主流医疗服务机构互动时，让他们更积极地参与支持无家可归者。这样的模式需要回应这一人群姑息治疗需求的性质和复杂性，并为那些通常不认为医疗场所安全的人提供支持。关键工作者随着时间推移建立起来的信任关系是识别无家可归者的姑息治疗需求并支持他们获得姑息治疗的关键资源。
