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Community Based

Family medicine resident silhouettes at lakeside

Dr. Eva Purkey

Principal Investigator: Dr. Meredith MacKenzie

Co-Investigator: Dr. Eva Purkey (pictured above)

Thirty-five thousand Canadians are homeless on any given night, and mortality rates are much higher than for the general population.  Studies have identified barriers to accessing end of life care among the homeless, including logistical barriers and experiences of stigma.  Canada prides itself on a public healthcare system that is available to all, yet in reality, many services are not accessible to equity-seeking groups.  Family physicians, as community-based practitioners, need to be aware of the barriers to care for the populations they serve. 

This study seeks to explore the experience, goals, fears, and hopes surrounding death in the setting of homelessness or vulnerable housing using a qualitative phenomenological study involving focus groups and in-depth interviews and the collection of additional sociodemographic data from participants.  The setting, South East Local Health Integration Network (SELHIN) in Ontario, Canada, with a catchment area of 443,000.  Participants included 31 people living in the SELHIN with lived experience of homelessness. 

Themes included extensive experience with death and dying, relationship with mortality, ideas for a good death, and desires for end of life care.  Participants presented suggestions for improving end of life care including care that was delivered by people with lived experience of homelessness and substance use; care that was provided either as outreach or in a welcoming, flexible institutional environment;  care that minimized stigma and enhanced dignity; and care that respected people’s desires to use substances at the end of life. 

Participants with lived experience of homelessness were articulate in their desires and needs for end of life care.  They have extensive exposure to mortality and feel that their needs are not met by the current palliative care system.  Recommendations for system change that include harm reduction and equity-oriented healthcare, as well as a combination of outreach and inpatient services, are necessary before palliative care services will be accessible for this population.