# Patient Perspectives on Palliative Care Outreach to Adults Living With Homelessness

## TL;DR

This study explores how a palliative care outreach program is experienced by homeless adults with life-limiting illnesses, highlighting its compassionate and accessible approach.

## Contribution

The study provides patient perspectives on a community-based palliative care outreach program, revealing how it addresses medical and social needs while overcoming systemic barriers.

## Key findings

- Participants credited the program with eliminating systemic barriers and improving physical and mental well-being.
- The program's compassionate, person-centered approach was central to participants' trust and engagement.
- Participants highlighted the need for accessible care addressing both medical and social determinants of health.

## Abstract

This qualitative study evaluates the Palliative Education and Care for the Homeless program, a community-based palliative care outreach intervention, from the perspective of adults experiencing homelessness and life-limiting illness.

How do people living with homelessness and life-limiting illness experience a community-based palliative care outreach program?

Fourteen patients of the Palliative Education and Care for the Homeless (PEACH) program were interviewed for this qualitative study, and 6 major themes were identified: life before PEACH, outreach and community care, medical needs, social needs, relational care, and constructive feedback. PEACH was credited with eliminating systemic barriers, improving physical and mental well-being, and addressing social determinants of health while employing a distinctly compassionate, person-centered approach.

Findings of this qualitative study underscore the value of palliative care outreach programs for adults living with homelessness and terminal illness and may inform the development and implementation of future outreach programs.

People experiencing homelessness face higher rates of early mortality, multimorbidity, and unmet needs at the end of life, but despite these risks, they often encounter systemic barriers to accessing palliative care. Outreach-based models have emerged to address this gap, yet little is known about how these models are perceived by those receiving care.

To evaluate a palliative care outreach intervention, the Palliative Education and Care for the Homeless (PEACH) program, from the perspective of patients living with homelessness and life-limiting illness.

This qualitative descriptive study using semistructured interviews with adult PEACH patients was conducted in Toronto, Ontario, Canada, between May 1, 2023, and November 30, 2024. PEACH participants were sampled purposively or conveniently. Interviews were conducted in person or by phone, transcribed verbatim, and analyzed using a reflexive, iterative approach informed by interpretive qualitative description.

Receipt of care from the PEACH program during the research period.

Patients’ experiences with the PEACH program, perspectives on program benefits, and evaluation of program strengths and weaknesses.

Fourteen patients between the ages of 20 and 70 years were interviewed: 7 with malignant conditions and 7 with nonmalignant conditions. All but 2 participants were men. The mean (range) duration of contact with PEACH at interview was 18 (3-69) months. Six major themes were identified: life before PEACH, outreach and community care, medical needs, social needs, relational care, and constructive feedback. PEACH addressed barriers by providing low-barrier access and coordination across health care professionals. Participants described improvements in pain and symptom management, mental health, access to supplies, and support with income and housing. The team’s compassionate, person-centered approach, described as relational care, was central to participants’ trust and engagement. Many said they would not be alive without the intervention. Although most feedback was positive, some participants noted areas for improvement, including communication gaps and lack of a single assigned palliative care physician.

In this qualitative study of a palliative care outreach intervention from the perspective of people experiencing homelessness, participants emphasized the need for an accessible, compassionate approach that addresses medical and social needs. Findings offer insights for future outreach program development and evaluation.