{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T19:28:10Z","timestamp":1792006090730,"version":"4.4.0"},"reference-count":34,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2024,1,25]],"date-time":"2024-01-25T00:00:00Z","timestamp":1706140800000},"content-version":"unspecified","delay-in-days":24,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Palliative and End of Life Care Research Partnership Scheme","award":["NIHR135250"],"award-info":[{"award-number":["NIHR135250"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,1,8]]},"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Due to the recognition that people experiencing homelessness (PEH) often die young and unsupported, a growing number of initiatives focusing on palliative care and homelessness are emerging across the UK. However, there has been no systematic exploration of the nature and landscape of this work.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To understand the range, aims, successes and challenges of current initiatives within the field of palliative care and homelessness in the UK, by exploring existing projects and initiatives.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>An online survey was distributed to members of an Extension for Community Healthcare Outcomes network focusing on palliative care and homelessness for a mixed professional audience. The survey collated the aims, successes and challenges of initiatives aiming to improve palliative care for PEH. Responses were summarised using descriptive statistics, and free-text responses were analysed using thematic analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>162 professionals completed the survey. Of these, 62% reported involvement in at least one palliative care and homelessness initiative. Initiatives focused on service delivery (59%), training (28%) and research (28%). Themes for success included improved service engagement, relationship formation, housing provision, honouring end-of-life wishes, upskilling staff and enabling safe hospital discharge. The main challenges included stigma around substance misuse, securing funding, staff capacity, equipment and facilities, and engaging communities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The number and scope of initiatives aiming to support PEH with advanced ill health and palliative care needs across the UK is growing, with a range of professionals engaging in the field. Future research may benefit from exploring initiatives in more detail to understand the specific drivers of impact on PEH and the staff and services supporting them.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-075498","type":"journal-article","created":{"date-parts":[[2024,1,25]],"date-time":"2024-01-25T12:31:25Z","timestamp":1706185885000},"page":"e075498","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Understanding aims, successes and challenges of palliative care and homelessness initiatives across the UK: an exploratory study"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2574-4420","authenticated-orcid":false,"given":"Jodie","family":"Crooks","sequence":"first","affiliation":[{"name":"Policy and Research, Marie Curie, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Flemming","sequence":"additional","affiliation":[{"name":"University of York, York, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Shulman","sequence":"additional","affiliation":[{"name":"Pathway, London, UK"},{"name":"UCL, Marie Curie Palliative Care Research Department, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Briony","family":"Hudson","sequence":"additional","affiliation":[{"name":"Policy and Research, Marie Curie, London, UK"},{"name":"UCL, Marie Curie Palliative Care Research Department, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,1,25]]},"reference":[{"key":"2025121602390366000_14.1.e075498.1","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/S0140-6736(17)31869-X","article-title":"Morbidity and mortality in homeless individuals, prisoners, sex workers, and individuals with substance use disorders in high-income countries: a systematic review and meta-analysis","volume":"391","author":"Aldridge","year":"2018","journal-title":"The Lancet"},{"key":"2025121602390366000_14.1.e075498.2","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.b4036","article-title":"Mortality