A Macroergonomic Study of Hospice and Life-Prolonging Treatment in the UK

Abstract

This research explored how people attribute meanings to care in a hospice and life-prolonging treatment and in what ways these two types of care can coexist in the British hospice model. The objectives of this research were to understand the commonality of life-prolonging treatment in conjunction with care in a hospice in the UK and patient awareness of this possibility; to understand patient decisions to receive or not receive care in a hospice and to receive or not receive life-prolonging treatment; and to understand physician decision-making when recommending a hospice and/or life-prolonging treatment to a patient. In-depth semi-structured interviews were conducted with seventeen palliative care physicians working in hospices or hospitals and oncologists in the London area. The results indicate that negative meanings attached to hospice by patients, the general public, and physicians are prevalent; that improved communication between hospice physicians, palliative care physicians, and treating physicians is necessary to decrease these meanings; that patient attitudes often shift positively once a patient is receiving care in a hospice; that patients may choose to opt out of life-prolonging treatment once they are in hospice for a variety of reasons; and that opting out may lead to further shifts in attitude. This research has implications for policies surrounding hospice care in both the UK and the United States.