How to Explore the End-of-Life Preferences of Homeless People in the UK

Palliative care is a holistic, multidisciplinary team approach to the care of people with life-limiting conditions that focuses on improving quality of life and the prevention and relief of pain and suffering, whether physical, psychosocial or spiritual.1 UK health policy states that palliative care should be universally accessible, inclusive and readily available at the point of need, wherever a person may be and irrespective of socioeconomic deprivation.2 The reality in the UK, however, is far from this for marginalised groups, such as those experiencing homelessness.3,4 Homelessness is a growing problem, both in the UK and worldwide.5,6 It is also a complex, multidimensional issue that brings with it considerable health problems. Tri-morbidity – the combination of physical ill-health with mental ill-health and drug or alcohol misuse – is often associated with homelessness and has a significant impact on both quality of life and life expectancy.4 Homeless people in the UK die on average 30 years younger than members of the general population, so that the average age of death for a homeless person is 47 years for males and 43 years for females, compared with the general population statistics of 74 and 80 years, respectively.7 People who are homeless also experience greater difficulty than the general population in accessing specialist palliative and end-of-life (EoL) care services,8 and the reasons for this are well documented by Shulman et al.4 However, the particular EoL needs and preferences of this marginalised group are underexplored, particularly here in the UK.8. © Hayward Medical Communications 2018. All rights reserved.