Addressing palliative care needs for a housing-insecure patient with metastatic renal cell carcinoma and severe mental illness: A case report

Palliative care for underserved populations presents unique challenges due to complex medical, psychiatric, and social needs. We report a case of a 54-year-old housing-insecure male with schizophrenia and metastatic chromophobe renal cell carcinoma, initially diagnosed during hospitalization for a seizure and infection. Initially lacking capacity, he was deemed appropriate for hospice but was lost to follow-up after discharge to a skilled nursing facility. Re-engagement occurred through a Federally Qualified Health Center (FQHC) embedded in a homeless shelter, where care was delivered through an integrated, community-based model. The patient primarily interacted with his primary care physician, board-certified in family medicine and palliative care, while receiving support from behavioral health, outreach, and case management staff. Through coordinated efforts—including facilitation of oncology appointments, outreach support, and ongoing trust-building interactions—the patient adhered to partial radiation therapy and systemic treatment while maintaining autonomy and quality of life. This case highlights the importance of trauma-informed, patient-centered care, demonstrates how interdisciplinary collaboration can support complex decision-making, and underscores the role of community-based FQHC models in addressing social determinants of health while building trust and supporting patient autonomy for medically and socially complex individuals facing homelessness and severe mental illness.