Table 1 Characteristics of the papers included
Reference | Aim | Country | Setting | Method | Participants | N | Informa-tion on 1,2, 3,b | Critical appraisal scorec |
|---|---|---|---|---|---|---|---|---|
[31] | To know more about the content of advance directives completed by homeless people who participated in a guided intervention arm | USA | Homeless drop-in shelter | Qualitative analysis of participants’ responses to individual items in an advance directivea | Homeless people with a terminal illness | Homeless people (n = 17) | 1, 2, 3 | 24/20 Moderate |
[32] | To identify the observed changes in general condition or behaviour of homeless people with advanced liver disease who may be in deteriorating health and approaching the end of life in order to better recognize an increased likelihood of death and to explore staff’s experiences of death of residents | UK | Homeless shelter | Case note review, focus groups (qualitative) | Case notes about homeless people with advanced liver disease, staff members of a supporting home for homeless people | Case notes (n = 27) staff members (n = 13) | 1, 2, 3 | 22/21 Moderate |
[37] | To explore the staff members’ experiences of and reasoning about the palliative care they provided | Sweden | Support home for homeless | Paired and individual conversations (qualitative) | Staff members of a support and housing home for homeless | Staff members (n = 12) | 1, 2, 3 | 34/31 Good |
[49] | To describe challenges of caring for homeless veterans at end of life as perceived by Veterans Affairs Medical Centre (VAMC) homeless and EOL care staff | USA | Veterans Affairs Medical Centres (VAMC) with programmes for homeless veterans with a short life expectancy | E-mail survey (quantitative) | Care staff of homeless and EOL programmes | 50 VAMCs | 2 | 28/23 Moderate |
[43] | To assess the extent to which homeless persons may underuse healthcare services even when they are at a high risk of death and to examine potential opportunities for intervention in this population | USA | Boston Health Care for the Homeless Program | Review of medical records (quantitative) | Deceased homeless adults | Medical records (n = 558) | 2, 3 | 27/25 Moderate |
[23] | To explore the views, concerns, and needs regarding advance care planning among older homeless adults | USA | Transitional housing facility | Semi-structured face-to-face interviews (qualitative) | Homeless adults aged 60 and older | Homeless (n = 21) | 1, 2, 3 | 30/29 Good |
[24] | To explore older homeless adults’ perspectives toward good and bad deaths and their concerns regarding their EOL care needs | USA | Transitional housing facility | Semi-structured face-to-face interviews (qualitative) | Homeless adults aged 60 and older | Homeless (n = 21) | 1, 2, 3 | 30/33 Good |
[36] | To explore how access to Toronto’s palliative services can be improved to better serve the city’s homeless | Canada | Providers of care for the homeless | Semi-structured interviews (qualitative) | Homeless care providers with extensive experience and experience dealing with death and dying | Registered nurses (n = 3) outreach workers (n = 4) | 1, 2, 3 | 19/18 Poor |
[41] | To determine the rate of advance directive completion using a one-on-one counsellor-guided intervention | Canada | Shelter for homeless men | Counsellor-guided intervention (quantitative)a | Chronically homeless individuals in a managed alcohol harm reduction programa | Shelter residents (n = 205) | 1, 2 | 31/33 Good |
[47] | To identify best practice for managing the palliative care needs of clients experiencing homelessness in a community setting and to guide the development of policies for a community-based palliative care service working with these clients | Australia | Community-based palliative care service | Semi-structured individual interviews (qualitative) | Workers from hospital and community organizations | Staff members (n = 6) | 2, 3 | 27/24 Moderate |
[30] | To explore and describe aspects of social networks that have a potential for caregiving during the terminal phase of a disease | USA | Patients of two medical centres, living in single room buildings | Semi-structured individual interviews (qualitative) | Homeless who had been diagnosed with unresectable lung cancer | Homeless (n = 8) | 2 | 21/19 Moderate |
[26] | To identify challenges health and social service providers face in facilitating and delivering end-of-life care services to homeless illicit drug users | Canada | Health and social care services | Semi-structured individual interviews (qualitative) | Health and social services professionals involved in end-of-life care services delivery to homeless persons | Healthcare professionals and managers (n = 50) | 2, 3 | 29/31 Good |
