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Stajduhar KI, Giesbrecht M, Mollison A, Whitlock K, Burek P, Black F, Gerke J, Dosani N, Colgan S. "You can't die here": an exploration of the barriers to dying-in-place for structurally vulnerable populations in an urban centre in British Columbia, Canada. BMC Palliat Care 2024; 23:12. [PMID: 38200482 PMCID: PMC10782732 DOI: 10.1186/s12904-024-01340-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 01/03/2024] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND One measure of quality in palliative care involves ensuring people approaching the end of life are able to receive care, and ultimately die, in the places they choose. Canadian palliative care policy directives stem from this tenet of autonomy, acknowledging that most people prefer to die at home, where they feel safe and comfortable. Limited research, however, considers the lack of 'choice' people positioned as structurally vulnerable (e.g., experiencing extreme poverty, homelessness, substance-use/criminalization, etc.) have in regard to places of care and death, with the option of dying-in-place most often denied. METHODS Drawing from ethnographic and participatory action research data collected during two studies that took place from 2014 to 2019 in an urban centre in British Columbia, Canada, this analysis explores barriers preventing people who experience social and structural inequity the option to die-in-place. Participants include: (1) people positioned as structurally vulnerable on a palliative trajectory; (2) their informal support persons/family caregivers (e.g., street family); (3) community service providers (e.g., housing workers, medical professionals); and (4) key informants (e.g., managers, medical directors, executive directors). Data includes observational fieldnotes, focus group and interviews transcripts. Interpretive thematic analytic techniques were employed. RESULTS Participants on a palliative trajectory lacked access to stable, affordable, or permanent housing, yet expressed their desire to stay 'in-place' at the end of life. Analysis reveals three main barriers impeding their 'choice' to remain in-place at the end of life: (1) Misaligned perceptions of risk and safety; (2) Challenges managing pain in the context of substance use, stigma, and discrimination; and (3) Gaps between protocols, policies, and procedures for health teams. CONCLUSIONS Findings demonstrate how the rhetoric of 'choice' in regard to preferred place of death is ethically problematic because experienced inequities are produced and constrained by socio-structural forces that reach beyond individuals' control. Ultimately, our findings contribute suggestions for policy, programs and practice to enhance inclusiveness in palliative care. Re-defining 'home' within palliative care, enhancing supports, education, and training for community care workers, integrating palliative approaches to care into the everyday work of non-health care providers, and acknowledging, valuing, and building upon existing relations of care can help to overcome existing barriers to delivering palliative care in various settings and increase the opportunity for all to spend their end of life in the places that they prefer.
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Affiliation(s)
- Kelli I Stajduhar
- Institute on Aging and Lifelong Health, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada
| | - Melissa Giesbrecht
- Institute on Aging and Lifelong Health, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada.
| | - Ashley Mollison
- Institute on Aging and Lifelong Health, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada
| | - Kara Whitlock
- Institute on Aging and Lifelong Health, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada
| | - Piotr Burek
- Canadian Institute for Substance Use Research, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada
| | - Fraser Black
- Faculty of Medicine - Island Medical Program, University of British Columbia, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada
| | - Jill Gerke
- Palliative and End of Life Care Program, Vancouver Island Health Authority, 1952 Bay Street, Victoria, BC, V8R 1J8, Canada
| | - Naheed Dosani
- Palliative Care Physician, Department of Family & Community Medicine, St Michael's Hospital at Unity Health Toronto, 36 Queen St E, Toronto, ON, M5B 1W8, Canada
| | - Simon Colgan
- Cumming School of Medicine, University of Calgary, 2500 University Dr. NW, Calgary, AB, T2N 1N4, Canada
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2
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Bulle S, Arya A, Dosani N. From Cultural Safety to Anti-Racism: Reflections on Addressing Inequities in Palliative Care. Curr Oncol 2023; 30:7920-7925. [PMID: 37754490 PMCID: PMC10527891 DOI: 10.3390/curroncol30090575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/23/2023] [Accepted: 08/26/2023] [Indexed: 09/28/2023] Open
Abstract
The purpose of palliative care is to ease the suffering of individuals with a serious and often life-limiting illness throughout the course of their disease by providing holistic care that considers the physical, spiritual, and psychosocial dimensions of health and well-being. Research shows that a palliative approach to care is cost-effective for the healthcare system and results in improved quality of life for patients and their loved ones. However, it is well-documented in the literature that structurally vulnerable populations have greater difficulty accessing equitable and culturally safe palliative care. Several domains are identified as contributing factors to the disparities seen in the literature, including systemic racism, cultural differences around death and suffering, and language barriers. Although Canada has had a national palliative care framework since 2018, ongoing issues of access and equity continue to disproportionately impact certain groups, including racially marginalized, immigrant, and low-income communities. In this commentary, successes and ongoing gaps in providing culturally safe and anti-racist palliative care are explored. In these proposed interventions, we advocate for a palliative approach to care that is grounded in equity, justice, and human rights.
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Affiliation(s)
- Seana Bulle
- Department of Family & Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada;
| | - Amit Arya
- Palliative Care Physician, Freeman Centre for the Advancement of Palliative Care, North York General Hospital, 4001 Leslie Street Ontario, North York, ON M2K 1E1, Canada;
- Specialist Palliative Care in Long-Term Care Outreach Team, Kensington Health, 25 Brunswick Avenue, Toronto, ON M5S 2L9, Canada
- Division of Palliative Care, Department of Family & Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada
- Division of Palliative Care, Department of Family Medicine, McMaster University, 100 Main Street West, Hamilton, ON L8P 1H6, Canada
| | - Naheed Dosani
- Department of Family & Community Medicine, St. Michael’s Hospital, Unity Health Toronto, 36 Queen Street East, Toronto, ON M5B 1W6, Canada
- PEACH (Palliative Education And Care for the Homeless) Program, Inner City Health Associates, 145 Front Street East, Toronto, ON M5A 1E3, Canada
- Kensington Hospice, Kensington Health, 45 Brunswick Avenue, Toronto, ON M5A 3M3, Canada
- Canadian Partnership against Cancer, 145 King Street West, Toronto, ON M5H 1J8, Canada
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3
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Buchanan N, Dosani N, Bond A, Spaner D, Tedesco A, Persaud N, Morey T. Palliative Education and Care for the Homeless (PEACH): A Model of Outreach Palliative Care for Structurally Vulnerable Populations. Healthc Q 2023; 26:24-30. [PMID: 37144698 DOI: 10.12927/hcq.2023.27055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The Palliative Education and Care for the Homeless (PEACH) program comprises a community palliative care team serving some of the most complex clients in the healthcare system. Formal partnerships bring together physician, nursing, psychosocial and homecare, health and housing navigation supports. PEACH has served over 1,000 clients, leading field-defining research, medical education and public advocacy. The PEACH program demonstrates that innovation through deep interorganizational and intersectoral integration can drive value-based impact for the most complex clients, providing instructive lessons for public health system reform well beyond the margins faced by people who are unhoused. This paper describes how PEACH's unique model, critical community partnerships and research have been necessary for it to become a leader in community-based palliative care for structurally vulnerable people.
