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Bradley NM, Dowrick CF, Lloyd-Williams M. A survey of hospice day services in the United Kingdom & Republic of Ireland : how did hospices offer social support to palliative care patients, pre-pandemic? Palliat Care 2022; 21:170. [PMID: 36195870 PMCID: PMC9532229 DOI: 10.1186/s12904-022-01061-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 09/09/2022] [Accepted: 09/15/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Social support is described by patients and other stakeholders to be a valuable component of palliative day care. Less is known about the range of hospice services that have been used in practice that facilitate social support. An online survey aimed to gain an overview of all hospice day services that facilitated social support for adults outside of their own homes. METHODS An online survey was distributed via email to people involved in managing hospice day services. Questions were asked on hospice characteristics, including staff and volunteer roles. Respondents were asked to identify services they felt offered social support to patients. Data collection took place between August 2017 and May 2018. RESULTS Responses were received from 103 hospices in the UK and ROI (response rate 49.5%). Results provide an overview of hospice day and outpatient services that offer social support to patients. These are: multi-component interventions, activity groups, formal support groups, befriending, and informal social activities. Multi-component interventions, such as palliative day care, were the most commonly reported. Their stated aims tend to focus on clinical aspects, but many survey respondents considered these multicomponent interventions to be the 'most social' service at their hospice. The survey also identified a huge variety of activity groups, as well as formal therapeutic support groups. Informal 'social-only' activities were present, but less common. Over a third of all the services were described as 'drop in'. Most responding hospices did not routinely use patient reported outcome measures in their 'most social' services. CONCLUSIONS The survey documents hospice activity in facilitating social support to be diverse and evolving. At the time of data collection, many hospices offered multiple different services by which a patient might obtain social support outside of their own home and in the presence of other patients.
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Affiliation(s)
- N M Bradley
- Research Fellow in Realist Evaluation, Centre for Health & Clinical Research, University of the West of England, Glenside Campus, BS16 1DD., Bristol, United Kingdom.
| | - C F Dowrick
- Emeritus Professor, Department of Primary Care and Mental Health, University of Liverpool, Waterhouse Building, L69 3BX., Liverpool, United Kingdom
| | - M Lloyd-Williams
- Professor & Honorary Consultant in Palliative Medicine, Department of Primary Care and Mental Health, University of Liverpool, Waterhouse Building, L69 3BX, Liverpool, United Kingdom
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Terjung T, Stiel S, Schneider N, Herbst FA. Status, demand and practice models of palliative day-care clinics and day hospices: a scoping review. BMJ Support Palliat Care 2021:bmjspcare-2021-003171. [PMID: 34312186 DOI: 10.1136/bmjspcare-2021-003171] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/15/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Little is known about the structure, accessibility, service provision and needs of palliative and hospice day-care in Germany and abroad. Researchers, healthcare providers and policy makers would benefit from a systematic overview. AIM The aim was to identify, describe and summarise available evidence on status, demand and practice models of palliative day-care clinics and day hospices. A secondary aim was to disclose research gaps and present recommendations for clinical practice and future research. DESIGN The scoping review followed the methodological framework of Arksey and O'Malley. The analysed publications included studies of varying kinds to describe the current state of the art. DATA SOURCES Using a highly sensitive search strategy, the authors searched PubMed, Web of Science Core Collection, CINAHL and Google Scholar within the publication window of inception to 12 June 2020. An additional hand search of the reference lists of the identified review articles was conducted. RESULTS The authors screened the titles and abstracts of 2643 studies, retrieved 197 full texts and included 32 articles in the review. The review identified nine major themes: (1) the referral process, (2) models of care, (3) patient characteristics, (4) demand, (5) the discharge process, (6) perceptions of services, (7) funding and costs, (8) outcome measurement and (9) education. CONCLUSIONS There is a need for further research to identify groups of patients who would receive the most benefit from palliative and hospice day-care and to determine any necessary revisions in admission criteria.
