{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T19:28:11Z","timestamp":1792006091579,"version":"4.4.0"},"reference-count":65,"publisher":"BMJ","issue":"11","funder":[{"DOI":"10.13039\/100001275","name":"The Oak Foundation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100001275","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Coordinate My Care"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2017,10,6]]},"published-print":{"date-parts":[[2017,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To explore the views and experiences of people who are homeless and those supporting them regarding conversations and approaches to palliative care<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>\n                      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\n                      <jats:bold>).<\/jats:bold>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2017-017502","type":"journal-article","created":{"date-parts":[[2017,11,28]],"date-time":"2017-11-28T19:20:21Z","timestamp":1511896821000},"page":"e017502","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":40,"title":["Challenges to discussing palliative care with people experiencing homelessness: a qualitative study"],"prefix":"10.1136","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2907-1764","authenticated-orcid":false,"given":"Briony F","family":"Hudson","sequence":"first","affiliation":[{"name":"Pathway, London, UK"},{"name":"Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Shulman","sequence":"additional","affiliation":[{"name":"Pathway, London, UK"},{"name":"Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK"},{"name":"Kings Health Partners, Kings College Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Low","sequence":"additional","affiliation":[{"name":"Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nigel","family":"Hewett","sequence":"additional","affiliation":[{"name":"Pathway, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian","family":"Daley","sequence":"additional","affiliation":[{"name":"Pathway, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Davis","sequence":"additional","affiliation":[{"name":"Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nimah","family":"Brophy","sequence":"additional","affiliation":[{"name":"St Mungos, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Howard","sequence":"additional","affiliation":[{"name":"Coordinate My Care, The Royal Marsden NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bella","family":"Vivat","sequence":"additional","affiliation":[{"name":"Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Kennedy","sequence":"additional","affiliation":[{"name":"Pathway, London, UK"},{"name":"St Mungos, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Stone","sequence":"additional","affiliation":[{"name":"Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2017,11,28]]},"reference":[{"key":"2025121604475558000_7.11.e017502.1","unstructured":"Public Health England. Guidance to Homelessness: applying all our health: Evidence and guidance to enable healthcare professionals make improvements against wider factors that affect health and wellbeing. 2016 https:\/\/www.gov.uk\/government\/publications\/homelessness-applying-all-our-health"},{"key":"2025121604475558000_7.11.e017502.2","unstructured":"Department for communities and local government. Rough sleeping statistics Autumn 2016, England. 2017 https:\/\/www.gov.uk\/government\/statistics\/rough-sleeping-in-england-autumn-2016"},{"key":"2025121604475558000_7.11.e017502.3","doi-asserted-by":"publisher","DOI":"10.7861\/clinmedicine.14-4-349"},{"key":"2025121604475558000_7.11.e017502.4","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b4036"},{"key":"2025121604475558000_7.11.e017502.5","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e5999"},{"key":"2025121604475558000_7.11.e017502.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2015.03.038"},{"key":"2025121604475558000_7.11.e017502.7","doi-asserted-by":"crossref","first-page":"1478","DOI":"10.1016\/S0140-6736(14)61132-6","article-title":"The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations","volume":"384","author":"Fazel","year":"2014","journal-title":"The Lancet"},{"key":"2025121604475558000_7.11.e017502.8","unstructured":"Thomas B . Homelessness Kills: an analysis of the mortality of homeless people in early twenty-first century England. London: Crisis and The University of Sheffield, 2012. 