title: "I'm sitting here by myself ...": experiences of patients with serious illness at an Urban Public Hospital.
abstract: OBJECTIVE
  To describe experiences of serious illness including concerns, preferences, and perspectives on improving end-of-life (EOL) care in underserved inpatients.
  
  
  METHODS
  Qualitative analysis of 1-hour interviews with inpatients at a public hospital whose physician "would not be surprised" by the patient's death or intensive care unit (ICU) admission within a year. Patients who were non-English speaking, lacked mental capacity, or had uncontrolled symptoms were excluded. A semistructured interview guide was developed and used for all interviews. We digitally recorded, transcribed, and conducted a thematic analysis of the interviews.
  
  
  RESULTS
  Twenty patients participated. Difficult events such as estrangement, homelessness, substance abuse, and imprisonment shaped patients' approaches to serious illness. This influence manifested in interpersonal relationships, conceptualizations of death and concerns about dying, and approaches to coping with EOL. Because patients lacked social support, providers played significant roles at EOL. Patients preferred honest communication with providers and sharing in medical decision-making. A prolonged dying process was feared more than sudden death. Concerns included pain, dying in the hospital, and feeling unwelcome in the hospital. Patients coped by advocating for their own care, engaging with religion/spirituality, and viewing illness as similar to past trauma. Participants suggested that providers listen to their concerns and requested accessible chaplaincy and home-based services.
  
  
  CONCLUSIONS
  Providers should consider that difficult life events influence underserved patients' approaches to dying. Attention to patients' specific preferences and palliative care in public hospitals and locations identified as home may improve care for patients who lack social support.
authors.affiliation: School of Medicine, UCSF, San Francisco, California 94122, USA. virginia.dzul-church@ucsf.edu
authors.forename: Virginia
authors.initials: V
authors.lastname: Dzul-Church
authors.forename: Jenica W
authors.initials: JW
authors.lastname: Cimino
authors.forename: Shelley R
authors.initials: SR
authors.lastname: Adler
authors.forename: Piera
authors.initials: P
authors.lastname: Wong
authors.forename: Wendy G
authors.initials: WG
authors.lastname: Anderson
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006779:Hospitals, Public; D006801:Humans; D007362:Intensive Care Units; D007407:Interviews as Topic; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D010344:Patient Advocacy; D057240:Patient Preference; D010361:Patients / Q000523:psychology*; D012495:San Francisco; D012720:Severity of Illness Index; D012934:Social Isolation; D013727:Terminal Care; D014505:Urban Population