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Affiliation(s)
- Nicole Buchanan
- Is a palliative care fellow at the University of Toronto, based in Toronto, ON. She is interested in improving the accessibility of palliative care for structurally vulnerable populations. Nicole can be reached by e-mail at
| | - Naheed Dosani
- Is a palliative care physician at the Department of Family and Community Medicine of St Michael's Hospital at Unity Health Toronto and an assistant professor at the University of Toronto, based in Toronto, ON. A health justice activist, Naheed is the founder and lead physician of the PEACH program at ICHA
| | - Andrew Bond
- Is a medical director and community justice physician at ICHA and a lecturer at the Department of Family and Community Medicine, University of Toronto, based in Toronto, ON. He is the founder and co-chair of the Canadian Network for the Health and Housing of People Experiencing Homelessness. As a physician executive, he is dedicated to radically rethinking the design and delivery of healthcare systems bringing together health, home and community for population health equity
| | - Donna Spaner
- Is a clinical director at the Palliative Care Program - Toronto Grace Health Centre and a PEACH physician at ICHA, based in Toronto, ON. She has an interest in working with structurally vulnerable clients and has been with the PEACH program since 2016
| | - Alissa Tedesco
- Is a palliative care physician at the Temmy Latner Centre for Palliative Care, Sinai Health System, and a PEACH physician at ICHA, based in Toronto, ON. She is also a lecturer at the University of Toronto who works to improve equitable access to high-quality care to structurally vulnerable populations through her work
| | - Nadine Persaud
- Is the executive director at Kensington Hospice and the senior director of Client Services at Kensington Health, based in Toronto, ON. She has been working in the palliative care field for the past 16 years. Through her multiple leadership positions and her clinical practice, Nadine works to ensure that palliative care is equitable and accessible with the overall goal of supporting individuals to live well
| | - Trevor Morey
- Is a palliative care physician at PEACH, ICHA, based in Toronto, ON. He has a passion for ensuring equitable access to palliative care
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4
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Rollans C, Baek J, Bloch G, Nyhof-Young J, Morey T, Dosani N, Spaner D. Exploring the Barriers and Facilitators Experienced by Palliative Health Care Providers Working with Patients Experiencing Homelessness during the COVID-19 Pandemic. Palliat Med Rep 2023; 4:3-8. [PMID: 36743340 PMCID: PMC9892914 DOI: 10.1089/pmr.2022.0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 01/19/2023] Open
Abstract
Background Patients experiencing homelessness not only have higher rates of medical complexity, comorbidity, and mortality, but also face barriers to accessing palliative care services. In structurally vulnerable populations with palliative care needs, these barriers are compounded, creating significant challenges for both patients and providers that have important health equity implications. Objective The aim is to explore the experiences of palliative care providers working with patients experiencing homelessness during the COVID-19 pandemic and understand the barriers they faced in providing care, as well as facilitators that aided in the success of their teams. Methods Seven health care providers from two Canadian palliative outreach teams involved in delivering palliative care services to patients experiencing homelessness during the COVID-19 pandemic participated in audio-recorded and transcribed videoconferencing interviews. Analysis was completed using generic descriptive thematic analysis. Results Five key themes were identified: (1) factors negatively impacting patient health, (2) use of technology, (3) care provider emotions, (4) care provider education and advocacy, and (5) outreach team factors. Conclusion Identified barriers during the pandemic included worsening of existing patient vulnerabilities, as well as challenges incorporating technology into care. Providers faced increased emotional burden, with a rise in workload, stress, fear, and grief. However, several facilitators allowed teams to provide high-quality care to this vulnerable population, including team support, interprofessional collaboration, and advocacy and education initiatives. The outreach model also proved to be a highly flexible, resilient, and adaptable model for providing care during the COVID-19 pandemic.
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Affiliation(s)
- Claire Rollans
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Justine Baek
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.,Address correspondence to: Justine Baek, MD, CFPC, Department of Family and Community Medicine, Mount Sinai Hospital, 60 Murray Street, L4-000 Box #13, Toronto, Ontario M5T 3L9, Canada.
| | - Gary Bloch
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.,Primary Care, Inner City Health Associates, Toronto, Ontario, Canada
| | - Joyce Nyhof-Young
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.,Academics Program, Women's College Hospital, Toronto, Ontario, Canada
| | - Trevor Morey
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.,Palliative Education and Care for the Homeless, Inner City Health Associates, Toronto, Ontario, Canada
| | - Naheed Dosani
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.,Palliative Education and Care for the Homeless, Inner City Health Associates, Toronto, Ontario, Canada
| | - Donna Spaner
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.,Palliative Education and Care for the Homeless, Inner City Health Associates, Toronto, Ontario, Canada.,Palliative Care, Toronto Grace Health Centre, Toronto, Ontario, Canada
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5
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Robinson L, Trevors Babici L, Tedesco A, Spaner D, Morey T, Dosani N. Assessing the impact of a health navigator on improving access to care and addressing the social needs of palliative care patients experiencing homelessness: A service evaluation. Palliat Med 2022; 37:646-651. [PMID: 36576315 PMCID: PMC10074742 DOI: 10.1177/02692163221146812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Health navigators are healthcare professionals who specialize in care coordination, case management, navigating transitions, and reducing barriers to care. There is limited literature on the impact of health navigators on community-based palliative care for people experiencing homelessness. AIM We devised key performance indicators in nine categories with the aim to quantify the impact of a health navigator on the delivery of palliative care to patients experiencing homelessness. DESIGN Data were collected prospectively for all patient encounters involving a health navigator from July 2020 to 2021 and reviewed to determine the distribution of the health navigator's role and the ways in which patient care was impacted. SETTING AND PARTICIPANTS This study was conducted in Toronto, Ontario with the Palliative Education and Care for the Homeless (PEACH) Program. At any one time, the PEACH health navigator served a total of 50 patients. RESULTS We identified five key areas of the health navigator role including (1) facilitating access (2) coordinating care (3) addressing social determinants of health (4) advocating for patients, and (5) counselling patients and loved ones. The health navigator role was split evenly between activities pertaining to palliative care for structurally vulnerable populations and community-based palliative care for the general population. To achieve high impact outcomes, a considerable investment of time and energy was required of the health navigator, speaking to the importance of adequate and sustainable funding. CONCLUSIONS These findings underscore the potential for health navigators to add value to community-based palliative care teams, especially those caring for structurally vulnerable populations.
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Affiliation(s)
- Lilian Robinson
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Leeann Trevors Babici
- Palliative Education and Care for the Homeless Program, Toronto, ON, Canada.,Second Mile Club, Kensington Health, Toronto, ON, Canada
| | - Alissa Tedesco
- Palliative Education and Care for the Homeless Program, Toronto, ON, Canada
| | - Donna Spaner
- Palliative Education and Care for the Homeless Program, Toronto, ON, Canada
| | - Trevor Morey
- Palliative Education and Care for the Homeless Program, Toronto, ON, Canada
| | - Naheed Dosani
- Palliative Education and Care for the Homeless Program, Toronto, ON, Canada
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6
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Buchman DZ, Lo S, Ding P, Dosani N, Fazelzad R, Furlan AD, Isenberg SR, Spithoff S, Tedesco A, Zimmermann C, Lau J. Palliative care for people who use drugs during communicable disease epidemics and pandemics: A scoping review on access, policies, and programs and guidelines. Palliat Med 2022; 37:426-443. [PMID: 36522840 PMCID: PMC9760505 DOI: 10.1177/02692163221143153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND People who use drugs with life-limiting illnesses experience substantial barriers to accessing palliative care. Demand for palliative care is expected to increase during communicable disease epidemics and pandemics. Understanding how epidemics and pandemics affect palliative care for people who use drugs is important from a service delivery perspective and for reducing population health inequities. AIM To explore what is known about communicable disease epidemics and pandemics, palliative care, and people who use drugs. DESIGN Scoping review. DATA SOURCES We searched six bibliographic databases from inception to April 2021 as well as the grey literature. We included English and French records about palliative care access, programs, and policies and guidelines for people ⩾18 years old who use drugs during communicable disease epidemics and pandemics. RESULTS Forty-four articles were included in our analysis. We identified limited knowledge about palliative care for people who use drugs during epidemics and pandemics other than HIV/AIDS. Through our thematic synthesis of the records, we generated the following themes: enablers and barriers to access, organizational barriers, structural inequity, access to opioids and other psychoactive substances, and stigma. CONCLUSIONS Our findings underscore the need for further research about how best to provide palliative care for people who use drugs during epidemics and pandemics. We suggest four ways that health systems can be better prepared to help alleviate the structural barriers that limit access as well as support the provision of high-quality palliative care during future epidemics and pandemics.
