Hospice Architecture in England v1
Research type
Research Study
Full title
Exploring ‘the domestic’ in contemporary hospice architecture: a critical examination of the architecture and design of in-patient palliative care facilities in England.
IRAS ID
301113
Contact name
Miriam Johnson
Contact email
Sponsor organisation
University of Hull
Duration of Study in the UK
1 years, 8 months, 30 days
Research summary
Although many people need hospice care each year, we understand very little about how the hospice buildings themselves affect the people that use them. At the moment, providing a “homelike”, not “hospital-like”, place of care is thought to be helpful, but we need to study this approach more closely.
I will explore how the design of the buildings affects the experiences of patients, visitors and staff using hospices. I will ask what they think of “homelike” design, to what extent their hospice is “homelike” for them, and whether making hospices “homelike” may lead to some groups feeling excluded or uncomfortable.
I will spend 2-4 weeks at two hospice inpatient units in England to observe staff, patients and visitors (family and friends), and take notes about how they use the buildings and grounds.
I will also interview between 8 and 15 patients, visitors and staff at each hospice, to explore people’s experiences and opinions of hospices in more detail, and whether the building helps to meet their needs or not. Interviews with patients and visitors will be done individually. I will talk to staff members in small groups or individually depending on availability.
The information I gather will show how individuals use and experience hospice buildings, what they think about them and whether they meet their needs.
The final aim of this research is to provide insights for policy makers about how to design inclusive hospice buildings which meet the needs of those receiving and giving palliative care.Lay summary of study results:
What was the study about?
In this study we explored the architecture and design of hospice buildings in England and looked at how their designs affect the experiences of hospice patients, visitors and staff. Providing “homelike” places of care, rather than “hospital-like” places, was previously thought to be helpful in hospices, but this approach needed to be studied more closely because it was not clear whose homes were being referred to in homelike designs.What did we do?
We looked at 10 hospices across England and recruited 49 participants to the study (12 patients, 7 family members, 26 staff and 4 volunteers). We explored what kinds of homes hospices looked like and whether making hospices homelike led to some groups feeling excluded or uncomfortable. We also explored what participants thought about homelike hospice design and to what extent their hospice was homelike for them.What did we find?
We found that homelike hospice buildings most commonly looked like either stately homes or suburban detached or semi-detached houses with gardens. Some hospices also looked like luxury hotels or spas. Detached and semi-detached homes with private gardens are linked to wealthier, white populations in England. This means that homelike hospices reflect settings which are more likely to be familiar to people from these groups. This raises questions about whether the designs of homelike hospices in England are equally welcoming to all people. The similarity of some hospices to luxury settings also raises questions about whether people from all backgrounds would feel equally welcome or included in these spaces.
We found that the way hospice buildings are designed has a significant impact on what people think about hospice care and who they think is included. Some study participants felt reassured by hospice design and found that spending time in a hospice’s buildings or gardens reduced their anxiety about hospice care. In some instances, however, people thought hospices were “posh” places because of either their homelike architecture and design, or the kinds of neighbourhoods in which they were based. Hospice designs also did not work well for all patients and families. In particular, hospice inpatient units commonly did not have enough space to accommodate larger extended families.
Participants in the study had mixed opinions about whether hospices should be designed to look like domestic homes. While some thought that looking like a home could be positive and welcoming, many participants raised concerns about this kind of design. These included concerns that homelike design features were impractical and too difficult to keep clean; that they make hospice care appear unprofessional; and that they give people the impression they can “make themselves at home” and stay at the hospice as long as they want. It was also seen as impossible to create a homelike hospice design which would make everyone feel equally welcome and included because preferences about domestic design are so personal. These concerns were raised across all participant groups.What do we recommend?
Based on the findings of this study, we do not recommend that hospices in England should be designed to look like domestic homes. This applies to both the outside and inside of buildings. Instead, hospice design should offer flexible spaces which can be easily adapted to different people according to their needs or preferences.
Participants supported the development of official hospice design guidance for the UK to help hospice care organisations create designs which are equally welcoming to all people and based on evidence from research. It was seen as important that this guidance be created in collaboration with hospice staff and volunteers and well as representatives from patient and community groups.REC name
London - Fulham Research Ethics Committee
REC reference
22/PR/1704
Date of REC Opinion
18 Jan 2023
REC opinion
Favourable Opinion