Title: Learning from the deaths of homeless people; supporting understanding in order to improve access to palliative care in the final year of life
Funder: Marie Curie

Abstract: Background: Deaths of people experiencing homelessness (PEH) are often perceived as sudden and unexpected, with little access to palliative care until very late in an individual’s illness, if at all. In the general population diagnosis is the primary determinant of access to Palliative care even though cancer only accounts for approximately 29% of deaths [1]. We believe this also to be true in PEH where cancer accounts for an even smaller proportion of deaths. This study aims to look at the final year of life for PEH in Manchester to try to identify recurring themes in order to better understand prognostic indicators in this group. Question: To discover if diagnosis impacts access to palliative care and if there are missed opportunities for palliative care involvement in the last year of life for people experiencing homelessness who died between 2010 – 2020. Study Design: A retrospective study of general practice electronic patient records. Methods: Electronic patient records from a general practice surgery specialising in care for homeless people in Manchester will be examined. Potential impact: There is currently very little quantitative research regarding homelessness and access to palliative care. The value of this study lies in the understanding of the last year of life for PEH, what their palliative care needs were and what missed opportunities can be identified and learned from to support better identification of this group going forward. Dissemination: Learnings will be disseminated through written reports supported with parliamentary/policy briefings shared with palliative care and inclusion health professionals, frontline homelessness organisations, Integrated Care Systems, local commissioners, political stakeholders, presented at conferences and within journal papers. Parliamentary activity such as motions of support and/or written oral parliamentary questions will be undertaken if appropriate, PR activity (press releases, blogs, opinion pieces and social media) will be used for wider public engagement.

Lay abstract: Background: Deaths of homeless people are often seemingly sudden and unexpected, with little access to palliative care until late in an individual’s illness, if at all. In the general population, diagnosis is the primary factor determining access to Palliative care. Those with a cancer diagnosis make up the vast majority of referrals even though cancer only accounts for a small proportion of deaths each year. In homeless people cancer accounts for an even smaller proportion of deaths. There are many barriers to extending palliative care to people with a non-cancer diagnosis, many of which greatly impact on homeless people. Question: This study aims to look at the final year of life of homeless people in Manchester to try to identify recurring themes in order to better understand prognostic indicators in this patient group. Homeless people often have illnesses with less predictable disease trajectories that are more difficult to identify at a terminal stage. There may also be a lack of clarity about appropriate palliative care goals and greater likelihood of comorbid conditions. We aim to discover if diagnosis impacts access to palliative care in homeless people and if there are missed opportunities for palliative care involvement in the last year of life for people experiencing homelessness. Expected outcome: The outcome of this study is expected to highlight the gaps in palliative care provision for homeless people, identifying the number of people who could have benefited from palliative care input but who did not receive it. It will aim to provide greater insight into prognostic indicators to reduce the number of missed opportunities and help guide towards an alternative model of care for this patient group. This learning will be summarised in a report that will outline findings and recommendations for best practice and earlier identification of palliative need in this patient group.

Research activity codes: 7.2 END OF LIFE CARE
Health categories: GENERIC HEALTH RELEVANCE