among residents of shelters, rooming houses, and hotels in Canada: 11 year followup study","volume":"339","author":"Hwang","year":"2009","journal-title":"BMJ"},{"key":"2025121602390366000_14.1.e075498.3","unstructured":"Thomas B . [2012]. Homelessness kills: An analysis of the mortality of homeless people in crisis, Available: https:\/\/apo.org.au\/node\/31560"},{"key":"2025121602390366000_14.1.e075498.4","doi-asserted-by":"publisher","DOI":"10.1177\/0269216317717101"},{"key":"2025121602390366000_14.1.e075498.5","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp19X704609"},{"key":"2025121602390366000_14.1.e075498.6","doi-asserted-by":"publisher","DOI":"10.1136\/jech-2020-215204"},{"key":"2025121602390366000_14.1.e075498.7","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp20X710141"},{"key":"2025121602390366000_14.1.e075498.8","doi-asserted-by":"publisher","DOI":"10.1186\/s13722-014-0022-1"},{"key":"2025121602390366000_14.1.e075498.9","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1177\/0030222818801150","article-title":"Bearing witness: exploring the end-of-life needs of homeless persons and barriers to appropriate care","volume":"82","author":"West","year":"2020","journal-title":"OMEGA (Westport)"},{"key":"2025121602390366000_14.1.e075498.10","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2017-017502","article-title":"Challenges to discussing palliative care with people experiencing homelessness: a qualitative study","volume":"7","author":"Hudson","year":"2017","journal-title":"BMJ Open"},{"key":"2025121602390366000_14.1.e075498.11","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1089\/jpm.2016.0313","article-title":"Utility of the \u2018sur-Prise\u2019 question in predicting survival among older patients with acute surgical conditions","volume":"20","author":"Lilley","year":"2017","journal-title":"J Palliat Med"},{"key":"2025121602390366000_14.1.e075498.12","unstructured":"Marie curie . [2020]. End of life care is one of the lowest funded areas of healthcare research, Available: https:\/\/www.mariecurie.org.uk\/media\/press-releases\/end-of-life-care-is-one-of-the-lowest-funded-areas-of-healthcare-research\/266666#_ftn1"},{"key":"2025121602390366000_14.1.e075498.13","unstructured":"St Ann\u2019s Hospice . Homeless palliative care service [2023]. n.d. Available: https:\/\/www.sah.org.uk\/how-we-help\/our-services\/homeless-palliative-care-service\/"},{"key":"2025121602390366000_14.1.e075498.14","unstructured":"St Gemma\u2019s Hospice . Hospice care everywhere \u2013 end of life care for people experiencing homelessness [2023]. n.d. Available: https:\/\/www.st-gemma.co.uk\/blog\/end-of-life-care-homelessness#:~:text=St%20Gemma\u2019s%20has%20launched%20a,can\u2019t%20easily%20access%20it"},{"key":"2025121602390366000_14.1.e075498.15","unstructured":"Hospice UK . Equality in hospice and end of life care: challenges and change. London: Hospice UK, 2021."},{"key":"2025121602390366000_14.1.e075498.16","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":"2025121602390366000_14.1.e075498.17","doi-asserted-by":"publisher","DOI":"10.1136\/bmjspcare-2021-003020"},{"key":"2025121602390366000_14.1.e075498.18","doi-asserted-by":"crossref","first-page":"120","DOI":"10.12968\/ijpn.2020.26.3.120","article-title":"Life\u2019s hard and then you die: the end-of-life priorities of people experiencing homelessness in the UK","volume":"26","author":"Webb","year":"2020","journal-title":"Int J Palliat Nurs"},{"key":"2025121602390366000_14.1.e075498.19","unstructured":"NHS Improving . [2023]. End of life care Achieving quality in hostels and for homeless people - a route to success, Available: https:\/\/www.england.nhs.uk\/improvement-hub\/wp-content\/uploads\/sites\/44\/2017\/11\/End-of-Life-Care-Hostels-and-Homeless-People.pdf"},{"key":"2025121602390366000_14.1.e075498.20","doi-asserted-by":"crossref","first-page":"405","DOI":"10.12968\/bjhc.2016.22.8.405","article-title":"Homeless medical respite in the UK: a needs assessment for South London","volume":"22","author":"Dorney-Smith","year":"2016","journal-title":"British Journal of Healthcare Management"},{"key":"2025121602390366000_14.1.e075498.21","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1108\/HCS-08-2018-0021","article-title":"Homeless medical respite service provision in the