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Affiliation(s)
- Daniel Z Buchman
- Everyday Ethics Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,University of Toronto Joint Centre for Bioethics, Toronto, ON, Canada
| | - Samantha Lo
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Philip Ding
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Naheed Dosani
- Department of Medicine, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Palliative Education And Care for the Homeless (PEACH), Inner City Health Associates, Toronto, ON, Canada.,Division of Palliative Care, McMaster University, Hamilton, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Rouhi Fazelzad
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Andrea D Furlan
- Toronto Rehab, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Institute for Work & Health, Toronto, ON, Canada
| | - Sarina R Isenberg
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Bruyère Research Institute, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sheryl Spithoff
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Women's College Hospital, Toronto, ON, Canada
| | - Alissa Tedesco
- Palliative Education And Care for the Homeless (PEACH), Inner City Health Associates, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, ON, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Palliative Medicine, University of Toronto, ON, Canada.,Division of Palliative Care, University Health Network, Toronto, ON, Canada
| | - Jenny Lau
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Division of Palliative Care, University Health Network, Toronto, ON, Canada
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7
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Arya A, Davey R, Sharma A, Dosani N, Grewal D, Afzal A, Bhargava R, Chasen M, Med P. Utilization of Point-of-Care Ultrasound in a Specialist Palliative Care Team Across Multiple Care Settings: A Retrospective Chart Review. Palliat Med Rep 2022; 3:229-234. [PMID: 36341470 PMCID: PMC9629911 DOI: 10.1089/pmr.2021.0067] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Technological advancements have rapidly increased the use of point-of-care ultrasound (POCUS) across various medical disciplines, leading to real-time information for clinicians at the bed side. However, literature reveals scant evidence of POCUS use in palliative care. The objective of this study was to examine the use of POCUS in a specialist palliative care setting. METHODS A retrospective chart review was conducted from January 2018 to June 2019 in Brampton, Canada, to evaluate characteristics of patients for whom POCUS was utilized. Patients were identified through pre-existing logs and descriptive information was collected from electronic health records, including demographic information, life-limiting diagnosis, patient assessment location, diagnosis made with POCUS, and, if applicable, volume of fluid drained. RESULTS We identified 126 uses of POCUS in 89 unique patients. Sixty-two patients (69.7%) had a cancer diagnosis, with patients most commonly suffering from gastrointestinal, lung, and breast pathologies. Sixty-one POCUS cases (48.4%) were in the outpatient setting. Eighty-one POCUS cases (64.3%) revealed a diagnosis of ascites and 21 POCUS cases (16.7%) revealed a diagnosis of pleural effusion. Other diagnoses made with POCUS included bowel obstruction, pneumonia, and congestive heart failure. During the study period, 52 paracentesis and 7 thoracentesis procedures were performed using POCUS guidance. CONCLUSION We identified multiple indications in our specialist palliative care setting where POCUS aided in diagnosis/management of patients in both inpatient and outpatient settings. Further studies can be conducted to identify the potential benefits in symptom burden, patient and caregiver satisfaction, and health care utilization in palliative care patients receiving POCUS.
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Affiliation(s)
- Amit Arya
- Freeman Centre for the Advancement of Palliative Care, North York General Hospital, Toronto, Ontario, Canada
- Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- *Address correspondence to: Amit Arya, MD, CCFP (PC), FCFP, Freeman Centre for the Advancement of Palliative Care, Room 3S-376, 4001 Leslie Street, Toronto M2K 1E1, Ontario, Canada.
| | - Roddy Davey
- Division of Supportive and Palliative Care, Brampton Civic Hospital, Brampton, Ontario, Canada
- Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Achal Sharma
- Corporate Department of Research, William Osler Health System, Brampton, Ontario, Canada
| | - Naheed Dosani
- Department of Family & Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
- Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Dilnoor Grewal
- Corporate Department of Research, William Osler Health System, Brampton, Ontario, Canada
| | - Aysha Afzal
- Corporate Department of Research, William Osler Health System, Brampton, Ontario, Canada
| | - Ravi Bhargava
- Corporate Department of Research, William Osler Health System, Brampton, Ontario, Canada
| | | | - Pall Med
- Division of Supportive and Palliative Care, Brampton Civic Hospital, Brampton, Ontario, Canada
- Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
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8
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Shariff S, Richard L, Hwang S, Kwong J, Forchuk C, Dosani N, Booth R. COVID-19 vaccine coverage and factors associated with vaccine uptake among individuals with a recent experience of homelessness: a population-based analysis from Ontario, Canada. Int J Popul Data Sci 2022. [DOI: 10.23889/ijpds.v7i3.1807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
ObjectivesTo describe COVID-19 vaccine coverage (i.e., the estimated percentage of people who have received a vaccine) and determinants of vaccine receipt among individuals with a recent experience of homelessness in Ontario, Canada.
ApproachWe conducted a retrospective, population-based cohort study of 23,247 individuals (≥18 years) with a recent experience of homelessness as recorded in routinely collected healthcare databases. Participants were followed from December 14, 2020 to September 30, 2021 for the receipt of a COVID-19 vaccine. Using modified Poisson regression, we identified sociodemographic, healthcare usage, and clinical factors associated with the receipt of one or more doses of a COVID-19 vaccine.
ResultsBy September 30, 14,271 (61.4%) of participants with a recent experience of homelessness had received a first dose of a COVID-19 vaccine and 11,082 (47.7%) had received two doses. Over the same period, 86.6% and 81.6% of the total adult population of Ontario had received a first dose and second dose, respectively. In multivariable analysis, factors associated with increased COVID-19 uptake included ≥1 visit to a general practitioner (adjusted Risk Ratio [aRR]:1.37[95% CI 1.31-1.42]), older age (vs. 18-29 years: 50-59 years, aRR:1.18[1.14-1.22]; 60+ years, aRR:1.27[1.22-1.31]), receipt of an influenza vaccine (aRR:1.25[1.23-1.28]), receipt of ≥1 SARS-CoV-2 test (aRR:1.23[1.20-1.26]) and the presence of chronic health conditions (vs. 0 conditions: 1 condition, aRR:1.05[1.03, 1.08]; 2+ conditions, aRR:1.11[1.08-1.14]). In contrast, living in a smaller metropolitan region (aRR:0.92[0.90-0.94]) or rural location (aRR:0.93[0.90-0.97]) compared to a large metropolitan region was associated with lower uptake.
