Space, Place and Home: Lived experiences of hospice day care

Abstract

Up to a third of cancer patients have been shown to use some form of complementary or alternative medicine (CAM), with hospices being the largest provider of this care in the UK. The high demand for CAM among UK cancer patients and increasing political pressure to develop CAM services has led to a more integrative approach to cancer care, though progress is hindered by a narrow focus on medical determinants of efficacy. Subsequently, calls for a wider research perspective have been made in order to encourage a more complex and multi-dimensional analysis of this provision.

The importance of setting and in particular, ‘place’, is recognised by the field of health geography, and it is suggested there is a need for a focus on how ‘place’ affects CAM and vice versa. There is little mention of hospice as a place for such research, yet as the largest provider of complementary therapies (CT) to cancer patients in the UK, hospices represent an important area for research.

Though some studies have engaged with geographical perspectives and metaphors, there has been no consideration of hospices as places in themselves, which have utilised a humanistic geographical framework. This study explores patient, staff and therapist interpretations of their experiences of a hospice day care unit as a place. It seeks an understanding of how space and place affects, and is affected by the use and provision of complementary therapies within a hospice day care unit. The concept of therapeutic landscapes (TL) was initially proposed as an analytical framework. However, through the analysis of the data it was evident that concepts from humanistic geography combined with a phenomenology of medicine provided a more fitting conceptual framework for a critical examination of the data.

A hermeneutic phenomenological approach has been adopted. The sample incorporates day care patients, complementary therapists and healthcare professionals. Photo-elicitation interviews, semi-structured interviews, participant observation and postcard diaries have been used. Twenty-three participants (6 therapists – 6 health care staff and 11 patients) were interviewed using a combination of these data collection methods.

I propose three existential modes of being that characterised the patients’ experiences of hospice day care as a place. Drifting - characterised by states of uncertainty and anxiety; Sheltering characterised by homeliness, familiarity, and security; and Venturing, characterised by seeking and exploring new experiences, places and spaces. Through an examination of these modes, it was discovered that patients found ‘home’, both within the self and within the world. This was possible through various facets of the hospice including complementary therapies, which were seen as an integral part of the holistic landscape of care.