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. 2007 Apr;22(4):435-41.
doi: 10.1007/s11606-006-0046-7.

Dying on the streets: homeless persons' concerns and desires about end of life care

John Song  1 , Dianne M Bartels, Edward R Ratner, Lucy Alderton, Brenda Hudson, Jasjit S Ahluwalia
Affiliations

Dying on the streets: homeless persons' concerns and desires about end of life care

John Song et al. J Gen Intern Med. 2007 Apr.

Abstract

Background: There is little understanding about the experiences and preferences at the end of life (EOL) for people from unique cultural and socioeconomic backgrounds. Homeless individuals are extreme examples of these overlooked populations; they have the greatest risk of death, encounter barriers to health care, and lack the resources and relationships assumed necessary for appropriate EOL care. Exploring their desires and concerns will provide insight for the care of this vulnerable and disenfranchised population, as well as others who are underserved.

Objective: Explore the concerns and desires for EOL care among homeless persons.

Design: Qualitative study utilizing focus groups.

Participants: Fifty-three homeless persons recruited from agencies providing homeless services.

Measurements: In-depth interviews, which were audiotaped and transcribed.

Results: We present 3 domains encompassing 11 themes arising from our investigation, some of which are previously unreported. Homeless persons worried about dying and EOL care; had frequent encounters with death; voiced many unique fears, such as dying anonymously and undiscovered; favored EOL documentation, such as advance directives; and demonstrated ambivalence towards contacting family. They also spoke of barriers to EOL care and shared interventions to improve dying among the very poor and estranged.

Conclusions: Homeless persons have significant personal experience and feelings about death, dying, and EOL care, much of which is different from those previously described in the EOL literature about other populations. These findings have implications not only for homeless persons, but for others who are poor and disenfranchised.

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Comment in

  • Dying on the streets.
    Jackson JL, Sessums L. Jackson JL, et al. J Gen Intern Med. 2007 Apr;22(4):554-5. doi: 10.1007/s11606-007-0145-0. J Gen Intern Med. 2007. PMID: 17372810 Free PMC article. No abstract available.

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References

    1. National Institutes of Health State-of-the-Science Conference Statement on Improving End-of-Life Care December 6–8, 2004. Available at: http://www.consensus.nih.gov/2004/2004EndOfLifeCareSOS024html.htm. Accessed March 16, 2006. - PubMed
    1. None
    2. Burt MR. Homelessness: definitions and counts. In: Baumohl J, ed. Homelessness in America. Phoenix, AZ: Oryx Press, 1996:15–23.
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1001/jama.262.10.1352', 'is_inner': False, 'url': 'https://doi.org/10.1001/jama.262.10.1352'}, {'type': 'PubMed', 'value': '2761036', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/2761036/'}]}
    2. Breakey WR, Fischer PJ, Kramer M. Health and mental problems of homeless men and women in Baltimore. JAMA 1989; 262:1352–7. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1001/jama.262.14.1973', 'is_inner': False, 'url': 'https://doi.org/10.1001/jama.262.14.1973'}, {'type': 'PubMed', 'value': '2778933', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/2778933/'}]}
    2. Gelberg L, Linn LS. Assessing the physical health of homeless adults. JAMA 1989; 262:1973–9. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'PMC', 'value': 'PMC1508869', 'is_inner': False, 'url': 'https://pmc.ncbi.nlm.nih.gov/articles/PMC1508869/'}, {'type': 'PubMed', 'value': '10191796', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/10191796/'}]}
    2. Barrow SM, Herman DB, Cordova PBA. Mortality among shelter residents in New York City. Am J Public Health 1999; 89:529–34. - PMC - PubMed

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