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Life’s hard and then you die: Exploring the end of life priorities of people experiencing homelessness in the United Kingdom

Webb, W.A. (2019) Life’s hard and then you die: Exploring the end of life priorities of people experiencing homelessness in the United Kingdom. PhD thesis, University of Worcester.

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Abstract

Background
People experiencing homelessness consistently fail to access palliative care services
(Care Quality Commission, 2017). They often die young, on the streets or in hostels, and
without adequate support. The average age of death for a person experiencing
homelessness is 47 years for a male and 43 years for a female. However, despite
homelessness increasing in the United Kingdom, research specifically concerned with
end of life care for this population has not yet been prioritised. Furthermore, while there
is ample literature surrounding the barriers to appropriate end of life care (Klop et al.,
2018), the end of life priorities of homeless people in the United Kingdom remain poorly
understood (Care Quality Commission, 2017) This study aims to bridge the gap in
knowledge.
The Research Question
The central question for this research is: ‘What matters most to people experiencing
homelessness in the United Kingdom as they consider their own end of life?’. When the
answers to this important question are understood, the issue of homeless people dying
without adequate support and with very little dignity or choice can begin to be addressed.
Aim of study
The aim of this interpretive phenomenological study is to explore the end of life concerns,
fears, preferences and priorities of a sample of people experiencing homelessness in
the United Kingdom.
Methodology
This qualitative PhD research is an interpretive phenomenological study underpinned by
the philosophy of French phenomenologist, Maurice Merleau-Ponty. Data have been
collected through semi-structured, audio-recorded, face-to-face interviews with 21
participants across several counties in the United Kingdom. Data have been analysed
iteratively using thematic analysis.
Findings
Findings have been presented within the following eight themes to tell the stories of
participants’ concerns, fears, preferences and priorities regarding end of life: spiritual concerns; practical concerns; fear of needing care; fear of being forgotten; preference
for dying suddenly; preference for being somewhere comfortable where people know
me; prioritising autonomy and self-determination; and prioritising authenticity.
Discussion
Findings have then been viewed through the lens of Merleau-Ponty’s philosophy using
the following six dimensions of his philosophy: perception and embodiment; temporality
and perspective; ambiguity and mystery; intentionality and relationality; situated
freedom; and childhood experiences. Implications for future policy and practice have
been outlined and a strengths-based, trauma-informed, person-centred, collaborative
‘compassionate community’ approach to care has been recommended.
Conclusion
Discussion of the findings exposed four key messages: the pauper’s funeral is a real but
previously unreported concern for homeless people in the United Kingdom; the ‘face of
care’ is more important than the ‘place of care’; traditional palliative care services are
possibly an unattractive resource for this population so new approaches to care are
required; and a strengths-based, trauma-informed, person-centred, collaborative,
‘compassionate community’ approach to care is recommended. This is where the hostel
is established as the hub of a compassionate palliative care community within a local
neighbourhood and where the development of peer support workers, with lived
experience of homelessness, is actively encouraged and supported.

Item Type: Thesis (PhD)
Additional Information:

A thesis submitted in partial fulfilment of the University’s
requirements for the Degree of Doctor of Philosophy.
September 2019
University of Worcester
Three Counties School of Nursing and Midwifery

Publications arising from this project:

Webb, W.A., Mitchell, Theresa, Nyatanga, Brian and Snelling, Paul (2018) How to Explore the End-of-Life Preferences of Homeless People in the UK. European Journal of Palliative Care, 25 (2). pp. 59-62. ISSN Print: 1352-2779 Online:1479-0793
https://eprints.worc.ac.uk/6759/

Webb, W.A., Mitchell, Theresa, Nyatanga, Brian and Snelling, Paul (2018) Nursing Management of People Experiencing Homelessness at the End of Life. Nursing Standard, 32 (27). pp. 53-63. ISSN 0029-6570
https://eprints.worc.ac.uk/6340/

Webb, W.A., Mitchell, Theresa, Snelling, Paul and Nyatanga, Brian (2018) The Spiritual Concerns of People Experiencing Homelessness at the End of Life. International Journal of Palliative Nursing, 24 (9). pp. 428-435. ISSN 1357-6321
https://eprints.worc.ac.uk/7174/

Webb, W.A. (2018) Life’s hard and then you die - with no choice and no voice: Exploring end of life priorities within the homeless population in the UK. Homeless in Europe. pp. 4-6.
https://eprints.worc.ac.uk/9941/

Webb, W.A., Mitchell, Theresa, Nyatanga, Brian and Snelling, Paul (2017) 'Who cares and what matters?': exploring end of life priorities of homeless adults in the UK. In: Marie Curie Research Conference 2017. (Unpublished)
https://eprints.worc.ac.uk/9940/

Uncontrolled Discrete Keywords: end of life care, priorities, homelessness, Maurice Merleau-Ponty, phenomenology, advanced care planning, compassionate communities, homeless people
Subjects: R Medicine > R Medicine (General)
R Medicine > RT Nursing
Divisions: College of Health, Life and Environmental Sciences > School of Nursing and Midwifery
Related URLs:
Depositing User: Janet Davidson
Date Deposited: 05 Nov 2020 16:09
Last Modified: 07 Dec 2020 17:14
URI: https://eprints.worc.ac.uk/id/eprint/9924

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