UK. housing","volume":"22","author":"Dorney-Smith","year":"2018","journal-title":"HCS"},{"key":"2025121602390366000_14.1.e075498.22","doi-asserted-by":"crossref","first-page":"1202","DOI":"10.1177\/02692163211006318","article-title":"The benefits and challenges of Embedding specialist palliative care teams within homeless hostels to enhance support and learning: perspectives from palliative care teams and hostel staff","volume":"35","author":"Armstrong","year":"2021","journal-title":"Palliat Med"},{"key":"2025121602390366000_14.1.e075498.23","unstructured":"NICE . [2022]. Integrated health and social care for people experiencing homelessness, Available: https:\/\/www.nice.org.uk\/guidance\/ng214\/resources\/integrated-health-and-social-care-for-people-experiencing-homelessness-pdf-66143775200965"},{"key":"2025121602390366000_14.1.e075498.24","unstructured":"Marie curie . [2022]. Project ECHO Homelessness network, Available: https:\/\/www.mariecurie.org.uk\/professionals\/project-echo\/homelessness-network"},{"key":"2025121602390366000_14.1.e075498.25","doi-asserted-by":"crossref","unstructured":"Cooper H , Camic PM , Long DL , et al . APA handbook of research methods in psychology, vol 2: research designs: quantitative, qualitative, neuropsychological, and biological. In: Thematic analysis. Washington: American Psychological Association, 2012. doi:10.1037\/13620-000","DOI":"10.1037\/13620-000"},{"key":"2025121602390366000_14.1.e075498.26","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s12904-020-0520-8","article-title":"International palliative care research priorities: a systematic review","volume":"19","author":"Hasson","year":"2020","journal-title":"BMC Palliat Care"},{"key":"2025121602390366000_14.1.e075498.27","unstructured":"Gov UK . Hospice and palliative care funding allocations 2019 to 2020, . 2019 Available: https:\/\/www.gov.uk\/government\/publications\/hospice-and-palliative-care-funding-allocations-2019-to-2020"},{"key":"2025121602390366000_14.1.e075498.28","unstructured":"Sue Ryder . [2021]. England\u2019s palliative care funding challenge, Available: https:\/\/www.sueryder.org\/sites\/default\/files\/202106\/Palliative%20care%20funding%20briefing_0.pdf"},{"key":"2025121602390366000_14.1.e075498.29","unstructured":"UKCRC HRCS . [2018]. UK Health Research Analysis 2018, Available: https:\/\/hrcsonline.net\/reports\/analysis-reports\/uk-health-research-analysis-2018\/"},{"key":"2025121602390366000_14.1.e075498.30","unstructured":"NIHR . [2022]. Palliative and End of Life Care, Available: https:\/\/www.nihr.ac.uk\/documents\/palliative-and-end-of-life-care\/32107"},{"key":"2025121602390366000_14.1.e075498.31","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)31959-1"},{"key":"2025121602390366000_14.1.e075498.32","unstructured":"Marie curie . [2015]. Palliative and end of life care Priority Setting Partnership (PeolcPSP), Available: https:\/\/www.jla.nihr.ac.uk\/priority-setting-partnerships\/palliative-and-end-of-life-care\/downloads\/Palliative-and-end-of-life-care-PSP-final-report.pdf"},{"key":"2025121602390366000_14.1.e075498.33","first-page":"1","article-title":"Evaluating the perceived added value of a threefold intervention to improve palliative care for persons experiencing homelessness: a mixed-method study among social service and palliative care professionals","volume":"21","author":"Klop","year":"2022","journal-title":"BMC Palliat Care"},{"key":"2025121602390366000_14.1.e075498.34","doi-asserted-by":"crossref","DOI":"10.1186\/s12904-018-0320-6","article-title":"Palliative care for homeless people: a systematic review of the concerns, care needs and preferences, and the barriers and facilitators for providing palliative care","volume":"17","author":"Klop","year":"2018","journal-title":"BMC Palliat Care"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2023-075498","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T10:39:09Z","timestamp":1765881549000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2023-075498"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1]]},"references-count":34,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1,25]]},"published-print":{"date-parts":[[2024,1]]}},"alternative-id":["10.1136\/bmjopen-2023-075498"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2023-075498","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1]]}}}