Patient Perspectives on Palliative Care Outreach to Adults Living With Homelessness

Importance People experiencing homelessness face higher rates of early mortality, multimorbidity, and unmet needs at the end of life, but despite these risks, they often encounter systemic barriers to accessing palliative care. Outreach-based models have emerged to address this gap, yet little is known about how these models are perceived by those receiving care. Objective To evaluate a palliative care outreach intervention, the Palliative Education and Care for the Homeless (PEACH) program, from the perspective of patients living with homelessness and life-limiting illness. Design, Setting, and Participants This qualitative descriptive study using semistructured interviews with adult PEACH patients was conducted in Toronto, Ontario, Canada, between May 1, 2023, and November 30, 2024. PEACH participants were sampled purposively or conveniently. Interviews were conducted in person or by phone, transcribed verbatim, and analyzed using a reflexive, iterative approach informed by interpretive qualitative description. Exposure Receipt of care from the PEACH program during the research period. Main Outcomes and Measures Patients’ experiences with the PEACH program, perspectives on program benefits, and evaluation of program strengths and weaknesses. Results Fourteen patients between the ages of 20 and 70 years were interviewed: 7 with malignant conditions and 7 with nonmalignant conditions. All but 2 participants were men. The mean (range) duration of contact with PEACH at interview was 18 (3-69) months. Six major themes were identified: life before PEACH, outreach and community care, medical needs, social needs, relational care, and constructive feedback. PEACH addressed barriers by providing low-barrier access and coordination across health care professionals. Participants described improvements in pain and symptom management, mental health, access to supplies, and support with income and housing. The team’s compassionate, person-centered approach, described as relational care, was central to participants’ trust and engagement. Many said they would not be alive without the intervention. Although most feedback was positive, some participants noted areas for improvement, including communication gaps and lack of a single assigned palliative care physician. Conclusions and Relevance In this qualitative study of a palliative care outreach intervention from the perspective of people experiencing homelessness, participants emphasized the need for an accessible, compassionate approach that addresses medical and social needs. Findings offer insights for future outreach program development and evaluation.