From Palliative Medicine
Homelessness is a social and health issue with serious implications for palliative and end-of-life (EOL) care delivery. The aim of this study was to evaluate the evidence surrounding advance care planning, palliative care, and end-of-life care interventions. The conclusion from this evaluation was that models of interventions that address the needs of homeless individuals are needed. This systematic review should help inform clinicians, researchers, and policymakers in future studies investigating this population.
Background: Homeless individuals have a high prevalence of multiple chronic comorbidities and early mortality compared to the general population. They also experience significant barriers to access and stigmatization in the healthcare system. Providing advance
care planning, palliative care, and end-of-life care for this underserved population is an important health issue.
Aim: To summarize and evaluate the evidence surrounding advance care planning, palliative care, and end-of-life care interventions
for homeless persons.
Design: A systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.
Data sources: Articles from MEDLINE, EMBASE, CINAHL, PsycINFO, Social Work Abstracts, Cochrane Library, Web of Science,
and PubMed databases were searched through 13 June 2015. Peer-reviewed studies that implemented advance care planning, palliative
care, and end-of-life care interventions for homeless populations were included. Data from studies were independently extracted
by two investigators using pre-specified criteria, and quality was assessed using modified Cochrane and Critical Appraisal Skills
Results: Six articles met inclusion criteria. Two studies were randomized controlled trials involving advance directive completion.
Two cohort studies investigated the costs of a shelter-based palliative care intervention and predictors for completing advance
directives. These studies were rated low to fair quality. Two qualitative studies explored the interface between harm-reduction services and end-of-life care and the conditions for providing palliative care for homeless persons in a support home.
Conclusion: The effectiveness of advance care planning, palliative care, and end-of-life care interventions for homeless individuals is uncertain. High-quality studies of interventions that reflect the unique and complex circumstances of homeless populations and investigate patient-related outcomes, caregiver burden, and cost-effectiveness are needed.
Rafael Sumalinog, Katy Harrington, Naheed Dosani, and Stephen W Hwang
Advance care planning, palliative care, and end-of-life care interventions for homeless people: A systematic reviewPalliat Med 0269216316649334, first published on June 3, 2016 doi:10.1177/0269216316649334