Homeless individuals typically suffer from elevated levels of medical complexity, multiple co-existing conditions, and increased mortality risks. They also confront major obstacles when seeking palliative care. Among structurally disadvantaged groups needing end-of-life support, these obstacles intensify, creating significant challenges for patients and clinicians alike and carrying notable consequences for health equity. This study examined firsthand accounts of palliative care clinicians who supported homeless patients during the COVID-19 pandemic. The focus was on uncovering the obstacles they encountered while delivering care and the elements that contributed to their teams’ effectiveness. Seven healthcare professionals from two Canadian palliative outreach teams responsible for providing end-of-life care to homeless patients during the COVID-19 pandemic joined audio-recorded videoconference interviews, which were subsequently transcribed. Data examination relied on generic descriptive thematic analysis.
Five primary themes surfaced: (1) factors negatively impacting patient health, (2) use of technology, (3) care provider emotions, (4) care provider education and advocacy, and (5) outreach team factors. Challenges noted during the pandemic included the exacerbation of patients’ pre-existing vulnerabilities and difficulties integrating technology into care provision. Clinicians dealt with a heavier emotional toll marked by higher workloads, elevated stress, heightened fear, and greater grief. Still, various supportive factors enabled teams to deliver excellent care to this at-risk population, including robust team backing, cross-professional teamwork, and efforts centered on advocacy and education. The outreach approach also emerged as an exceptionally adaptable, durable, and flexible framework for delivering care amid the COVID-19 pandemic.
