{
  "abstract": "Background People experiencing homelessness have significantly worse health outcomes, with mortality rates up to six times higher than the general population and markedly limited access to palliative care (Office for National Statistics. Deaths of homeless people in England and Wales: 2021 registrations. ONS. 2022 [internet]; Crooks, Flemming, Shulman, et al. BMJ Open. 2024;14:e075498). Despite high symptom burden and complex needs, systemic exclusion, stigma, and late recognition of end-of-life trajectories create substantial barriers to appropriate care (Shulman, Hudson, Low, et al. Palliat Med. 2018;32(1):36–45; Armstrong, Shulman, Hudson, et al. Palliat Med. 2021;35(6):1202-14). A 12-month Homelessness Outreach Project was conducted by an NHS hospital palliative care service, including the secondment of a Clinical Nurse Specialist (CNS) into frontline homelessness services.Aim To gather first-hand reflections on the progress, challenges, and successes of the Homelessness Outreach Project, and to explore the experiences of the seconded Clinical Nurse Specialist. The study aimed to understand how the CNS’s role and practice evolved in implementing the project, including interactions with clients, teams, and systems, as part of a broader evaluation of development, reach, and sustainability.Method A longitudinal qualitative approach was used to explore the CNS’s experience during the 12-month Homelessness Outreach Project. Two semi-structured interviews were conducted four months apart, with a final interview planned at project end. Data were analysed using thematic analysis following Braun and Clarke’s approach (Qual Res Psychol. 2006;3(2):77–101).Results Analysis of both interviews identified changes in the CNS’s role, perceptions, and working relationships over time. Early themes centred on building trust, scoping unmet need, and raising awareness of palliative care. By the second interview, expanded themes reflected increased identification of individuals with advanced ill health, improved multidisciplinary collaboration, and greater staff confidence in advocating for clients. The CNS’s consistent presence supported continuity and trust, particularly for socially isolated service users. Staff felt more valued, and support workers reported increased confidence. Key overarching themes included the importance of trauma-informed, holistic care, the value of visible presence in building inter-agency relationships, and ongoing systemic barriers to healthcare access. Despite progress, emotional strain, professional isolation, and concerns around sustainability persisted.Funding and support for the project was received from St. James’s Place Charitable Foundation (via a grant managed by Hospice UK) and Sobell House Hospice Charity.",
  "authors": [
    {
      "affiliations": [
        "Nuffield Department Of Medicine (NDM), University of Oxford, Oxford, UK",
        "Oxford University Hospitals NHS Foundation Trust, Oxford, UK"
      ],
      "name": "Karen Shepherd"
    },
    {
      "affiliations": [
        "Oxford University Hospitals NHS Foundation Trust, Oxford, UK"
      ],
      "name": "Nicole Satullo"
    },
    {
      "affiliations": [
        "Oxford University Hospitals NHS Foundation Trust, Oxford, UK"
      ],
      "name": "Mary Walding"
    },
    {
      "affiliations": [
        "Nuffield Department Of Medicine (NDM), University of Oxford, Oxford, UK",
        "Oxford University Hospitals NHS Foundation Trust, Oxford, UK",
        "Harris Manchester College, Oxford, UK"
      ],
      "name": "Bee Wee"
    }
  ],
  "title": "P-168 Exploring the journey: A clinical nurse specialist’s perspective on a palliative care homelessness outreach project – A longitudinal case study",
  "uid": "c565d374-fa98-5065-822b-07b6ba340a69"
}