Format

Send to

Choose Destination
BMC Palliat Care. 2019 Jan 26;18(1):11. doi: 10.1186/s12904-019-0396-7.

"Just too busy living in the moment and surviving": barriers to accessing health care for structurally vulnerable populations at end-of-life.

Author information

1
Institute on Aging and Lifelong Health, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada. kis@uvic.ca.
2
School of Nursing, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada. kis@uvic.ca.
3
Institute on Aging and Lifelong Health, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada.
4
BC Centre on Substance Use, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
5
Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
6
School of Nursing, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada.
7
Canadian Institute for Substance Use Research, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada.
8
School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC, V2Y 1Y1, Canada.
9
Inner City Health Associates, 59 Adelaide St. E, Toronto, ON, M5C 1K6, Canada.
10
School of Social Work, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada.
11
Victoria Cool Aid Community Health Centre, 1st Floor, Access Health Centre, 713 Johnson Street, Victoria, BC, V8W 1M8, Canada.
12
AIDS Vancouver Island, 713 Johnson St, Victoria, BC, V8W 1M8, Canada.

Abstract

BACKGROUND:

Despite access to quality care at the end-of-life (EOL) being considered a human right, it is not equitable, with many facing significant barriers. Most research examines access to EOL care for homogenous 'normative' populations, and as a result, the experiences of those with differing social positioning remain unheard. For example, populations experiencing structural vulnerability, who are situated along the lower rungs of social hierarchies of power (e.g., poor, homeless) will have unique EOL care needs and face unique barriers when accessing care. However, little research examines these barriers for people experiencing life-limiting illnesses and structural vulnerabilities. The purpose of this study was to identify barriers to accessing care among structurally vulnerable people at EOL.

METHODS:

Ethnography informed by the critical theoretical perspectives of equity and social justice was employed. This research drew on 30 months of ethnographic data collection (i.e., observations, interviews) with structurally vulnerable people, their support persons, and service providers. Three hundred hours of observation were conducted in homes, shelters, transitional housing units, community-based service centres, on the street, and at health care appointments. The constant comparative method was used with data collection and analysis occurring concurrently.

RESULTS:

Five significant barriers to accessing care at EOL were identified, namely: (1) The survival imperative; (2) The normalization of dying; (3) The problem of identification; (4) Professional risk and safety management; and (5) The cracks of a 'silo-ed' care system. Together, findings unveil inequities in accessing care at EOL and emphasize how those who do not fit the 'normative' palliative-patient population type, for whom palliative care programs and policies are currently built, face significant access barriers.

CONCLUSIONS:

Findings contribute a nuanced understanding of the needs of and barriers experienced by those who are both structurally vulnerable and facing a life-limiting illness. Such insights make visible gaps in service provision and provide information for service providers, and policy decision-makers alike, on ways to enhance the equitable provision of EOL care for all populations.

KEYWORDS:

Access to care; Canada; EOL care; Ethnographic methods; Health equity; Homelessness; Structural vulnerability

Supplemental Content

Full text links

Icon for BioMed Central Icon for PubMed Central
Loading ...
Support Center