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Affiliation(s)
- Teresa Terjung
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
| | - Stephanie Stiel
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
| | - Nils Schneider
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
| | - Franziska A Herbst
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
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Apolinarski B, Herbst FA, Röwer HAA, Schneider N, Stiel S. Status quo palliativmedizinischer Tageskliniken und Tageshospize in Deutschland: Ergebnisse einer gemischt-methodischen Studie. ZEITSCHRIFT FÜR PALLIATIVMEDIZIN 2021. [DOI: 10.1055/a-1514-8871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Zusammenfassung
Ziel der Studie Der Bestand von Tageshospizen und palliativmedizinischen Tageskliniken in Deutschland soll erstmals systematisch erhoben und analysiert werden.
Methodik In dieser gemischt-methodischen Studie wurden Einrichtungsleitungen in leitfadengestützten Interviews (06.–07.2020) und standardisierter Fragebogenerhebung (08.–10.2020) zu einrichtungsbezogenen Kriterien befragt. Interviewdaten wurden qualitativ inhaltsanalytisch, quantitative Daten deskriptiv ausgewertet.
Ergebnisse Die Interviews (n = 7) liefern einen Überblick über Organisation und Versorgungsangebot hospizlich-palliativer Tageseinrichtungen. Von 28 standardisiert befragten Einrichtungen waren 13 bereits in Betrieb. Die zumeist an andere Versorger angebundenen Einrichtungen bieten in der Regel zwischen 2 und 8 Tagesplätze an.
Schlussfolgerung Aufgrund der gezeigten Entstehungsdynamik scheint eine systematische Integration der neuen Strukturen in die bestehende Hospiz- und Palliativversorgung sinnvoll.
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Affiliation(s)
- Beate Apolinarski
- Institut für Allgemeinmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Franziska A. Herbst
- Institut für Allgemeinmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Hanna A. A. Röwer
- Institut für Allgemeinmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Nils Schneider
- Institut für Allgemeinmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Stephanie Stiel
- Institut für Allgemeinmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
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Hasson F, Jordan J, McKibben L, Graham-Wisener L, Finucane A, Armour K, Zafar S, Hewison A, Brazil K, Kernohan WG. Challenges for palliative care day services: a focus group study. BMC Palliat Care 2021; 20:11. [PMID: 33435954 PMCID: PMC7802306 DOI: 10.1186/s12904-020-00699-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 12/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Palliative care day services provide a safe environment for people with palliative care needs, enabling them to access a range of services while acting as a respite services for family caregivers. Viewed as marginal services, they are often under resourced and under researched. The aim of this study was to understand how palliative day care services contribute to client care from the perspective of management and hospice multidisciplinary teams. METHODS A descriptive qualitative study, using six focus groups conducted with staff at three United Kingdom hospices in England, Scotland and Northern Ireland. Thirty-five participants were recruited, including management and staff. Discussions were transcribed and analysed thematically. RESULTS Four key themes emerged: (1) variations of care, beyond heterogeneity of patients; (2) unclear referrals and inconsistent patient population; (3) recognising strengths and challenges and (4) an uncertain future. A major focus of group discussions was the model of care and the benefits of the service, however the importance of demonstrating services' effectiveness and value for money was highlighted. CONCLUSIONS Management and hospice staff believed day-services to be a helpful introduction to palliative care, providing both social and medical support. Economic pressures and patient demand were influencing them to move from a social model to a hybrid model. Further research is needed to understand the effectiveness of the service.
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Affiliation(s)
- Felicity Hasson
- Ulster University, Institute of Nursing and Health Research, Shore Road, Newtownabbey, BT37 0QB, Northern Ireland.