ConclusionsAs of September 30, 2021, COVID-19 vaccine coverage among individuals with a recent experience of homelessness in Ontario was substantially lower than the general adult population of Ontario for a first and second dose. Findings underscore the importance of leveraging organizations that are accessed and trusted by people who experience homelessness for targeted vaccine delivery.
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9
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Liu M, Richard L, Campitelli MA, Nisenbaum R, Dosani N, Dhalla IA, Wadhera RK, Shariff SZ, Hwang SW. Drug Overdoses During the COVID-19 Pandemic Among Recently Homeless Individuals. Addiction 2022; 117:1692-1701. [PMID: 35129239 PMCID: PMC9111216 DOI: 10.1111/add.15823] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 01/17/2022] [Indexed: 11/30/2022]
Abstract
AIMS To examine how weekly rates of emergency department (ED) visits for drug overdoses changed among individuals with a recent history of homelessness (IRHH) and their housed counterparts during the pre-pandemic, peak, and re-opening periods of the first wave of the COVID-19 pandemic, using corresponding weeks in 2019 as a historical control. DESIGN Population-based retrospective cohort study conducted between September 30, 2018 and September 26, 2020. SETTING Ontario, Canada. PARTICIPANTS A total of 38 617 IRHH, 15 022 369 housed individuals, and 186 858 low-income housed individuals matched on age, sex, rurality, and comorbidity burden. MEASUREMENTS ED visits for drug overdoses of accidental and undetermined intent. FINDINGS Average rates of ED visits for drug overdoses between January and September 2020 were higher among IRHH compared with housed individuals (rate ratio [RR], 148.0; 95% CI, 142.7-153.5) and matched housed individuals (RR, 22.3; 95% CI, 20.7-24.0). ED visits for drug overdoses decreased across all groups by ~20% during the peak period (March 17 to June 16, 2020) compared with corresponding weeks in 2019. During the re-opening period (June 17 to September 26, 2020), rates of ED visits for drug overdoses were significantly higher among IRHH (RR, 1.56; 95% CI, 1.44-1.69), matched housed individuals (RR, 1.25; 95% CI, 1.08-1.46), and housed individuals relative to equivalent weeks in 2019 (RR, 1.07; 95% CI, 1.02-1.11). The relative increase in drug overdose ED visits among IRHH was larger compared with both matched housed individuals (P = 0.01 for interaction between group and year) and housed individuals (P < 0.001) during this period. CONCLUSIONS Recently homeless individuals in Ontario, Canada experienced disproportionate increases in ED visits for drug overdoses during the re-opening period of the COVID-19 pandemic compared with housed people.
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Affiliation(s)
- Michael Liu
- Harvard Medical SchoolBostonMAUSA,MAP Centre for Urban Health SolutionsLi Ka Shing Knowledge Institute, St. Michael's HospitalTorontoCanada,ICES CentralTorontoCanada
| | | | | | - Rosane Nisenbaum
- MAP Centre for Urban Health SolutionsLi Ka Shing Knowledge Institute, St. Michael's HospitalTorontoCanada,Division of Biostatistics, Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
| | - Naheed Dosani
- Division of Palliative CareMcMaster UniversityHamiltonCanada
| | - Irfan A. Dhalla
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada,Division of General Internal Medicine, Department of MedicineUniversity of TorontoTorontoCanada
| | - Rishi K. Wadhera
- Richard A. and Susan F. Smith Center for Outcomes ResearchBeth Israel Deaconess Medical CenterBostonMAUSA
| | | | - Stephen W. Hwang
- MAP Centre for Urban Health SolutionsLi Ka Shing Knowledge Institute, St. Michael's HospitalTorontoCanada,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada,Division of General Internal Medicine, Department of MedicineUniversity of TorontoTorontoCanada
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10
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Shariff SZ, Richard L, Hwang SW, Kwong JC, Forchuk C, Dosani N, Booth R. COVID-19 vaccine coverage and factors associated with vaccine uptake among 23 247 adults with a recent history of homelessness in Ontario, Canada: a population-based cohort study. Lancet Public Health 2022; 7:e366-e377. [PMID: 35278362 PMCID: PMC8906815 DOI: 10.1016/s2468-2667(22)00037-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/04/2022] [Accepted: 02/09/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND People experiencing homelessness face a high risk of SARS-CoV-2 infection and transmission, as well as health complications and death due to COVID-19. Despite being prioritised for receiving the COVID-19 vaccine in many regions, little data are available on vaccine uptake in this vulnerable population. Using population-based health-care administrative data from Ontario, Canada-a region with a universal, publicly funded health system-we aimed to describe COVID-19 vaccine coverage (ie, the estimated percentage of people who have received a vaccine) and determinants of vaccine receipt among individuals with a recent history of homelessness. METHODS We conducted a retrospective, population-based cohort study of adults (aged ≥18 years) with a recent experience of homelessness, inadequate housing, or shelter use as recorded in routinely collected health-care databases between June 14, 2020, and June 14, 2021 (a period within 6 months of Dec 14, 2020, when COVID-19 vaccine administration was initiated in Ontario). Participants were followed up from Dec 14, 2020, to Sept 30, 2021, for the receipt of one or two doses of a COVID-19 vaccine using the province's real-time centralised vaccine information system. We described COVID-19 vaccine coverage overall and within predefined subgroups. Using modified Poisson regression, we further identified sociodemographic factors, health-care usage, and clinical factors associated with receipt of at least one dose of a COVID-19 vaccine. FINDINGS 23 247 individuals with a recent history of homelessness were included in this study. Participants were predominantly male (14 752 [63·5%] of 23 247); nearly half were younger than 40 years (11 521 [49·6%]) and lived in large metropolitan regions (12 123 [52·2%]); and the majority (18 226 [78·4%]) visited a general practitioner for an in-person consultation during the observation period. By Sept 30, 2021, 14 271 (61·4%; 95% CI 60·8-62·0) individuals with a recent history of homelessness had received at least one dose of a COVID-19 vaccine and 11 082 (47·7%; 47·0-48·3) had received two doses; in comparison, over the same period, 86·6% of adults in the total Ontario population had received a first dose and 81·6% had received a second dose. In multivariable analysis, factors positively associated with COVID-19 uptake were one or more outpatient visits to a general practitioner (adjusted risk ratio [aRR] 1·37 [95% CI 1·31-1·42]), older age (50-59 years vs 18-29 years: 1·18 [1·14-1·22], ≥60 years vs 18-29 years: 1·27 [1·22-1·31]), receipt of an influenza vaccine in either of the two previous influenza seasons (1·25 [1·23-1·28]), being identified as homeless via a visit to a community health centre versus exclusively a hospital-based encounter (1·13 [1·10-1·15]), receipt of one or more SARS-CoV-2 tests between March 1, 2020, and Sept 30, 2021 (1·23 [1·20-1·26]), and the presence of chronic health conditions (one condition: 1·05 [1·03-1·08]; two or more conditions: 1·11 [1·08-1·14]). By contrast, living in a smaller metropolitan region (aRR 0·92 [95% CI 0·90-0·94]) or rural location (0·93 [0·90-0·97]) versus large metropolitan regions were associated with lower uptake. INTERPRETATION In Ontario, COVID-19 vaccine coverage among adults with a recent history of homelessness has lagged and, as of Sept 30, 2021, was 25 percentage points lower than that of the general adult population in Ontario for a first dose and 34 percentage points lower for a second dose. With high usage of outpatient health services among individuals with a recent history of homelessness, better utilisation of outpatient primary care structures might offer an opportunity to increase vaccine coverage in this population. Our findings underscore the importance of leveraging existing health and service organisations that are accessed and trusted by people who experience homelessness for targeted vaccine delivery. FUNDING The Public Health Agency of Canada. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Salimah Z Shariff
- ICES (formerly the Institute for Clinical Evaluative Sciences), London, ON, Canada; Lawson Health Research Institute, London, ON, Canada; Arthur Labatt Family School of Nursing, Western University, London, ON, Canada.
