Exploring perspectives regarding death cafés for people experiencing homelessness:a qualitative study

Abstract Background: People experiencing homelessness often die at a younger age than the general population. Advanced ill-health often occurs late in its trajectory (if at all), leaving many people experiencing homelessness to die without adequate support from hospital-, hospice- or community-based palliative care services. Despite the high rate of bereavement and exposure to death among people experiencing homelessness, there are rarely opportunities for them to reflect on their experiences, thoughts and preferences around death or receive bereavement support. Death cafés are a global social franchise, providing a space for people to participate in an open group discussion about death, dying and bereavement. They are free to attend and unstructured but facilitated. Objectives: To explore the perspectives of people experiencing homelessness and the professionals that support them with regards to the potential acceptability, benefits and challenges of death cafes. Methods: A qualitative study comprising of: interviews with nine homelessness and/or palliative care professionals with experience of running death cafés for, or supporting people experiencing homelessness in other ways, and two focus groups with nine people with lived experience of homelessness. The research was co-produced with a lived experience co-researcher forming a core part of the research team. Reflexive thematic analysis was utilised to develop themes. Results: Five themes were developed to highlight the perspectives and experiences of death cafés for people experiencing homelessness: Choice; Expertise in facilitation: recognizing risk and the unstructured nature; Promoting safety against potential risk; Potential benefits; and Potential practical considerations. Themes highlight the need for a trauma informed approach. Death cafés could be impactful, where done well, but they are not without risk. Conclusions: Death cafés for people experiencing homelessness pose risks that require comprehensive consideration and trauma-informed, expert facilitation. However, this research highlighted that a low- pressure space to explore thoughts around death, dying and bereavement is currently an unmet need within this population.