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“Everybody in this community is at risk of dying”: An ethnographic exploration on the potential of integrating a palliative approach to care among workers in inner-city settings

Published online by Cambridge University Press:  07 May 2020

Kelli I. Stajduhar ,
Melissa Giesbrecht Open the ORCID record for Melissa Giesbrecht [Opens in a new window] ,
Ashley Mollison  and
Margo d'Archangelo
Kelli I. Stajduhar*
Affiliation:
Institute on Aging and Lifelong Health, University of Victoria, Victoria, BC, Canada School of Nursing, University of Victoria, Victoria, BC, Canada
Melissa Giesbrecht
Affiliation:
Institute on Aging and Lifelong Health, University of Victoria, Victoria, BC, Canada
Ashley Mollison
Affiliation:
Institute on Aging and Lifelong Health, University of Victoria, Victoria, BC, Canada
Margo d'Archangelo
Affiliation:
Victoria Hospice, Education and Research, Victoria, BC, Canada
*
Author for correspondence: Kelli I. Stajduhar, Institute on Aging and Lifelong Health, University of Victoria, 3800 Finnerty Road, Victoria, BC, CanadaV8P 5C2. E-mail: kis@uvic.ca
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Abstract

Objective

At the end of life, the need for care increases. Yet, for structurally vulnerable populations (i.e., people experiencing homelessness and poverty, racism, criminalization of illicit drug use, stigma associated with mental health), access to care remains highly inaccessible. Emerging research suggests that enhancing access to palliative care for these populations requires moving care from traditional settings, such as the hospital, into community settings, like shelters and onto the street. Thus, inner-city workers (ICWs) (e.g., housing support and community outreach) have the potential to play pivotal roles in improving access to care by integrating a “palliative approach to care” in their work.

Method

Drawing upon observational field notes and interview data collected for a larger critical ethnographic study, this secondary thematic analysis examines ICWs’ (n = 31) experiences providing care for dying clients and garners their perspectives regarding the constraints and facilitators that exist in successfully integrating a palliative approach to care in their work.

Results

Findings reveal three themes: (1) Approaches, awareness, and training; (2) Workplace policies and filling in the gaps; and (3) Grief, bereavement, and access to supports. In brief, ICWs who draw upon harm reduction strategies strongly parallel palliative approaches to care, although more knowledge/training on palliative approaches was desired. In their continuous work with structurally vulnerable clients, ICWs have the opportunity to build trusting relationships, and over time, are able to identify those in need and assist in providing palliative support. However, despite death and dying is an everyday reality of ICWs, many described a lack of formal acknowledgement by employers and workplace support as limitations.

Significance of results

Findings contribute promising practices for enhancing equitable access to palliative care for society's most vulnerable populations by prioritizing front-line workers’ perspectives on how best to integrate a palliative approach to care where structurally vulnerable populations live and die.

Keywords

Critical ethnographyHealth disparitiesMarginalized populationsPalliative approachStructurally vulnerable populations
Type
Original Article
Information
Palliative & Supportive Care , Volume 18 , Issue 6 , December 2020 , pp. 670 - 675
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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