{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T17:23:09Z","timestamp":1785172989017,"version":"3.55.0"},"reference-count":59,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"National Institute for Health Research (NIHR) under its Research for Patient Benefit (RFPB) programme","award":["NIHR275107"],"award-info":[{"award-number":["NIHR275107"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Palliat&amp;#65533;Care"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Homeless people using substances at the end-of-life face many challenges in accessing and receiving good care. These can relate to poor interdisciplinary working by health and social care practitioners, stigma and structural disadvantage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>Using positioning theory, we explored the challenges of existing models of practice for practitioners supporting this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Research design:<\/jats:title>\n                    <jats:p>This is a qualitative descriptive study in which data were collected via four interdisciplinary practitioner focus groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data sources and methods:<\/jats:title>\n                    <jats:p>The four online interdisciplinary focus groups were conducted within a region of North-West England. This included 24 participants from health and social care providers with experience of working with and\/or supporting people experiencing homelessness and using substances.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The findings indicated three primary discourse positions related to (i) What constitutes a good death and where? (ii) The limitations of professional boundaries and (iii) Maintaining moral adequacy in the face of traumatic death. For practitioners, maintaining moral adequacy was often compromised by ineffective multi-disciplinary collaboration. Practitioners were often exposed to traumatic working experiences with limited resources to effect change.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The findings support work examining the structural and environmental challenges of palliative care provision for hostel-users and unsheltered homeless people in providing care at the end of life for people experiencing homelessness.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/26323524251382262","type":"journal-article","created":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T05:13:20Z","timestamp":1764220400000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Is moral adequacy possible in the face of structural disadvantage? The experiences of health and social care staff in supporting homeless people using substances at the end of life"],"prefix":"10.1177","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8575-7533","authenticated-orcid":false,"given":"Gary","family":"Witham","sequence":"first","affiliation":[{"name":"School of Nursing and Public Health, Manchester Metropolitan University, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gemma Anne","family":"Yarwood","sequence":"additional","affiliation":[{"name":"School of Nursing and Public Health, Manchester Metropolitan University, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Galvani","sequence":"additional","affiliation":[{"name":"School of Nursing and Public Health, Manchester Metropolitan University, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucy","family":"Webb","sequence":"additional","affiliation":[{"name":"School of Nursing and Public Health, Manchester Metropolitan University, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sam","family":"Wright","sequence":"additional","affiliation":[{"name":"School of Nursing and Public Health, Manchester Metropolitan University, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,11,26]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2023-075498"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.5694\/mja2.52585"},{"key":"e_1_3_2_4_2","unstructured":"Galvani S Clayson A Webb L et al. Will a new approach to end-of-life care for people who use substances improve their access to and experience of palliative and end-of-life care? https:\/\/endoflifecaresubstanceuse.com\/wp-content\/uploads\/2023\/03\/Galvani-et-al.-NIHR-exec-summary-Final-21-Feb-2023.pdf (2023 accessed October 2024)."},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12904-019-0396-7"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1177\/0269216317717101"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthplace.2018.06.005"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.3122\/jabfm.2019.06.190066"},{"key":"e_1_3_2_9_2","unstructured":"GM Government. From harm to hope: a 10-year drugs plan to cut crime and save lives. First annual report 2022\u201323 https:\/\/assets.publishing.service.gov.uk\/media\/64b8f0482059dc00125d262c\/15.109_HO_Harm_to_Hope_AR_2022-23.pdf (2023 accessed 14 February 2024)."},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-017502"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12904-018-0368-3"},{"issue":"5","key":"e_1_3_2_12_2","article-title":"End of life care for people with alcohol and drug problems: findings from a Rapid Evidence Assessment","volume":"27","author":"Witham G","year":"2019","unstructured":"Witham G, Peacock M, Galvani S. End of life care for people with alcohol and drug problems: findings from a Rapid Evidence Assessment. Health Soc Care Commun 2019; 27(5): e637\u2013e650.","journal-title":"Health Soc Care Commun"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/0969733019871685"},{"key":"e_1_3_2_14_2","unstructured":"Templeton L Galvani S Peacock M et al. Key informant interviews: end of life care for people with alcohol and drug problems https:\/\/endoflifecaresubstanceuse.files.wordpress.com\/2018\/11\/end-of-life-care-for-people-with-substance-use-ki-full-report.pdf (2018 accessed August 2025)."},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2018.05.011"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.3122\/jabfm.2019.06.190093"},{"key":"e_1_3_2_17_2","unstructured":"Wright S Yarwood GA Templeton L et al. Experiences of families friends carers: phase 1 end of life care for people with alcohol and drug Problems 2018 https:\/\/endoflifecaresubstanceuse.files.wordpress.com\/2018\/11\/end-of-life-care-for-people-with-substance-use-family-strand-phase-1-report.pdf (accessed March 2023)."