| | - Lucie Richard
- ICES (formerly the Institute for Clinical Evaluative Sciences), London, ON, Canada,MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
| | - Stephen W Hwang
- ICES (formerly the Institute for Clinical Evaluative Sciences), London, ON, Canada,MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada,Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jeffrey C Kwong
- ICES (formerly the Institute for Clinical Evaluative Sciences), London, ON, Canada,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada,Public Health Ontario, Toronto, ON, Canada,University Health Network, Toronto, ON, Canada
| | - Cheryl Forchuk
- Lawson Health Research Institute, London, ON, Canada,Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Naheed Dosani
- Division of Palliative Care, Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Richard Booth
- ICES (formerly the Institute for Clinical Evaluative Sciences), London, ON, Canada,Lawson Health Research Institute, London, ON, Canada,Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
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11
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Buchman DZ, Ding P, Lo S, Dosani N, Fazelzad R, Furlan AD, Isenberg SR, Spithoff S, Tedesco A, Zimmermann C, Lau J. Palliative care for people who use substances during communicable disease epidemics and pandemics: a scoping review protocol. BMJ Open 2021; 11:e053124. [PMID: 34706961 PMCID: PMC8551744 DOI: 10.1136/bmjopen-2021-053124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Communicable disease epidemics and pandemics magnify the health inequities experienced by marginalised populations. People who use substances suffer from high rates of morbidity and mortality and should be a priority to receive palliative care, yet they encounter many barriers to palliative care access. Given the pre-existing inequities to palliative care access for people with life-limiting illnesses who use substances, it is important to understand the impact of communicable disease epidemics and pandemics such as COVID-19 on this population. METHODS AND ANALYSIS We will conduct a scoping review and report according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews reporting guidelines. We conducted a comprehensive literature search in seven bibliographical databases from the inception of each database to August 2020. We also performed a grey literature search to identify the publications not indexed in the bibliographical databases. All the searches will be rerun in April 2021 to retrieve recently published information because the COVID-19 pandemic is ongoing at the time of this writing. We will extract the quantitative data using a standardised data extraction form and summarise it using descriptive statistics. Additionally, we will conduct thematic qualitative analyses and present our findings as narrative summaries. ETHICS AND DISSEMINATION Ethics approval is not required for a scoping review. We will disseminate our findings to healthcare providers and policymakers through professional networks, digital communications through social media platforms, conference presentations and publication in a scientific journal.
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Affiliation(s)
- Daniel Z Buchman
- Bioethics, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada
| | - Philip Ding
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
| | - Samantha Lo
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
| | - Naheed Dosani
- Department of Medicine, Unity Health Toronto, Toronto, Ontario, Canada
- Inner City Health Associates, Toronto, Ontario, Canada
| | - Rouhi Fazelzad
- Library and Information Services, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Andrea D Furlan
- Toronto Rehab, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Work & Health, University Health Network, Toronto, Ontario, Canada
| | - Sarina R Isenberg
- Bruyere Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Sheryl Spithoff
- Women's College Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Alissa Tedesco
- Inner City Health Associates, Toronto, Ontario, Canada
- Sinai Health System, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Palliative Care, University Health Network, Toronto, Ontario, Canada
- Division of Palliative Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jenny Lau
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Palliative Care, University Health Network, Toronto, Ontario, Canada
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12
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Schneider E, Dosani N. Retrospective Study of a Toronto-Based Palliative Care Program for Individuals Experiencing Homelessness. J Palliat Med 2021; 24:1232-1235. [PMID: 33794110 DOI: 10.1089/jpm.2020.0772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Individuals experiencing homelessness face increased morbidity and mortality. The Canadian Toronto-based Palliative Education and Care for the Homeless (PEACH) program was launched to better support those experiencing homelessness with life-limiting illness. Objective: To describe the population served by PEACH. Methods: A chart review of deceased clients from 2014 to 2017 was conducted. Results: Sixty-three individuals were included in the analysis. 85.7% were male and the median age was 60 years. 35.4% resided in shelters, 26.2% in supportive/transitional housing; only 3.2% were sleeping on the streets. Cancer was the most common diagnosis (61.9%). 58.7% of clients had mental health diagnoses and 61.9% endorsed substance use. Locations of death included palliative care unit and hospice (44.4%), hospital (23.8%), supportive housing (12.6%), and shelter (7.9%). Discussion: PEACH serves diverse clientele with unique care needs. This study will inform further palliative care research and interventions for those experiencing homelessness.
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Affiliation(s)
- Evan Schneider
- Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.,Temmy Latner Centre for Palliative Care, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Naheed Dosani
- Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.,Palliative Education and Care for the Homeless, Inner City Health Associates, Toronto, Ontario, Canada
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13
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Whisler A, Dosani N, To MJ, O’Brien K, Young S, Hwang SW. The effect of a Housing First intervention on primary care retention among homeless individuals with mental illness. PLoS One 2021; 16:e0246859. [PMID: 33571302 PMCID: PMC7877594 DOI: 10.1371/journal.pone.0246859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 01/27/2021] [Indexed: 11/22/2022] Open
Abstract
Background Primary care retention, defined as ongoing periodic contact with a consistent primary care provider, is beneficial for people with serious chronic illnesses. This study examined the effect of a Housing First intervention on primary care retention among homeless individuals with mental illness. Methods Two hundred individuals enrolled in the Toronto site of the At Home Project and randomized to Housing First or Treatment As Usual were studied. Medical records were reviewed to determine if participants were retained in primary care, defined as having at least one visit with the same primary care provider in each of two consecutive six-month periods during the 12 month period preceding and following randomization. Results Medical records were obtained for 47 individuals randomized to Housing First and 40 individuals randomized to Treatment As Usual. During the one year period following randomization, the proportion of Housing First and Treatment As Usual participants retained in primary care was not significantly different (38.3% vs. 47.5%, p = 0.39). The change in primary care retention rates from the year preceding randomization to the year following randomization was +10.6% in the Housing First group and -5.0% in the Treatment As Usual group. Conclusion Among homeless individuals with mental illness, Housing First did not significantly affect primary care retention over the follow-up period. These findings suggest Housing First interventions may need to place greater emphasis on connecting clients with primary care providers.
