Systematic search and narrative review seeking to identify the current prevalence of potentially life-limiting respiratory conditions among those who have experienced homelessness, incarceration or had criminal justice involvement, and current developments in, and barriers to, delivery of supportive and palliative respiratory care to these populations.
We know that people experiencing homelessness, prison or other criminal justice system involvement have worse health and health care outcomes than those who do not, including higher rates of substance misuse, higher levels of long-term conditions and poorer mental health. They also “age” more quickly (experiencing levels of illness normally associated with people 10 years older) and die younger.
Potentially life-limiting respiratory conditions such as asthma, chronic obstructive pulmonary disease (COPD) and pulmonary tuberculosis are particularly common in these populations suggesting their need for supportive and palliative care. However, there are particular challenges in delivering both respiratory and palliative care services to these groups – including their ability to access services and delivering services that meet their particular needs.
To understand the current prevalence and nature of potentially life-limiting respiratory conditions among these groups, and identify current developments and barriers to supportive and palliative respiratory care for them, a review of recent relevant research literature was conducted.
We aimed understand:
1) the current prevalence and nature of potentially life-limiting respiratory conditions among these groups, and
2) current developments in, and barriers to, delivery of supportive and palliative respiratory care to them.
With the help of a medical librarian, we systematically searched the research literature published between January 2019 and April 2020 to identify studies about supportive and palliative care of people with potentially life-limiting respiratory conditions who experienced:
- homelessness (i.e. sleeping rough, living in a homeless hostel, living in insecure accommodation)
- incarceration or criminal justice involvement (“prison populations”)
Studies found to be relevant studies were checked for their quality (to give confidence in the information they contained), and then relevant information from the studies was identified relating to (1) prevalence of potentially life-limiting respiratory conditions and (2) supportive and palliative care related to respiratory conditions. This information was then summarised, and the findings reported.
Potential or actual impact:
We found that:
- most studies investigated the prevalence of respiratory conditions
- prevalence of respiratory conditions was high
- only one study directly explored supportive and palliative care (and this was in a prison population)
- no studies considered or addressed palliative or end-of-life needs of these vulnerable groups, or ways to address them
- there were no qualitative studies
- there were no studies of the impact on, or role of, family, friends or informal networks (informal carers)
There is a need for evidence-based interventions to reduce the risk of communicable respiratory conditions and a greater understanding of how conditions change over time (and the impact of this) and management for these vulnerable groups, including provision of accessible appropriate supportive, palliative and end-of-life care.
The review has been published in Current Opinion in Supportive & Palliative Care.
Gardener AC, Kuhn I, Micklewright K & Farquhar M. Supportive and palliative care of adults with respiratory problems experiencing structural vulnerability from homelessness, prison or other criminal justice system involvement. Current Opinion in Supportive & Palliative Care 2020;14(3):197-205 doi: 10.1097/SPC.0000000000000511
We will seek to explore evidence-based interventions to enable provision of accessible, appropriate and effective supportive, palliative and end-of-life care that addresses the needs of these individuals, and those who support them formally and informally.
Who is involved?
PI Prof Morag Farquhar
Researchers and institutions
Morag Farquhar & Kerry Micklewright (University of East Anglia)
Carole Gardener & Isla Kuhn (University of Cambridge)