| | - Joanne Jordan
- Ulster University, Institute of Nursing and Health Research, Shore Road, Newtownabbey, BT37 0QB, Northern Ireland
| | - Laurie McKibben
- Ulster University, Institute of Nursing and Health Research, Shore Road, Newtownabbey, BT37 0QB, Northern Ireland
| | - Lisa Graham-Wisener
- School of Psychology, Queen's University Belfast, Belfast, BT7 1NN, Northern Ireland
| | - Anne Finucane
- Marie Curie Hospice, Frogston Road West, Edinburgh, EH10 7DR, Scotland
| | - Kathy Armour
- Marie Curie Hospice, Marsh Lane Solihull, West Midlands, B91 2PQ, England
| | - Shazia Zafar
- University of Birmingham, Institute of Clinical Sciences, School of Nursing, College of Medical & Dental Services, Birmingham, BT15 2TT, England
| | - Alistair Hewison
- University of Birmingham, Institute of Clinical Sciences, School of Nursing, College of Medical & Dental Services, Birmingham, BT15 2TT, England
| | - Kevin Brazil
- School of Nursing and Midwifery Centre for Evidence and Social Innovation, Queens University, Belfast, BT7 1NN, Northern Ireland
| | - W George Kernohan
- Ulster University, Institute of Nursing and Health Research, Shore Road, Newtownabbey, BT37 0QB, Northern Ireland
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Kennett C, Payne M. Understanding Why Palliative Care Patients ‘Like Day Care’ and ‘Getting Out’. J Palliat Care 2019. [DOI: 10.1177/082585970502100409] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Field-Richards SE, Arthur A. Negotiating the boundary between paid and unpaid hospice workers: a qualitative study of how hospice volunteers understand their work. Am J Hosp Palliat Care 2012; 29:627-31. [PMID: 22310022 DOI: 10.1177/1049909111435695] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To explore the nurse-volunteer relationship in a day hospice. METHOD Underpinned by an interpretive approach, face-to-face semistructured interviews were conducted with 12 day hospice volunteers. FINDINGS The nature and dynamics of the relationship between nursing staff and volunteers within the day hospice were characterized by increasing formality and changes in the division of labor, which challenged smooth working relationships. CONCLUSIONS Volunteers see their role as becoming increasingly formalized partly as a response to increasing administrative demands on hospice nurses. The willingness of volunteers to take on new roles is variable. For volunteers to feel secure and valued and working relationships to remain strong, the process of how boundaries between paid and unpaid workers are negotiated needs to be transparent.
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Bradley SE, Frizelle D, Johnson M. Patients' psychosocial experiences of attending Specialist Palliative Day Care: a systematic review. Palliat Med 2011; 25:210-28. [PMID: 21228097 DOI: 10.1177/0269216310389222] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Recent reviews conclude that the benefits of attending Specialist Palliative Day Care (SPDC) are likely to be in social, psychological and spiritual domains. However, these areas are not easily identified, leaving researchers and practitioners unclear as to what aspects of these domains patients most need and desire. The objective of this review was to systematically evaluate literature on patient-perceived psychosocial experiences of attendance at SPDC. Twelve studies were included. Evidence showed that patients value a person-centred approach that reduces isolation, increases social support, encourages communication and provides activities. Future research could focus on investigating why patients value the psychosocial experiences reported and how these experiences can be defined in a way that would be meaningful to clinical service commissioners. Once this has been done, clinicians can start to measure more effectively clinical effectiveness and devise justifiable interventions to help this patient group.
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Affiliation(s)
- Sarah E Bradley
- Department of Clinical Psychology, University of Hull, Hull, UK.
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Abstract
This systematic review evaluates the evidence underpinning the provision of palliative day care services (PDS) to determine whether such services have a measurable effect on attendees' wellbeing. The majority of studies reviewed were qualitative and elicited individual perceptions of the benefits PDS. Although it was difficult to determine the quality of many studies, it would appear that attendance at PDS had a positive impact on attendees' quality of life. Fewer studies utilized validated outcome measures to determine the effect of PDS on attendees' wellbeing and small sample sizes combined with high attrition rates influenced the significance of some the results. However little quantitative evidence was offered to prove that PDS had an impact on attendees' quality of life or wellbeing. The review concludes that dying people find attending PDS a valuable experience that allows them to engage with others and to be supported in a restorative environment. However, further well-powered empirical studies are required to provide quality evidence to determine whether or not attendance at PDS does indeed have a positive impact on the wellbeing of attendees.
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Affiliation(s)
- Elaine Stevens
- University of the West of Scotland, School of Health, Nursing & Midwifery, UK.
