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


METHODS
Qualitative study utilizing focus groups.


METHODS
Fifty-three homeless persons recruited from agencies providing homeless services.


METHODS
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.
Song
John
J
Center for Bioethics, University of Minnesota, Minneapolis, MN 55455, USA. songx006@umn.edu
Bartels
Dianne M
DM
Ratner
Edward R
ER
Alderton
Lucy
L
Hudson
Brenda
B
Ahluwalia
Jasjit S
JS
D000328:Adult; D000368:Aged; D001293:Attitude to Death; D005260:Female; D017144:Focus Groups; D006703:Ill-Housed Persons / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D013727:Terminal Care / Q000523:psychology*; D019452:Terminally Ill / Q000523:psychology