},{"key":"e_1_3_2_18_2","unstructured":"Galvani SA Dance C Wright S. Experiences of hospice and substance use professionals: end of life care for people with alcohol and drug problems https:\/\/e-space.mmu.ac.uk\/621802\/1\/End%20of%20Life%20Care%20and%20SU%20Prof%20experience%20Strand%205%20full%20report%20final%205%20Nov%202018.pdf (2018 accessed October 2024)."},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1136\/spcare-2024-004883"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12904-024-01416-4"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1093\/hsw\/hlab039"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.29333\/ajqr\/15882"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.2011.03615.x"},{"key":"e_1_3_2_24_2","volume-title":"Nursing practice: the ethical issues","author":"Jameton A.","year":"1984","unstructured":"Jameton A. Nursing practice: the ethical issues. Prentice-Hall, 1984."},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11019-020-09942-7"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1111\/1467-9566.ep10486851"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1177\/1049732317736285"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1177\/1525822X16639015"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1177\/1468794109348683"},{"key":"e_1_3_2_30_2","first-page":"14","volume-title":"Positioning theory: moral context of intentional action","author":"Harr\u00e9 R","year":"1999","unstructured":"Harr\u00e9 R, Van Langenhove L. Introducing positioning theory. In Harr\u00e9 R, Langenhove L (eds) Positioning theory: moral context of intentional action. 1st ed. Blackwell, 1999, pp. 14\u201331.","edition":"1"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1177\/0959354308101417"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-5914.1990.tb00174.x"},{"key":"e_1_3_2_33_2","volume-title":"Handbook of qualitative research","author":"Denzin NK","year":"1994","unstructured":"Denzin NK, Lincoln YS (eds). Handbook of qualitative research. Sage, 1994"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1017\/S1478951515001285"},{"key":"e_1_3_2_35_2","volume-title":"Lectures on conversation","author":"Sacks H.","year":"1992","unstructured":"Sacks H. Lectures on conversation, vol. 1 and 11. Oxford: Blackwell, 1992."},{"key":"e_1_3_2_36_2","first-page":"162","volume-title":"Qualitative research: theory method and practice","author":"Baker CD.","year":"2004","unstructured":"Baker CD. Membership categories and interview accounts. In:Silverman D (ed.) Qualitative research: theory method and practice. Sage, 2004, pp. 162\u2013177."},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0303013"},{"key":"e_1_3_2_38_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2017.11.015"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2021.103984"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.1080\/07481187.2014.958629"},{"key":"e_1_3_2_41_2","doi-asserted-by":"publisher","DOI":"10.4324\/9781003187882-3"},{"key":"e_1_3_2_42_2","doi-asserted-by":"crossref","unstructured":"Ingle MP Cutforth A Hasche L et al. Centering humanizing individualized care amid systemic barriers: a qualitative exploration of provider approaches to palliative and end-of-life care for unhoused adults. Health Soc Care Commun 2025: 6631688. https:\/\/doi.org\/10.1155\/hsc\/6631688","DOI":"10.1155\/hsc\/6631688"},{"key":"e_1_3_2_43_2","doi-asserted-by":"publisher","DOI":"10.1080\/10530789.2021.1961990"},{"key":"e_1_3_2_44_2","doi-asserted-by":"crossref","unstructured":"Mittal A Lowe E Feldman C et al. \u201cI don\u2019t want to die on the street\u201d: patient and practitioner perspectives on street-based care for older adults experiencing unsheltered homelessness. J Gen Intern Med. Epub ahead of print 28 May 2025. https:\/\/doi.org\/10.1007\/s11606-025-09591-7","DOI":"10.1007\/s11606-025-09591-7"},{"key":"e_1_3_2_45_2","doi-asserted-by":"publisher","DOI":"10.4324\/9781003187882-4"},{"key":"e_1_3_2_46_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph191811484"},{"key":"e_1_3_2_47_2","doi-asserted-by":"publisher","DOI":"10.1177\/082585971202800308"},{"key":"e_1_3_2_48_2","doi-asserted-by":"publisher","DOI":"10.1177\/02692163211061994"},{"key":"e_1_3_2_49_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12904-022-01000-8"},{"key":"e_1_3_2_50_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12904-019-0502-x"},{"key":"e_1_3_2_51_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjspcare-2018-001674"},{"key":"e_1_3_2_52_2","doi-asserted-by":"publisher","DOI":"10.1177\/0969733020964859"},{"key":"e_1_3_2_53_2","doi-asserted-by":"publisher","DOI":"10.1177\/1049909120978826"},{"key":"e_1_3_2_54_2","doi-asserted-by":"publisher","DOI":"10.1177\/1359105315595120"},{"key":"e_1_3_2_55_2","unstructured":"GOV.WALES. Technical Advisory Group: moral injury in health care workers during the COVID-19 pandemic https:\/\/www.gov.wales\/technical-advisory-group-moral-injury-health-care-workers-during-covid-19-pandemic (2021 accessed February 2025)."},{"key":"e_1_3_2_56_2","first-page":"1","article-title":"When I can\u2019t help, I suffer: a scoping review of moral distress in service providers working with persons experiencing homelessness","volume":"23","author":"Perez S","year":"2024","unstructured":"Perez S, Kerman N, Dej E, et al. When I can\u2019t help, I suffer: a scoping review of moral distress in service providers working with persons experiencing homelessness. J Mental Health 2024; 23: 1\u201316.","journal-title":"J Mental Health"},{"key":"e_1_3_2_57_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph22071156"},{"key":"e_1_3_2_58_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2008.06.004"},{"key":"e_1_3_2_59_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.2011.03601.x"},{"key":"e_1_3_2_60_2","doi-asserted-by":"publisher","DOI":"10.4324\/9781003187882-16"}],"container-title":["Palliative Care and Social Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/26323524251382262","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/26323524251382262","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/26323524251382262","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T01:03:57Z","timestamp":1777597437000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/26323524251382262"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11]]},"references-count":59,"alternative-id":["10.1177\/26323524251382262"],"URL":"https:\/\/doi.org\/10.1177\/26323524251382262","relation":{},"ISSN":["2632-3524","2632-3524"],"issn-type":[{"value":"2632-3524","type":"print"},{"value":"2632-3524","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11]]},"article-number":"26323524251382262"}}