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Access to palliative care of homeless people: perceived barriers and facilitators from different viewpoints.

Veer, A.J.E. de, Stringer, B., Meijel, B. van, Verkaik, R., Francke, A. Access to palliative care of homeless people: perceived barriers and facilitators from different viewpoints. European Journal of Palliative Care: 2015 59. Abstract. 14th World Congress of the European Association for Palliative Care: Building Bridges. 8-10 mei 2015, Copenhagen.
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Background
Homeless people may have various physical, psychosocial and psychiatric problems, including substance abuse. They have a shorter life-expectancy (< 20 yrs) in comparison with the general population and often avoid help for the problems mentioned. They relatively often suffer from progressive diseases like COPD, chronic heart failure and lung cancer. Little is known about how palliative care for this target group is organized and can be improved.

Aim
The aim is to describe the characteristics of palliative care for homeless people in the Netherlands and what barriers and facilitators exist for palliative care from the perspectives of the patients, their relatives and professionals.

Methods
In this qualitative study fifteen cases of homeless people needing palliative care are intensively studied. For each case we interview on average 3 people, including patients, relatives/friends, doctors, nurses and social workers. The interviews are transcribed verbatim and analysed inductively. Interviews are held in 2014 and 2015.

Results
Preliminary data show that different organisations and professionals are involved with homeless people. It is difficult to maintain long-lasting relationships with the patients. Their social network is often not stable and unable to give sufficient support. Mental health professionals generally feel inadequately trained to provide good palliative care. On the other hand, professionals in palliative care feel inadequately trained in deal with psychiatric problems and challenging behavior.

Conclusion
As far as we know this is one of first studies describing palliative care practices for homeless people. Cooperation between palliative care professionals and mental health professionals, who have much experience in supporting this target group, is needed to improve care for homeless people at the end of life and to realize better access to palliative care.