978-1-899257-78-2."},{"key":"2025121604475558000_7.11.e017502.9","doi-asserted-by":"publisher","DOI":"10.7861\/clinmedicine.16-6-506"},{"key":"2025121604475558000_7.11.e017502.10","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.109-3756"},{"key":"2025121604475558000_7.11.e017502.11","doi-asserted-by":"publisher","DOI":"10.1177\/1049732315588500"},{"key":"2025121604475558000_7.11.e017502.12","doi-asserted-by":"publisher","DOI":"10.1111\/jan.12675"},{"key":"2025121604475558000_7.11.e017502.13","unstructured":"Homeless Link.The unhealthy state of homelessness: health audit results 2014: Homeless link, 2014"},{"key":"2025121604475558000_7.11.e017502.14","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1186\/s12904-016-0168-6","article-title":"Challenges to access and provision of palliative care for people who are homeless: a systematic review of qualitative research","volume":"15","author":"Hudson","year":"2016","journal-title":"BMC Palliat Care"},{"key":"2025121604475558000_7.11.e017502.15","unstructured":"Hudson BF , Shulman C , Stone P . \u2018Nowhere else will take him\u2019 \u2013 Palliative care and homelessness. J Palliat Med 2017;24."},{"key":"2025121604475558000_7.11.e017502.16","first-page":"026921631771710","article-title":"End-of-life care for homeless people: a qualitative analysis exploring the challenges to access and provision of palliative care","volume":"0","author":"Shulman","year":"2017","journal-title":"Palliat Med"},{"key":"2025121604475558000_7.11.e017502.17","doi-asserted-by":"crossref","unstructured":"McNeil R , Guirguis-Younger M . Dignity in design: the siting and design of community and shelter-based health facilities for homeless person. In: Guirguis-Younger M , McNeil R , Hwang SW . Homelessness and Health in Canada. Canada: University of Ottawa Press, 2014:233\u201351.","DOI":"10.1515\/9780776621487-013"},{"key":"2025121604475558000_7.11.e017502.18","doi-asserted-by":"publisher","DOI":"10.1186\/1472-684X-11-14"},{"key":"2025121604475558000_7.11.e017502.19","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-006-0046-7"},{"key":"2025121604475558000_7.11.e017502.20","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1086\/JCE200516312","article-title":"Dying while homeless: is it a concern when life itself is such a struggle?","volume":"16","author":"Song","year":"2005","journal-title":"J Clin Ethics"},{"key":"2025121604475558000_7.11.e017502.21","doi-asserted-by":"crossref","first-page":"187","DOI":"10.3747\/co.24.3129","article-title":"Palliative care as a public health issue: understanding disparities in access to palliative care for the homeless population living in Toronto, based on a policy analysis","volume":"24","author":"Henry","year":"2017","journal-title":"Curr Oncol"},{"key":"2025121604475558000_7.11.e017502.22","first-page":"59","article-title":"Developing palliative care services in regional areas. The Ipswich Palliative Care Network model","volume":"30","author":"Mitchell","year":"2001","journal-title":"Aust Fam Physician"},{"key":"2025121604475558000_7.11.e017502.23","doi-asserted-by":"publisher","DOI":"10.7861\/clinmedicine.16-3-213"},{"key":"2025121604475558000_7.11.e017502.24","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2005.8.36"},{"key":"2025121604475558000_7.11.e017502.25","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-006-0045-8"},{"key":"2025121604475558000_7.11.e017502.26","doi-asserted-by":"publisher","DOI":"10.1177\/1049909113482176"},{"key":"2025121604475558000_7.11.e017502.27","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1080\/07481187.2014.958629","article-title":"What constitutes a good and bad death?: perspectives of homeless older adults","volume":"39","author":"Ko","year":"2015","journal-title":"Death Stud"},{"key":"2025121604475558000_7.11.e017502.28","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1186\/1471-2458-12-312","article-title":"Harm