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The views of homeless people and healthcare professionals on palliative care and the desirability of setting up a consultation service: a focus group study.

Klop, H.T., Dongen, S.I. van, Francke, A.L., Veer, A.J.E. de, Rietjens, J.A.C., Gootjes, J.R.G., Onwuteaka-Philipsen, B.D. The views of homeless people and healthcare professionals on palliative care and the desirability of setting up a consultation service: a focus group study. Journal of Pain and Symptom Management: 2018, 56(3), 327-336
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Context
Palliative care for homeless people is often given late, if at all. Professionals in both palliative care and shelter care are often insufficiently equipped to provide this complex care.

Objectives
To provide insights into the palliative care experiences of professionals and homeless people., including barriers and facilitators to care, and to investigate whether a consultative function can help improve palliative care for homeless people.

Methods
Six focus groups; four with professionals (n=19) and two with severely ill homeless people (n=15). Professionals were sampled purposively in organizations providing (palliative) care to the homeless. Homeless people were recruited by opportunity sampling.

Results
Palliative care for homeless people is especially complex and differs substantially from regular palliative care. It differs greatly between professionals, institutions and cities. Homeless people get less autonomy than they would like. Homeless people and professionals have different perceptions of the care provided. Trusting relationships between professionals and homeless people are essential, and easily accessible, and flexible care is needed. Consultation, in particular involving exchange of expertise between professionals, can provide added value to professionals. Homeless people consider consultation primarily as an opportunity to train professionals to show more understanding, provide tailored palliative care and enhance professional collaboration. The local situation, characteristics of a consultant and role of a consultant in providing information and education must be considered when developing the consultation process.

Conclusion
Consultation can play an important role in improving palliative care by linking disciplines, providing support to professionals and providing appropriate palliative care to homeless people. (aut. ref.)