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Fisher C, O’Connor M, Abel K. The role of palliative day care in supporting patients: a therapeutic community space. Int J Palliat Nurs 2008; 14:117-25. [DOI: 10.12968/ijpn.2008.14.3.28891] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Colleen Fisher
- School of Exercise, Biomedical and Health Sciences, Edith Cowan University, Australia
| | - Moira O’Connor
- Western Australian Centre for Cancer and Palliative Care, Curtin University of Technology, Health Research Campus, Perth WA
| | - Kaye Abel
- School of Psychology, Edith Cowan University, Australia
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Abstract
Social objectives are poorly specified and evaluated in cancer care. Palliative day care is an example where social objectives are often identified but research has focused on health-care outcomes. A literature review identifies four types of social objective: emotional and spiritual care, general social care, services for families and carers and creative arts. Social objectives include: distinguishing between therapeutic work and leisure and supportive interventions, promoting service continuity, reducing social isolation, increasing social interaction, reassuring introduction to palliative care, rehearsal of reactions to illness with a sympathetic audience, integration of families and carers into care services, respite for carers and creative work for three separable objectives. It is argued that interventions to achieve social objectives may be defined and evaluated in a measurable way. Similarly, social objectives and interventions can be specified at other stages in the cancer journey.
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Affiliation(s)
- M Payne
- Manchester Metropolitan University, and Psycho-social and Spiritual Care, St. Christopher's Hospice, Sydenham, London, UK.
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11
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Kernohan WG, Hasson F, Hutchinson P, Cochrane B. Patient satisfaction with hospice day care. Support Care Cancer 2006; 14:462-8. [PMID: 16482449 DOI: 10.1007/s00520-005-0901-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2005] [Accepted: 10/20/2005] [Indexed: 11/29/2022]
Abstract
Day hospice allows patients to remain living at home while attending a specialist palliative care center. This paper describes patient feedback (n=26) on medical, social and therapeutic out-patient palliative care services provided at one such facility in Northern Ireland. Medical records of all attending patients (n=50) were reviewed, and patients completed a semi-structured questionnaire. Patients' comments on day hospice were largely positive. A number of suggestions for new service activities were made, and the need for education of multi-professional team members was recognized. Respondents recognized that day hospice allowed respite care for the family. Patients were very appreciative of the care that was offered--their concern for its continuance perhaps restraining any criticism they had. Such findings provide the opportunity for health professionals to gain further insights into day care to better meet patients' needs.
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Affiliation(s)
- W George Kernohan
- Institute of Nursing Research, School of Nursing, University of Ulster, Newtownabbey, Northern Ireland, UK
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Low J, Perry R, Wilkinson S. A qualitative evaluation of the impact of palliative care day services: the experiences of patients, informal carers, day unit managers and volunteer staff. Palliat Med 2005; 19:65-70. [PMID: 15690870 DOI: 10.1191/0269216305pm942oa] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To explore the experiences of people involved in UK palliative care day services (PCDS) and identify the important outcomes of this service. METHODS Focus groups were carried out separately with patients, informal carers and volunteers from four purposively selected palliative care day units and with day unit managers from 11 units. RESULTS Patients benefited from both the support of PCDS professionals and social support of fellow PCDS patients, which contributed to a perceived improvement in their quality of life. Carers appreciated both the respite and support from PCDS, but acknowledged that they still had a poor quality of life. The challenges facing PCDS include the difficulties of discharging patients and the future role of volunteers. DISCUSSION PCDS improved patients' perceived quality of life and future evaluations on patient outcomes could use concepts such as self-esteem, self-worth and confidence. Future service provision could explore the possibility of a mixed service using both the traditional and appointment-based system.
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Affiliation(s)
- Joe Low
- Marie Curie Palliative Care R & D Unit, Department of Psychiatry and Behavioural Sciences, Royal Free & University College Medical School, London, UK.
