Challenges to discussing palliative care with people experiencing homelessness: a qualitative study.
Challenges to discussing palliative care with people experiencing homelessness: a qualitative study.
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DOI：
10.1136/bmjopen-2017-017502
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发表时间：
2017-11-28
期刊：
影响因子：
2.9
通讯作者：
Stone P
中科院分区：
文献类型：
--
作者：
Hudson BF;Shulman C;Low J;Hewett N;Daley J;Davis S;Brophy N;Howard D;Vivat B;Kennedy P;Stone P
为了探讨无家可归者和支持他们的人对姑息治疗的对话和方法的看法和经历，我们在 2015 年 10 月至 2016 年 10 月期间在无家可归者旅馆和日间中心以及来自伦敦三个行政区的初级和二级医疗保健提供者以及社会护理服务机构的工作人员收集了数据。无家可归者 (n=28)、曾经无家可归者 (n=10)、健康和社会护理提供者 (n=48)、宿舍工作人员 (n=30) 和外展工作人员 (n=10)。在这项定性描述性研究中，参与者被招募参加伦敦三个行政区的访谈和焦点小组。与有无家可归经历的人、健康和社会护理专业人员以及宿舍和外展工作人员探讨了临终关怀的观点和经验。当讨论中没有出现新的主题时就达到了饱和。进行了 28 个焦点小组和 10 次个人访谈。参与者强调，与无家可归者探讨未来护理偏好和姑息治疗的对话很少。被确定为此类对话挑战的主题包括对死亡的态度；为无家可归者提供的服务以康复为重点；预后和护理地点的不确定性；以及对负面影响的恐惧。这项研究强调需要采取一种不同的方法来支持无家可归者和患有严重健康问题的人，这种方法要考虑到不确定性并促进福祉、尊严和选择。我们提出并行规划和绘图作为应对不确定性的一种方式。我们承认，这些方法并不总是简单明了，也不适合所有人，但将未来对话的焦点从死亡和临终转移到现在和未来可能会促进对话，并使无家可归者的愿望得到了解和探索。
To explore the views and experiences of people who are homeless and those supporting them regarding conversations and approaches to palliative care Data were collected between October 2015 and October 2016 in homeless hostels and day centres and with staff from primary and secondary healthcare providers and social care services from three London boroughs. People experiencing homelessness (n=28), formerly homeless people (n=10), health and social care providers (n=48), hostel staff (n=30) and outreach staff (n=10). In this qualitative descriptive study, participants were recruited to interviews and focus groups across three London boroughs. Views and experiences of end-of-life care were explored with people with personal experience of homelessness, health and social care professionals and hostel and outreach staff. Saturation was reached when no new themes emerged from discussions. 28 focus groups and 10 individual interviews were conducted. Participants highlighted that conversations exploring future care preferences and palliative care with people experiencing homelessness are rare. Themes identified as challenges to such conversations included attitudes to death; the recovery focused nature of services for people experiencing homelessness; uncertainty regarding prognosis and place of care; and fear of negative impact. This research highlights the need for a different approach to supporting people who are homeless and are experiencing advanced ill health, one that incorporates uncertainty and promotes well-being, dignity and choice. We propose parallel planning and mapping as a way of working with uncertainty. We acknowledge that these approaches will not always be straightforward, nor will they be suitable for everyone, yet moving the focus of conversations about the future away from death and dying, towards the present and the future may facilitate conversations and enable the wishes of people who are homeless to be known and explored.
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影响因子：
3.9
作者：
DANSEREAU, DF;JOE, GW;SIMPSON, DD
通讯作者：
SIMPSON, DD
影响因子：
3.2
作者：
Hakanson, Cecilia;Sandberg, Jonas;Ohlen, Joakim
通讯作者：
Ohlen, Joakim
DOI：
10.1177/1049909112448925
发表时间：
2013-05-01
影响因子：
1.9
作者：
Krakowsky, Yonah;Gofine, Mirriam;Knowles, Holly
通讯作者：
Knowles, Holly
影响因子：
--
作者：
Larson, Anne M
通讯作者：
Larson, Anne M
DOI：
10.1136/bmj.b4036
发表时间：
2009-10-26
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Hwang SW;Wilkins R;Tjepkema M;O'Campo PJ;Dunn JR
通讯作者：
Dunn JR