• Hanna T Klop, de Veer Anke J E AJE Netherlands Institute for Health Services Research (NIVEL), P.O. Box 1568, 3500 BN, Utrecht, Netherlands., Sophie I van Dongen, Anneke L Francke, Rietjens Judith A C JAC Department of Public Health, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, Netherlands., and Bregje D Onwuteaka-Philipsen.
• Amsterdam Public Health Research Institute (APH), Department of Public and Occupational Health, Expertise Centre for Palliative Care, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands. klophanna@gmail.com.
• BMC Palliat Care. 2018 Apr 24; 17 (1): 67.

BackgroundHomeless people often suffer from complex and chronic comorbidities, have high rates of morbidity and die at much younger ages than the general population. Due to a complex combination of physical, psychosocial and addiction problems at the end of life, they often have limited access to palliative care. Both the homeless and healthcare providers experience a lot of barriers. Therefore, providing palliative care that fits the needs and concerns of the homeless is a challenge to healthcare providers. This systematic review aims to summarize evidence about the concerns, palliative care needs and preferences of homeless people, as well as barriers and facilitators for delivering high quality palliative care.MethodsPubMed, Embase, PsycINFO, CINAHL and Web of Science were searched up to 10 May 2016. Included were studies about homeless people with a short life expectancy, their palliative care needs and the palliative care provided, that were conducted in Western countries. Data were independently extracted by two researchers using a predefined extraction form. Quality was assessed using a Critical Appraisal instrument. The systematic literature review was based on the PRISMA statement.ResultsTwenty-seven publications from 23 different studies met the inclusion criteria; 15 studies were qualitative and eight were quantitative. Concerns of the homeless often related to end-of-life care not being a priority, drug dependence hindering adequate care, limited insight into their condition and little support from family and relatives. Barriers and facilitators often concerned the attitude of healthcare professionals towards homeless people. A respectful approach and respect for dignity proved to be important in good quality palliative care.ConclusionsA patient-centred, flexible and low-threshold approach embodying awareness of the concerns of homeless people is needed so that appropriate palliative care can be provided timely. Training, education and experience of professionals can help to accomplish this.

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