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Affiliation(s)
- Adam Whisler
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Naheed Dosani
- Inner City Health Associates, Toronto, Ontario, Canada
- Department of Family & Community Medicine, St Michael’s Hospital, Toronto, Ontario, Canada
- Division of Palliative Care, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Division of Palliative Care, William Osler Health System, Brampton, Ontario, Canada
- * E-mail:
| | - Matthew J. To
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Kristen O’Brien
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Samantha Young
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Stephen W. Hwang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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14
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Tedesco A, Shanks L, Dosani N. The Good Wishes Project: An End-of-Life Intervention for Individuals Experiencing Homelessness. Palliat Med Rep 2020; 1:264-269. [PMID: 34223486 PMCID: PMC8241317 DOI: 10.1089/pmr.2020.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Individuals experiencing homelessness face marginalization, dehumanization, and barriers to accessing quality palliative care. Inspired by the 3 Wishes Project, the Good Wishes Project (GWP) facilitates granting wishes to individuals experiencing homelessness and receiving palliative care with a goal of enhancing comfort and personalizing the end-of-life experience. Objective: The main objective of this study was to elicit provider perspectives on the utility of the GWP in the delivery of end-of-life care to a population of homeless and vulnerably housed individuals. Design: For this qualitative study, GWP client information and wish data were collected anonymously and analyzed quantitatively and descriptively. Semistructured interviews were conducted with health and social service professionals who cared for GWP clients. Interviews were recorded, transcribed, and analyzed through qualitative content analysis. Results: At the time of evaluation, there were a total of 27 clients in the GWP. At 14 months after the project's launch, 40 wishes had been made, 24 of which had been granted. Wishes were classified into five categories: basic necessities, end-of-life preparations, personal connections, paying-it-forward, and leisure. From the provider perspective (n = 7), the project was found to have utility in three main domains: establishing and enhancing connection, satisfying basic needs, and promoting person-centered care. Conclusions: The GWP is a promising psychosocial intervention in providing quality palliative care to individuals experiencing homelessness, whose lives have largely been burdened with hardship and marginalization.
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Affiliation(s)
| | - Leslie Shanks
- Inner City Health Associates, Toronto, Ontario, Canada
| | - Naheed Dosani
- Inner City Health Associates, Toronto, Ontario, Canada
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15
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Dosani N, Bhargava R, Arya A, Pang C, Tut P, Sharma A, Chasen M. Perceptions of palliative care in a South Asian community: findings from an observational study. BMC Palliat Care 2020; 19:141. [PMID: 32928182 PMCID: PMC7491098 DOI: 10.1186/s12904-020-00646-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 09/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients often view "palliative care" (PC) as an approach that is synonymous with end-of-life and death, leading to shock and fear. Differing cultural and social norms and religious affiliations greatly determine perception of PC among diverse populations. METHODS This prospective observational study aimed to explore perceptions of PC among South Asian community members at one Canadian site. Patients who identified themselves as being of South Asian origin were consented and enrolled at a PC Clinic at a community hospital in Brampton, Ontario serving a large South Asian population. Participants filled out an 18-question survey created for the study and responded to a semi-structured interview consisting of 8 questions that further probed their perceptions of PC. Survey responses and semi-structured interviews content were analyzed by four authors who reached consensus on key exploratory findings. RESULTS Thirty-four participants of South Asian origin were recruited (61.8% males), and they were distributed by their age group as follows: [(30-49) - 18%; (50-64) - 21%; (65-79) - 41%; (≥ 80) - 21%]. Five main exploratory findings emerged: (i) differing attitudes towards talking about death; (ii) the key role of family in providing care; (iii) a significant lack of prior knowledge of PC; (iv) a common emphasis on the importance of alleviating suffering and pain to maintain comfort; and (v) that cultural values, faith, or spiritual belief do not pose a necessary challenge to acceptance of PC services. CONCLUSIONS Observations from this study provide a source of reference to understand the key findings and variability in perceptions of palliative care in South Asian communities. Culturally competent interventions based on trends observed in this study could assist Palliative Physicians in delivering personalized care to South Asian populations.
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Affiliation(s)
- Naheed Dosani
- Division of Supportive and Palliative Care, Brampton Civic Hospital, William Osler Health System, 2100 Bovaird Drive East, Brampton, Ontario, Canada. .,Division of Palliative Care, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
| | - Ravi Bhargava
- Division of Supportive and Palliative Care, Brampton Civic Hospital, William Osler Health System, 2100 Bovaird Drive East, Brampton, Ontario, Canada.,Corporate Department of Research, William Osler Health System, Brampton, ON, Canada.,The Global Institute of Psychosocial, Palliative and End-of-Life Care, University of Toronto, Toronto, ON, Canada
| | - Amit Arya
- Division of Supportive and Palliative Care, Brampton Civic Hospital, William Osler Health System, 2100 Bovaird Drive East, Brampton, Ontario, Canada.,Division of Palliative Care, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,The Global Institute of Psychosocial, Palliative and End-of-Life Care, University of Toronto, Toronto, ON, Canada
| | - Celeste Pang
- Corporate Department of Research, William Osler Health System, Brampton, ON, Canada
| | - Pavinder Tut
- Corporate Department of Research, William Osler Health System, Brampton, ON, Canada
| | - Achal Sharma
- Corporate Department of Research, William Osler Health System, Brampton, ON, Canada
| | - Martin Chasen
- Division of Supportive and Palliative Care, Brampton Civic Hospital, William Osler Health System, 2100 Bovaird Drive East, Brampton, Ontario, Canada.,The Global Institute of Psychosocial, Palliative and End-of-Life Care, University of Toronto, Toronto, ON, Canada
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16
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Affiliation(s)
- Melissa Perri
- Dalla Lana School of Public Health (Perri), University of Toronto; MAP Centre for Urban Health Solutions (Perri, Hwang), St. Michael's Hospital; Inner City Health Associates (Dosani); Division of Palliative Care (Dosani), Department of Family & Community Medicine, and Division of General Internal Medicine (Hwang), Department of Medicine, University of Toronto, Toronto, Ont.
| | - Naheed Dosani
- Dalla Lana School of Public Health (Perri), University of Toronto; MAP Centre for Urban Health Solutions (Perri, Hwang), St. Michael's Hospital; Inner City Health Associates (Dosani); Division of Palliative Care (Dosani), Department of Family & Community Medicine, and Division of General Internal Medicine (Hwang), Department of Medicine, University of Toronto, Toronto, Ont
| | - Stephen W Hwang
- Dalla Lana School of Public Health (Perri), University of Toronto; MAP Centre for Urban Health Solutions (Perri, Hwang), St. Michael's Hospital; Inner City Health Associates (Dosani); Division of Palliative Care (Dosani), Department of Family & Community Medicine, and Division of General Internal Medicine (Hwang), Department of Medicine, University of Toronto, Toronto, Ont
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17
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Stajduhar KI, Giesbrecht M, Mollison A, Dosani N, McNeil R. Caregiving at the margins: An ethnographic exploration of family caregivers experiences providing care for structurally vulnerable populations at the end-of-life. Palliat Med 2020; 34:946-953. [PMID: 32340556 PMCID: PMC7787672 DOI: 10.1177/0269216320917875] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND People experiencing structural vulnerability (e.g. homelessness, poverty, racism, criminalization of illicit drug use and mental health stigma) face significant barriers to accessing care at the end-of-life. 'Family' caregivers have the potential to play critical roles in providing care to these populations, yet little is known regarding 'who' caregivers are in this context and what their experiences may be. AIM To describe family caregiving in the context of structural vulnerability, to understand who these caregivers are, and the unique challenges, burdens and barriers they face. DESIGN Critical ethnography. SETTING/PARTICIPANTS Twenty-five family caregivers participated. Observational fieldnotes and semi-structured interviews were conducted in home, shelter, transitional housing, clinic, hospital, palliative care unit, community-based service centre and outdoor settings. RESULTS Family caregivers were found to be living within the constraints of structural vulnerability themselves, with almost half being street family or friends. The type of care provided varied greatly and included tasks associated with meeting the needs of basic survival (e.g. finding food and shelter). Thematic analysis revealed three core themes regarding experiences: Caregiving in the context of (1) poverty and substance use; (2) housing instability and (3) challenging relationships. CONCLUSION Findings offer novel insight into the experiences of family caregiving in the context of structural vulnerability. Engaging with family caregivers emerged as a missing and necessary palliative care practice, confirming the need to re-evaluate palliative care models and acknowledge issues of trust to create culturally relevant approaches for successful interventions. More research examining how 'family' is defined in this context is needed.
