Scoping review of serious illness communication with people experiencing homelessness: a protocol

Rates of homelessness are staggering, as are the number of adults living with chronic and life-threatening illnesses such as heart disease and cancer.1,2 Life expectancy among unhoused populations ranges from 64 to 70 years, considerably less than the general population.3 Living with a serious illness that threatens mortality requires quality communication about goals, values, and preferences (“serious illness communication”) throughout the illness trajectory (not just for the end of life);4 however these conversations are rarely initiated with unhoused adults.5 Adults experiencing homelessness frequent hospitals, clinics, and shelters, but experience fragmented and siloed care with missed opportunities to deliver and discuss diagnoses and prognoses. To increase the development and use of quality communication interventions for unhoused adults with life-threatening illnesses, we must first understand what we already know. Thus this scoping review seeks to describe the existing literature on the facilitators, barriers, and impact of serious illness communication interventions with unhoused populations. 1. Centers for Disease Control and Prevention. (2022). Chronic Diseases in America. https://www.cdc.gov/chronicdisease/resources/infographic/chronic-diseases.htm 2. National Alliance to End Homelessness. (2023). State of Homelessness.https://endhomelessness.org/homelessness-in-america/homelessness-statistics/state-of-homelessness/ 3. Metraux S, Eng N, Bainbridge J, Culhane DP. The impact of shelter use and housing placement on mortality hazard for unaccompanied adults and adults in family households entering New York City shelters: 1990–2002. Journal of Urban Health. 2011;88(6):1091-1104. 4. Tulsky JA, Beach MC, Butow PN, et al. A research agenda for communication between health care professionals and patients living with serious illness. JAMA Intern Med. 2017;177(9):1361-1366. 5. Sumalinog R, Harrington K, Dosani N, Hwang SW. Advance care planning, palliative care, and end-of-life care interventions for homeless people: A systematic review. Palliative Medicine. 2017;31(2):109-119. doi:10.1177/0269216316649334