Adapting the Serious Illness Conversation Guide for Older Adults Experiencing Homelessness

The population of older adults experiencing homelessness has grown exponentially over the last 20 years and that growth is expected to continue. They experience considerable physical and mental burdens and disparities in health care that prematurely advance their age and contribute to lower life expectancy than adults their age. Moreover, serious illnesses may rapidly progress due to delays in or a lack of diagnoses and treatment. Nurses, social workers, and other social service care providers frequently care for this population in shelters, emergency departments, and community clinics; yet, often feel ill-equipped to provide care for this populations’ complex care needs. Serious illness communication has been identified as a necessary component to promote quality of patient care, reduce end of life healthcare costs, and ensure goals and values are driving treatment decisions. The Serious Illness Conversation Guide (SICG) has yielded promising findings towards facilitating these values-based conversations but was developed and tested primarily in oncology settings. This study seeks to have a better understanding of current practices of serious illness communication with older adults who are homeless and to adapt the SICG to ensure fit, utility, acceptability and satisfaction and promote fit for future intervention testing.