Background: Palliative care aims to provide holistic support for people with life-limiting illness, responding to psychological, social and spiritual needs, as well as to clinical and physical. In the United Kingdom, hospice day services (including day care, group interventions, group activities, and social events for palliative care outpatients) aim to provide opportunities for patients to gain social support, which is thought to improve their quality of life.
Objectives: This research explored social support within hospice day services, to explain in detail how and why social support obtained within a hospice day service could be beneficial to palliative care patients.
Design: Qualitative research using observations of hospice day services and interviews with service providers.
Methods: Data collection involved nineteen interviews with hospice service providers (n = 19) and researcher observations of hospice day services. The findings detail how patient and hospice context interact to produce mechanisms that lead to outcomes beyond the hospice day service.
Results: Practical, clinical and social aspects of the hospice day service are important for patients feeling welcome and safe in the setting. The opportunity to connect with other people and work towards personal goals can boost self-confidence for patients who have lost access to meaningful activity. New friendships between patients encourages reciprocal support and feelings of belonging. It is beneficial to have permission to speak freely about topics deemed inappropriate elsewhere, because honest communication is helpful in accepting and adapting to their circumstances.
Conclusion: Hospice day services facilitate group settings for reciprocal social support. This research proposes an initial programme theory that can be further developed and tested. It explains how and why, in some contexts, social support increases personal and practical resources to cope with illness and death, leading to changes outside of the hospice (to mood, interpersonal interactions and behaviour) that could improve quality of life.
Keywords: death acceptance; emotional support; hospice day care; palliative care; realist evaluation; social support; supportive interventions.
Social support in hospice day services Hospices provide specialist palliative care to patients with life-limiting illness, offering both clinical and non-clinical support. Some hospices include social settings within their outpatient services which provide palliative care patients with opportunities to meet other people who might have similar experiences (‘in the same boat’). Social support gained within these groups is thought to be beneficial, but there isn’t much research on how and why this might be the case, and in what situations. We carried out observations of hospice day services and research interviews with hospice service providers. We focused on understanding the need for social support, the social support interactions between group members, and the consequences of these. The research suggests five processes through which social support within hospice day services could have positive outcomes for patients. These are:1. Choosing to be there2. Gaining confidence through new or adapted activity3. Building familiarity and reciprocity with other patients4. Honest conversations about illness and mortality5. Becoming a part of the club The findings propose how and why, in some situations, social support could lead to improvements in mood, behaviour and relationships. This will be useful to guide the development and evaluation of hospice day services.
© The Author(s), 2023.