• Eva Purkey and Meredith MacKenzie.
• From the Department of Family Medicine, Queen's University, Kingston Ontario, Canada (EP, MM); Street Health Centre, a part of Kingston Community Health Centres, Kingston Ontario, Canada (MM). eva.purkey@dfm.quuensu.ca.
• J Am Board Fam Med. 2019 Nov 1; 32 (6): 858-867.

BackgroundThirty-five thousand Canadians are homeless on any given night, and mortality rates are much higher than for the general population. Studies have identified barriers to accessing end-of-life care among the homeless, including logistic barriers and experiences of stigma. This study seeks to explore the experience, goals, fears, and hopes surrounding death in the setting of homelessness or vulnerable housing.MethodsQualitative phenomenological study involving focus groups and in-depth interviews with 31 people with lived experience of homelessness. Additional sociodemographic data collected from participants.FindingsThemes included extensive experience with death and dying, relationship with mortality, ideas for a good death, and desires for end-of-life care. Participants presented suggestions for improving end-of-life care including care that was delivered by people with lived experience of homelessness and substance use; care that was provided either as outreach or in a welcoming, flexible institutional environment; care that minimized stigma and enhanced dignity; and care that respected people's desires to use substances at the end of life.DiscussionParticipants with lived experience of homelessness were articulate in their desires and needs for end-of-life care. They have extensive exposure to mortality and feel that their needs are not met by the current palliative care system. Recommendations for system change that include harm reduction and equity-oriented health care, as well as a combination of outreach and inpatient services, are necessary before palliative care services will be accessible for this population.© Copyright 2019 by the American Board of Family Medicine.

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