Table 3.

Category Two: Unmet Needs: Gaps in Knowledge, Services and Approaches needed to Enhance End-of-Life Care

Theme 5: Comfort with providing care to those experiencing homelessnessLike if you don't think that you can set your judgements aside then you shouldn't be working with these individuals, right? […] And if you're going to cause more harm than good for the individual because you can't set your judgements aside and understand that you took an oath to provide care, then you need not to be working with those individuals. That to me is so so so important. (KI 10)
They're invisible. So, for me it's an exciting place to work because these rough looking people but these beautiful spirits come out and their ability to survive. [..] You know it's all those kids we think about when we hear these horrific news stories of abuse. They went into the foster care system and then we don't think of them again but that little kid ends up being the 30-year-old with a criminal record and that little kid ends up being a woman who's prostituted for the last 10 years. (KI 4)
Theme 6: Gaps in healthcare provider knowledge and/or attitudesI believe that staff and volunteers would benefit from specified training and development—substance dependency, trauma, other mental health issues, etc. (SR)
Compassion training, substance abuse training, harm-reduction training. More of an intensive like mental health training, um, de-escalation—lots of things, you know. Lots of things. (KI 10)
Oh we have to start changing the social construct of how we view individuals who use substances, who are homeless, who are suffering with mental health issues. If we don't change our views on how we see these individuals—that they are the root cause of all their problems—then I don't think anything will change. (KI 10)
Probably just having a list of services available in the city that you can give them. Like that we can jot down on a piece of paper for them or numbers that we can give them for them to get in contact with the proper people if the hospital doesn't um provide it. And if we had a bit of an idea of what was available I'm sure most of us would at least talk to them about it. (KI 7)
Theme 7: Gaps in available services and possible solutionsIt would be nice to have a space that we could provide for individuals that are palliative that is staffed and supported by individuals who have worked with people with chronic substance use, chronic mental health, the homeless, transient population—that have an understanding and can provide respectful, dignified care (KI 10)
We operate out of fixed locations or we operate, you know, at fixed addresses and I think that needs to change. I think, you know, we have a very high percentage of homelessness. And I feel that we need to maybe change some of the ways we're doing things to accommodate people who are unstably housed or living on the street or living at tent city or. I think we should have more outreach, palliative outreach. (KI 6)
I could envision an opportunity to even have some of our clients, who were maybe more leaders in this community, getting some training and being able to provide that themselves. [..] Peer support. I think that can be really powerful because there is this kind of kickback against anything they view as authoritative. (KI 4)
A harm reduction approach will always provide more options for an individual using illicit substances. If they know that care will still be provided to them in a nonjudgmental way, and in an environment that will address and support them with this issue, they are much more likely to access these services. (SR)
  • KI, key informant; SR, survey respondent.