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Goodwin DM, Higginson IJ, Myers K, Douglas HR, Normand CE. Effectiveness of palliative day care in improving pain, symptom control, and quality of life. J Pain Symptom Manage 2003; 25:202-12. [PMID: 12614955 DOI: 10.1016/s0885-3924(02)00688-7] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To evaluate the effectiveness of palliative day care in improving pain, symptom control, and quality of life (QOL), 120 consecutive new referrals to five specialist palliative day care centers were recruited into a prospective comparative study. Fifty-three comparison patients were identified as those patients receiving usual palliative care services (home care, inpatient care), but did not attend day care. Patients were assessed at 3 interviews (baseline, 6-8 weeks, and 12-15 weeks) using measures of health-related quality of life: McGill Quality of Life Questionnaire (MQOL) and Palliative Care Outcome Scale (POS). There were two main analyses: 1) patient demographic data were analyzed using chi-square (chi(2)), and 2) QOL data were compared, based on distribution of scores, using the Mann-Whitney test (MQOL and POS), and Wilcoxon Signed Rank for within group differences (POS data only); P < 0.05 was taken as significant. The patients were representative of those attending palliative day care in the UK. At baseline, the day care group were (non-significantly) worse than the comparison group in the MQOL support domain (P = 0.065). The comparison group had marginally more severe pain at baseline (P = 0.053) and more severe symptoms at second assessment (P = 0.025). Both patient groups maintained overall health-related quality of life during the three months of the study. Palliative day care was not found to improve overall health-related quality of life. The limitations of the QOL measures in identifying the effects (patient outcomes) of palliative day care and the differences between the two patient groups (age, employment, unequal sample sizes) were limitations of the study and indicate the need for further research in this area.
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Affiliation(s)
- Danielle M Goodwin
- Department of Palliative Care and Policy, King's College, University of London, London, UK
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Lee L. Interprofessional working in hospice day care and the patients’ experience of the service. Int J Palliat Nurs 2002; 8:389-400. [PMID: 12271260 DOI: 10.12968/ijpn.2002.8.8.10683] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This in-depth study of hospice day care considers professional team working and patient experience of the service. It includes an analysis of how patients' time is spent. The qualitative single case study design involved patient and staff interviews, observations and document analysis. A theoretical framework of interprofessional working informed the study. Analysis of the data revealed a range of goals, variable communication patterns and the existence of core and extended teams. The results challenge the theoretical literature by suggesting that the presence of a team structure alone did not promote interprofessional working. Patients were also seen as integral members of the team. Their experience of day care was a social one, with a wide range of patients identified unmet needs, day care was largely seen as positive. This was despite interprofessional working not clearly being identified in the results. Suggestions for future research are made and implications for practice discussed.
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Abstract
This paper traces the development and evaluation of day care hospice provision through analysis of the available literature. The CD-ROM was utilized to access and review the Medline, CINAHL and Healthstar databases. In addition, a hand search of Progress in Palliative Care was conducted. The literature describes the provision of a service within a day hospice, and access to day hospice services. Issues regarding the provision of a day hospice as a mechanism to meet consumer needs are explored. The literature reveals little evaluation of evidence-based practice or of the cost-effectiveness of day hospice provision. There is a dearth of research relating to day care, evaluation studies in particular. It is clearly important that future research compares outcomes with other models of service provision.
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Affiliation(s)
- D J Spencer
- Centre for Palliative Care, Education and Research, University of Central England, Edgbaston, UK
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Abstract
This paper reports on an ethnographic investigation of a palliative day care unit. The aim of the study was to explore communication processes amongst patients with terminal disease, in an 'open awareness' context. The research involved participant observation over a period of 7 weeks. Detailed field notes were written and documentary information gathered on site. Analysis of the data showed that in the day care environment, patients readily talked about cancer, illness and death. Five themes were identified in the content of such 'death talk': talk about illness, symptoms and treatment, stories about illness and death, talk about patient deaths, talk regarding bereavement, and talk concerning personal mortality. In addition to content, it is maintained that the form of the patients' talk is pertinent to an understanding of the discursive context of palliative day care. It is proposed that the light-hearted and humorous nature of patient 'death talk' serves an important psychological function in allowing patients to distance themselves from their own deaths whilst simultaneously permitting an acknowledgement of their terminal condition. This suggests that the provision of an appropriate 'social' environment for patients with terminal disease may be as important to patients as one-to-one counselling by clinical nurse specialists.
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Affiliation(s)
- A Langley-Evans
- Department of Psychology, University of Southampton, England
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