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Affiliation(s)
- Kelli I Stajduhar
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, BC, Canada.,School of Nursing, University of Victoria, Victoria, BC, Canada
| | - Melissa Giesbrecht
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, BC, Canada
| | - Ashley Mollison
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, BC, Canada
| | | | - Ryan McNeil
- BC Centre on Substance Use, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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18
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Dosani N. Web Exclusive. Annals Story Slam - What's a Life Worth? Ann Intern Med 2019; 171:SS1. [PMID: 31683306 DOI: 10.7326/w19-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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19
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Rajaram A, Morey T, Shah S, Dosani N, Mamdani M. Providing Data-Driven Equitable Palliative and End-of-Life Care for Structurally Vulnerable Populations: A Pilot Survey of Information Management Strategies. Am J Hosp Palliat Care 2019; 37:244-249. [PMID: 31466455 DOI: 10.1177/1049909119872756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND Considerable gains are being made in data-driven efforts to advance quality improvement in health care. However, organizations providing hospice-oriented palliative care for structurally vulnerable persons with terminal illnesses may not have the enabling data infrastructure or framework to derive such benefits. METHODS We conducted a pilot cross-sectional qualitative study involving a convenience sample of hospice organizations across North America providing palliative care services for structurally vulnerable patients. Through semistructured interviews, we surveyed organizations on the types of data collected, the information systems used, and the challenges they faced. RESULTS We contacted 13 organizations across North America and interviewed 9. All organizations served structurally vulnerable populations, including the homeless and vulnerably housed, socially isolated, and HIV-positive patients. Common examples of collected data included the number of referrals, the number of admissions, length of stay, and diagnosis. More than half of the organizations (n = 5) used an electronic medical record, although none of the record systems were specifically designed for palliative care. All (n = 9) the organizations used the built-in reporting capacity of their information management systems and more than half (n = 6) augmented this capacity with chart reviews. DISCUSSION A number of themes emerged from our discussions. Present data collection is heterogeneous, and storage of these data is highly fragmented within and across organizations. Funding appeared to be a key enabler of more robust data collection and use. Future work should address these gaps and examine opportunities for innovative ways of analysis and reporting to improve care for structurally vulnerable populations.
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Affiliation(s)
- Akshay Rajaram
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada.,Li Ka Shing-Centre for Healthcare Analytics, Research and Training, St Michael's Hospital, Toronto, Ontario, Canada
| | - Trevor Morey
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sonam Shah
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Naheed Dosani
- Inner City Health Associates Toronto, Ontario, Canada
| | - Muhammad Mamdani
- Li Ka Shing-Centre for Healthcare Analytics, Research and Training, St Michael's Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Leslie Dan Faculty of Pharmacy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Rajaram A, Morey T, Dosani N, Pou-Prom C, Mamdani M. Palliative Care in the Twenty-First Century: Using Advanced Analytics to Uncloak Insights from Big Data. J Palliat Med 2019; 22:124-125. [PMID: 30707078 DOI: 10.1089/jpm.2018.0609] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Akshay Rajaram
- 1 School of Medicine, Queen's University, Kingston, Ontario, Canada.,2 Li Ka Shing-Centre for Healthcare Analytics, Research and Training, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Trevor Morey
- 3 Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Naheed Dosani
- 3 Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.,4 Inner City Health Associates, Toronto, Ontario, Canada
| | - Chloé Pou-Prom
- 2 Li Ka Shing-Centre for Healthcare Analytics, Research and Training, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Muhammad Mamdani
- 2 Li Ka Shing-Centre for Healthcare Analytics, Research and Training, St. Michael's Hospital, Toronto, Ontario, Canada.,5 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,6 Leslie Dan Faculty of Pharmacy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Stajduhar KI, Mollison A, Giesbrecht M, McNeil R, Pauly B, Reimer-Kirkham S, Dosani N, Wallace B, Showler G, Meagher C, Kvakic K, Gleave D, Teal T, Rose C, Showler C, Rounds K. "Just too busy living in the moment and surviving": barriers to accessing health care for structurally vulnerable populations at end-of-life. BMC Palliat Care 2019; 18:11. [PMID: 30684959 PMCID: PMC6348076 DOI: 10.1186/s12904-019-0396-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 01/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite access to quality care at the end-of-life (EOL) being considered a human right, it is not equitable, with many facing significant barriers. Most research examines access to EOL care for homogenous 'normative' populations, and as a result, the experiences of those with differing social positioning remain unheard. For example, populations experiencing structural vulnerability, who are situated along the lower rungs of social hierarchies of power (e.g., poor, homeless) will have unique EOL care needs and face unique barriers when accessing care. However, little research examines these barriers for people experiencing life-limiting illnesses and structural vulnerabilities. The purpose of this study was to identify barriers to accessing care among structurally vulnerable people at EOL. METHODS Ethnography informed by the critical theoretical perspectives of equity and social justice was employed. This research drew on 30 months of ethnographic data collection (i.e., observations, interviews) with structurally vulnerable people, their support persons, and service providers. Three hundred hours of observation were conducted in homes, shelters, transitional housing units, community-based service centres, on the street, and at health care appointments. The constant comparative method was used with data collection and analysis occurring concurrently. RESULTS Five significant barriers to accessing care at EOL were identified, namely: (1) The survival imperative; (2) The normalization of dying; (3) The problem of identification; (4) Professional risk and safety management; and (5) The cracks of a 'silo-ed' care system. Together, findings unveil inequities in accessing care at EOL and emphasize how those who do not fit the 'normative' palliative-patient population type, for whom palliative care programs and policies are currently built, face significant access barriers. CONCLUSIONS Findings contribute a nuanced understanding of the needs of and barriers experienced by those who are both structurally vulnerable and facing a life-limiting illness. Such insights make visible gaps in service provision and provide information for service providers, and policy decision-makers alike, on ways to enhance the equitable provision of EOL care for all populations.