[27] | To identify barriers to the end-of-life care system for homeless populations and generate recommendations to improve their access to end-of-life care | Canada | Health and social services | Semi-structured individual interviews (qualitative) | Health and social services professionals involved in end-of-life care services delivery to homeless persons | Healthcare professionals and managers (n = 54) | 2, 3 | 32/35 Good |
[25] | To explore the role of harm reduction services in end-of-life care services delivery to homeless and marginally housed persons with problematic use of alcohol and/or illicit drugs | Canada | Health and social services | Semi-structured individual interviews (qualitative) | Health and social services professionals involved in end-of-life care services delivery to homeless persons | Healthcare professionals and managers (n = 54) | 2, 3 | 32/33 Good |
[45] | To determine the benefits and barriers of in-shelter palliative care and possible enablers to future implementation in Toronto | Canada | Three shelters | Semi-structured individual interviews (qualitative) | Shelter-based social service providers | Case workers, social support workers, shelter managers (n = 5) | 2, 3 | 23/19 Moderate |
[40] | To examine the treatment preferences of homeless (in comparison with preferences of physicians likely to be providing care for homeless persons and patients with oxygen-dependent COPD) | USA | Homeless shelters, hospitals | Cross-sectional survey (quantitative) | Visitors of homeless shelters, physicians providing care to homeless persons, patients with COPD | Homeless (n = 229), physicians (n = 236), COPD-patients (n = 111) | 1, 3 | 31/32 Good |
[44] | To improve the understanding of elderly homeless persons and to describe the living circumstances of the group, especially housing | USA | Multidisciplinary Street Team of Boston | Analysis of an interventiona (quantitative) | Elderly homeless individuals (> 50) | Homeless (n = 30) | 2, 3 | 15/13 Poor |
[48] | To explore if effective shelter-based palliative care could be provided to terminally ill homeless individuals at substantial cost savings | Canada | Shelter-based palliative care hospice | Analysis of records of a cohort and a five-member panel (quantitative) | Terminally ill homeless | Records of homeless (n = 28) | 2, 3 | 32/30 Good |
[38] | To explore the importance of end-of-life care for homeless people and the type of concerns | USA | Sites for homeless in Minnesota | Focus groups (qualitative) | Homeless individuals | Homeless (n = 57) | 1, 2, 3 | 18 Poor |
[33] | To understand the viewpoints of people who are homeless regarding end-of-life issues, to elucidate the barriers to good end-of-life care, and to offer insight into the most basic needs and wishes. | USA | Homeless shelter, two service organizations for homeless | Focus groups (qualitative) | Homeless individuals and social workers | Homeless (n = 11) service providers (n = 9) | 1, 2, 3 | 23/24 Moderate |
[29] | To explore the experiences and attitudes toward death and dying among homeless persons. | USA | Social service agencies which serve homeless | Focus groups (qualitative) | Homeless individuals | Homeless (n = 53) | 1, 2, 3 | 30/35 Good |
[28] | To examine how homelessness influences concerns and desires about care at the time of death. | USA | Social service agencies which serve homeless people | Focus groups (qualitative) | Homeless individuals | Homeless (n = 53) | 1, 2, 3 | 29/32 Good |
[46] | To improve the EOL decision-making process for homeless persons by facilitating ACP | USA | Drop-in centre | RCT comparing two types of interventionsa (quantitative) | Homeless individuals | Homeless (n = 59) | 2, 3 | 32/35 Good |
[42] | To determine whether homeless persons will complete a counselling session on advance care planning and fill out a legal advance directive designed to assess care preferences and preserve the dignity of marginalized persons | USA | Sites serving homeless persons | RCT comparing two type of interventionsa (quantitative) | Homeless individuals | Homeless (n = 262) | 1, 2, 3 | 31/35 Good |
[39] | To increase healthcare providers’ understanding and insight into how to better provide EOL care for homeless people. | USA | Free urban healthcare clinic for homeless individuals | Focus groups (qualitative) | Homeless individuals | Homeless (n = 20) | 1, 2, 3 | 31/28 Good |
[34] | To identify and examine the needs of older people who are homeless or who have previously experienced homelessness as they age and are faced with the issues of serious ill health, dying and death. | Ireland | Community where care, accommodation and support are being provided for people experiencing homelessness and those at risk | Interviews (qualitative) | Homeless individuals | Homeless (n = 16) | 1, 2, 3 | 22 Moderate |
[35] | To explore the views of hostel staff regarding palliative and end-of-life care for the homeless population | UK | Intermediate or long stay hostels | Semi-structured individual interviews (qualitative) | Hostel workers | Hostel workers (n = 7) | 1, 2, 3 | 28/33 Good |