reduction services as a point-of-entry to and source of end-of-life care and support for homeless and marginally housed persons who use alcohol and\/or illicit drugs: a qualitative analysis","volume":"12","author":"McNeil","year":"2012","journal-title":"BMC Public Health"},{"key":"2025121604475558000_7.11.e017502.29","doi-asserted-by":"publisher","DOI":"10.1177\/0269216311402713"},{"key":"2025121604475558000_7.11.e017502.30","doi-asserted-by":"publisher","DOI":"10.1177\/1049909112448925"},{"key":"2025121604475558000_7.11.e017502.31","doi-asserted-by":"crossref","first-page":"83","DOI":"10.12968\/ijpn.2014.20.2.83","article-title":"Reaching out to Ray: delivering palliative care services to a homeless person in Melbourne, Australia","volume":"20","author":"MacWilliams","year":"2014","journal-title":"Int J Palliat Nurs"},{"key":"2025121604475558000_7.11.e017502.32","doi-asserted-by":"crossref","first-page":"236","DOI":"10.12968\/ijpn.2015.21.5.236","article-title":"When dying at home is not an option: exploration of hostel staff views on palliative care for homeless people","volume":"21","author":"Webb","year":"2015","journal-title":"Int J Palliat Nurs"},{"key":"2025121604475558000_7.11.e017502.33","doi-asserted-by":"publisher","DOI":"10.1191\/0269216306pm1103oa"},{"key":"2025121604475558000_7.11.e017502.34","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1177\/082585971202800308","article-title":"Harm reduction and palliative care: is there a role for supervised drug consumption services?","volume":"28","author":"McNeil","year":"2012","journal-title":"J Palliat Care"},{"key":"2025121604475558000_7.11.e017502.35","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-008-0771-1"},{"key":"2025121604475558000_7.11.e017502.36","doi-asserted-by":"publisher","DOI":"10.1177\/0269216315575679"},{"key":"2025121604475558000_7.11.e017502.37","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-153-2-201007200-00003"},{"key":"2025121604475558000_7.11.e017502.38","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1177\/0269216316649334","article-title":"Advance care planning, palliative care, and end-of-life care interventions for homeless people: A systematic review","volume":"31","author":"Sumalinog","year":"2017","journal-title":"Palliat Med"},{"key":"2025121604475558000_7.11.e017502.39","unstructured":"Mayor of London. CHAIN annual report: greater London april 2015- march 2016. London: Greater London Authority, 2016. https:\/\/files.datapress.com\/london\/dataset\/chain-reports\/2017-06-30T09:03:07.84\/Greater London full 2016-17.pdf"},{"key":"2025121604475558000_7.11.e017502.40","unstructured":"Bhatti V , Currie D , Sapsaman T . Atlas of services for homeless people in London: London Housing Foundation, 2016."},{"key":"2025121604475558000_7.11.e017502.41","unstructured":"Bax A , Hewett N . Pathway annual report. 2015 https:\/\/www.pathway.org.uk\/wp-content\/uploads\/2013\/02\/Pathway-Annual-Report-2015.pdf"},{"key":"2025121604475558000_7.11.e017502.42","unstructured":"Finlayson S , Boelman V , Young R . Saving lives, saving money: how homeless health peer advocacy reduces health inequalities. London: The Young Foundation, Groundswell, The Oak Foundation, 2016."},{"key":"2025121604475558000_7.11.e017502.43","unstructured":"St Mungo\u2019s Ending Homeless and Rebuilding Lives. St Mungo\u2019s apprenticeship scheme. 2015 http:\/\/www.mungos.org\/apprenticeship_scheme: St Mungos Broadway"},{"key":"2025121604475558000_7.11.e017502.44","doi-asserted-by":"publisher","DOI":"10.1586\/erp.10.30"},{"key":"2025121604475558000_7.11.e017502.45","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"2025121604475558000_7.11.e017502.46","unstructured":"Willig C . Beyond appearances: A critical realist approach to social constructionist work. In: Nightingsale I , Cromby J . Social constructionist psychology: a critical analysis of theory and practice. Buckingham, 1999."