title: Harm reduction services as a point-of-entry to and source of end-of-life care and support for homeless and marginally housed persons who use alcohol and/or illicit drugs: a qualitative analysis.
abstract: BACKGROUND
  Homeless and marginally housed persons who use alcohol and/or illicit drugs often have end-of-life care needs that go unmet due to barriers that they face to accessing end-of-life care services. Many homeless and marginally housed persons who use these substances must therefore rely upon alternate sources of end-of-life care and support. This article explores the role of harm reduction services in end-of-life care services delivery to homeless and marginally housed persons who use alcohol and/or illicit drugs.
  
  
  METHODS
  A qualitative case study design was used to explore end-of-life care services delivery to homeless and marginally housed persons in six Canadian cities. A key objective was to explore the role of harm reduction services. 54 health and social services professionals participated in semi-structured qualitative interviews. All participants reported that they provided care and support to this population at end-of-life.
  
  
  RESULTS
  Harm reduction services (e.g., syringe exchange programs, managed alcohol programs, etc.) were identified as a critical point-of-entry to and source of end-of-life care and support for homeless and marginally housed persons who use alcohol and/or illicit drugs. Where possible, harm reduction services facilitated referrals to end-of-life care services for this population. Harm reduction services also provided end-of-life care and support when members of this population were unable or unwilling to access end-of-life care services, thereby improving quality-of-life and increasing self-determination regarding place-of-death.
  
  
  CONCLUSIONS
  While partnerships between harm reduction programs and end-of-life care services are identified as one way to improve access, it is noted that more comprehensive harm reduction services might be needed in end-of-life care settings if they are to engage this underserved population.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada. rmcneil@cfenet.ubc.ca
authors.forename: Ryan
authors.initials: R
authors.lastname: McNeil
authors.forename: Manal
authors.initials: M
authors.lastname: Guirguis-Younger
authors.forename: Laura B
authors.initials: LB
authors.lastname: Dilley
authors.forename: Tim D
authors.initials: TD
authors.lastname: Aubry
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Turnbull
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Hwang
mesh_terms: D000428:Alcohol Drinking / Q000453:epidemiology / Q000517:prevention & control; D001291:Attitude of Health Personnel; D002170:Canada; D005260:Female; D040261:Harm Reduction; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006801:Humans; D013287:Illicit Drugs; D007407:Interviews as Topic; D008297:Male; D011369:Professional-Patient Relations; D015397:Program Evaluation; D012107:Research Design; D012111:Residence Characteristics; D012308:Risk Management; D012720:Severity of Illness Index; D012944:Social Support; D015819:Substance Abuse, Intravenous / Q000453:epidemiology / Q000517:prevention & control; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000517:prevention & control; D013727:Terminal Care / Q000706:statistics & numerical data*
chemical_list: D013287:Illicit Drugs