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Affiliation(s)
- K. I. Stajduhar
- Institute on Aging and Lifelong Health, University of Victoria, 3800 Finnerty Road, Victoria, BC V8P 5C2 Canada
- School of Nursing, University of Victoria, 3800 Finnerty Road, Victoria, BC V8P 5C2 Canada
| | - A. Mollison
- Institute on Aging and Lifelong Health, University of Victoria, 3800 Finnerty Road, Victoria, BC V8P 5C2 Canada
| | - M. Giesbrecht
- Institute on Aging and Lifelong Health, University of Victoria, 3800 Finnerty Road, Victoria, BC V8P 5C2 Canada
| | - R. McNeil
- BC Centre on Substance Use, 608–1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
- Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9 Canada
| | - B. Pauly
- School of Nursing, University of Victoria, 3800 Finnerty Road, Victoria, BC V8P 5C2 Canada
- Canadian Institute for Substance Use Research, University of Victoria, 3800 Finnerty Road, Victoria, BC V8P 5C2 Canada
| | - S. Reimer-Kirkham
- School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC V2Y 1Y1 Canada
| | - N. Dosani
- Inner City Health Associates, 59 Adelaide St. E, Toronto, ON M5C 1K6 Canada
| | - B. Wallace
- School of Social Work, University of Victoria, 3800 Finnerty Road, Victoria, BC V8P 5C2 Canada
| | - G. Showler
- Victoria Cool Aid Community Health Centre, 1st Floor, Access Health Centre, 713 Johnson Street, Victoria, BC V8W 1M8 Canada
| | - C. Meagher
- Victoria Cool Aid Community Health Centre, 1st Floor, Access Health Centre, 713 Johnson Street, Victoria, BC V8W 1M8 Canada
| | - K. Kvakic
- AIDS Vancouver Island, 713 Johnson St, Victoria, BC V8W 1M8 Canada
| | - D. Gleave
- Victoria Cool Aid Community Health Centre, 1st Floor, Access Health Centre, 713 Johnson Street, Victoria, BC V8W 1M8 Canada
| | - T. Teal
- AIDS Vancouver Island, 713 Johnson St, Victoria, BC V8W 1M8 Canada
| | - C. Rose
- Institute on Aging and Lifelong Health, University of Victoria, 3800 Finnerty Road, Victoria, BC V8P 5C2 Canada
| | - C. Showler
- Institute on Aging and Lifelong Health, University of Victoria, 3800 Finnerty Road, Victoria, BC V8P 5C2 Canada
| | - K. Rounds
- Institute on Aging and Lifelong Health, University of Victoria, 3800 Finnerty Road, Victoria, BC V8P 5C2 Canada
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Henry B, Dosani N, Huynh L, Amirault N. Palliative care as a public health issue: understanding disparities in access to palliative care for the homeless population living in Toronto, based on a policy analysis. ACTA ACUST UNITED AC 2017; 24:187-191. [PMID: 28680279 DOI: 10.3747/co.24.3129] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Even in a developed country such as Canada, there are disparities in just access to adequate health care-and, more specifically, palliative care. That inequality is most notable in an underserved group such as the homeless population. Even the word "homeless" has become both a negative descriptor and a stereotype in our society. We posit that the provision of hospice palliative care is structured on several problematic assumptions: an expectation that patients will have an informal support network (family and friends), a stable and secure residence, a predictive terminal illness trajectory, and reasonable access to health care. Those assumptions create structural inequality within the system. Homeless individuals have considerable experience with death and dying, and qualitative research has shown them to hold the expectation that their death will be both sudden and violent. Here, we look at the current data concerning known disparities in access to good palliative care services experienced by the homeless population, based on a stakeholder analysis of the available literature. That information, coupled with the use of a public health ethics decision-making tool, such as the Good Decision Making in Real Time framework, is used to explore the common ethics challenges that can arise in public health interventions aimed at the provision of end-of-life care to homeless adults. A broad exploration of the system that underlies our care is critical to the proper and appropriate provision of care for homeless individuals.
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Affiliation(s)
- B Henry
- Sunnybrook Health Sciences Centre, Toronto.,North York General Hospital, Toronto.,Department of Family and Community Medicine, University of Toronto, Toronto
| | - N Dosani
- Department of Family and Community Medicine, University of Toronto, Toronto.,William Osler Health System, Brampton and North Etobicoke.,peach project (Palliative Education And Care for the Homeless), Inner City Health Associates, Toronto; and.,McMaster University, Hamilton, ON
| | - L Huynh
- Sunnybrook Health Sciences Centre, Toronto.,Department of Family and Community Medicine, University of Toronto, Toronto
| | - N Amirault
- William Osler Health System, Brampton and North Etobicoke
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Sumalinog R, Harrington K, Dosani N, Hwang SW. Advance care planning, palliative care, and end-of-life care interventions for homeless people: A systematic review. Palliat Med 2017; 31:109-119. [PMID: 27260169 DOI: 10.1177/0269216316649334] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Homeless individuals have a high prevalence of multiple chronic comorbidities and early mortality compared to the general population. They also experience significant barriers to access and stigmatization in the healthcare system. Providing advance care planning, palliative care, and end-of-life care for this underserved population is an important health issue. AIM To summarize and evaluate the evidence surrounding advance care planning, palliative care, and end-of-life care interventions for homeless persons. DESIGN A systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. DATA SOURCES Articles from MEDLINE, EMBASE, CINAHL, PsycINFO, Social Work Abstracts, Cochrane Library, Web of Science, and PubMed databases were searched through 13 June 2015. Peer-reviewed studies that implemented advance care planning, palliative care, and end-of-life care interventions for homeless populations were included. Data from studies were independently extracted by two investigators using pre-specified criteria, and quality was assessed using modified Cochrane and Critical Appraisal Skills Programme tools. RESULTS Six articles met inclusion criteria. Two studies were randomized controlled trials involving advance directive completion. Two cohort studies investigated the costs of a shelter-based palliative care intervention and predictors for completing advance directives. These studies were rated low to fair quality. Two qualitative studies explored the interface between harm-reduction services and end-of-life care and the conditions for providing palliative care for homeless persons in a support home. CONCLUSION The effectiveness of advance care planning, palliative care, and end-of-life care interventions for homeless individuals is uncertain. High-quality studies of interventions that reflect the unique and complex circumstances of homeless populations and investigate patient-related outcomes, caregiver burden, and cost-effectiveness are needed.
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Affiliation(s)
- Rafael Sumalinog
- 1 Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,2 Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Katy Harrington
- 2 Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Naheed Dosani
- 3 Inner City Health Associates, Toronto, ON, Canada.,4 Department of Family and Community Medicine, St Michael's Hospital, Toronto, ON, Canada.,5 Division of Palliative Care, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,6 Division of Palliative Care, William Osler Health System, Brampton, ON, Canada
| | - Stephen W Hwang
- 1 Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,2 Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,7 Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
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Abstract
Palliative care is an approach that focuses on the relief of pain and other symptoms for patients with advanced illnesses and their families, and on maximizing the quality of the patient’s remaining life. [...]
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Affiliation(s)
- M Chasen
- William Osler Health System, Brampton Civic Hospital, Brampton, ON
| | - N Dosani
- Division of Palliative Care, William Osler Health System, Brampton Civic Hospital, Brampton, ON
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Abstract
OBJECTIVE To determine the incidence of influenza vaccination among homeless individuals with mental illness in Toronto. METHODS A retrospective chart review was carried out using a random sample of homeless individuals with mental illness who were participants of the At Home/Chez Soi Study. Primary care charts were obtained and reviewed for the incidence influenza vaccination within a 1-year period. RESULTS Of the 75 participants for whom charts were reviewed, 5 (6.7%) had documentation indicating receipt of the influenza vaccination in the year prior to study recruitment. CONCLUSION This study raises awareness of the low incidence of homeless adults receiving the influenza vaccination in Toronto. The data are concerning given the high risk of morbidity from communicable respiratory illnesses in this group. Further research into the causes of low influenza vaccination rates among homeless Canadians is needed to develop strategies for increased delivery of the vaccination.
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Affiliation(s)
- Samantha Young
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Naheed Dosani
- St Michael's Hospital, Toronto, Ontario, Canada Inner City Health Associates, Toronto, Ontario, Canada McMaster University, Hamilton, Ontario, Canada
| | | | - Stephen Hwang
- St Michael's Hospital, Toronto, Ontario, Canada University of Toronto, Toronto, Ontario, Canada
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