},{"key":"2025121604475558000_7.11.e017502.47","doi-asserted-by":"publisher","DOI":"10.1177\/0969733015583926"},{"key":"2025121604475558000_7.11.e017502.48","doi-asserted-by":"publisher","DOI":"10.1378\/chest.127.6.2180"},{"key":"2025121604475558000_7.11.e017502.49","unstructured":"Breedvelt J . Psychologically informed environments: a literature review. London: Mental Health Foundation St Mungos, 2016. https:\/\/www.mentalhealth.org.uk\/sites\/default\/files\/pies-literature-review.pdf"},{"key":"2025121604475558000_7.11.e017502.50","unstructured":"Johnson R , Haigh R . Complex trauma and its effects: perspectives on creating an environment for recovery. Brighton: Pavilion Publishing, 2012."},{"key":"2025121604475558000_7.11.e017502.51","doi-asserted-by":"publisher","DOI":"10.1108\/14608791211238412"},{"key":"2025121604475558000_7.11.e017502.52","unstructured":"Keats H , Maguire N , Johnson R , et al . Psychologically informed services for homeless people good practice guide: Department of Communities and Local Government. 2012 http:\/\/www.rjaconsultancy.org.uk\/6454%20clg%20pie%20operational%20document%20aw-1.pdf"},{"key":"2025121604475558000_7.11.e017502.53","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2015-009241"},{"key":"2025121604475558000_7.11.e017502.54","doi-asserted-by":"crossref","first-page":"1271","DOI":"10.1089\/jpm.2013.0167","article-title":"Integration of palliative care in end-stage liver disease and liver transplantation","volume":"17","author":"Potosek","year":"2014","journal-title":"J Palliat Med"},{"key":"2025121604475558000_7.11.e017502.55","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1016\/j.cgh.2013.08.027","article-title":"Patients with cirrhosis and denied liver transplants rarely receive adequate palliative care or appropriate management","volume":"12","author":"Poonja","year":"2014","journal-title":"Clin Gastroenterol Hepatol"},{"key":"2025121604475558000_7.11.e017502.56","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1007\/s11894-015-0440-6","article-title":"Palliative care for patients with end-stage liver disease","volume":"17","author":"Larson","year":"2015","journal-title":"Curr Gastroenterol Rep"},{"key":"2025121604475558000_7.11.e017502.57","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1016\/j.jpainsymman.2015.07.014","article-title":"Benefit of early palliative care intervention in end-stage liver disease patients awaiting liver transplantation","volume":"50","author":"Baumann","year":"2015","journal-title":"J Pain Symptom Manage"},{"key":"2025121604475558000_7.11.e017502.58","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2014.58.7824"},{"key":"2025121604475558000_7.11.e017502.59","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1000678"},{"key":"2025121604475558000_7.11.e017502.60","doi-asserted-by":"publisher","DOI":"10.1001\/jama.296.24.2959"},{"key":"2025121604475558000_7.11.e017502.61","doi-asserted-by":"publisher","DOI":"10.1111\/j.1547-5069.1990.tb00225.x"},{"key":"2025121604475558000_7.11.e017502.62","doi-asserted-by":"publisher","DOI":"10.1111\/j.1547-5069.1988.tb00082.x"},{"key":"2025121604475558000_7.11.e017502.63","doi-asserted-by":"publisher","DOI":"10.1037\/0022-0167.40.4.385"},{"key":"2025121604475558000_7.11.e017502.64","unstructured":"NHS. Routes to recovery ITEP & BTEI: new approaches to psychosocial intervention. London: National Treatment Agency for Substance Misuse, The University of Birmingham, 2008 http:\/\/www.nta.nhs.uk\/uploads\/itep_routes_to_recovery_summary_180209.pdf"},{"key":"2025121604475558000_7.11.e017502.65","unstructured":"Homeless Link. Support for single homeless people in England annual review 2016. London: Homeless Link, 2016. http:\/\/www.homeless.org.uk\/sites\/default\/files\/site-attachments\/Full%20report%20-%20Support%20for%20single%20people%202016.pdf"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2017-017502","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T12:48:47Z","timestamp":1765889327000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2017-017502"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,11]]},"references-count":65,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2017,11,28]]},"published-print":{"date-parts":[[2017,11]]}},"alternative-id":["10.1136\/bmjopen-2017-017502"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2017-017502","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,11]]}}}