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Table 2 Challenges and suggestions for the provision of palliative and end of life care to people who are homeless

From: Challenges to access and provision of palliative care for people who are homeless: a systematic review of qualitative research

Codes Challenges to the provision of palliative and end of life care Suggestions for the provision of palliative and end of life care
Challenges related to the chaotic lifestyles associated with being homeless
 Death in the day to day context of homelessness Previous negative experiences of death and fear of death Peer advocates/community services to facilitate attendance & engagement
Unconventional living arrangements & social isolation Training for staff around addiction issues and associated complications
 Attitudes to health care; substance misuse & competing priorities Previous negative experiences or perceptions of health care & mistrust of professionals  
Poor engagement with services  
Substance and alcohol misuse  
Complex care needs & competing priorities  
Trends in accessing health care and poor adherence to treatment  
Communicating about death, dying and advance care planning  
Challenges to the delivery of end of life care and specialized palliative care within a hostel
 The hostel environment Limited resources Advocacy
Difficulty accessing support and specialist services Greater collaboration with medical services – MDT discussion
Limited medical information Greater in hostel support from medical and social services
 Practical and emotional burdens for staff Limitations of staff roles Increased training & specialised services
Emotional burden for staff  
Challenges to the provision of palliative care to homeless persons relating to mainstream health care systems
 Inflexibility of the health care service and limited planning Inflexible services and systems Flexibility in care model & locations
Strict rules and regulations Harm minimisation strategies
Lack of specialised services Linking with community services
Limited planning, especially at discharge Training for health care professionals
 Health care professionals’attitudes and inexperience in supporting homeless people Attitudes of professionals Person centred care
Emotional & practical burdens Increased training & specialised services