PurposeThe purpose of this study is to examine the way in which the theoretical construct of liminality contributes to understanding the process of dying of cancer from the perspective of patients, carers and professionals in a state-run organization undergoing privatization.Design/methodology/approachQualitative interviews were held with 13 patients and their carers and two focus groups with eight physiotherapists and occupational therapists. Data were analysed from the perspective of liminality for all three actors: patients, carers and health professionals.FindingsThe theoretical construct of liminality was useful for understanding the lived experience of patients and their carers. However, a major finding of this study reveals that health professionals operated in a dual space as both managers of the ritual process and individuals undergoing a liminal journey as their organization underwent transformation or restructure. Clients and carers had little knowledge of these tensions.Research limitations/implicationsThe findings are limited by the fact that the interviews did not directly ask questions about the restructure of the organization.Social implicationsIt would appear that professionals provide quality care despite their own struggles in moving from one organizational form to anotherOriginality/valueFew studies have explored the liminal rituals of dying at home that outline how professionals, as managers of the process, deal with their own liminal issues.
Ongoing participation in valued and essential everyday activities remains a priority for people with advanced disease. This study sought to understand factors influencing patients with advanced disease and caregivers’ utilisation of assistive equipment that enable this participation. Employing a pragmatic approach, purposive sampling identified participants who were interviewed in their homes. A semi-structured interview guide was employed to elicit community dwelling patients’ and caregivers’ perspectives about assistive equipment utilisation. Recorded interviews were analysed inductively and themes were constructed from the data. Fourteen interviews were conducted with patients and caregivers. Patients had a range of cancers and COPD. Three empirically developed themes demonstrate the complexities associated with the use of assistive equipment at the end of life: 1. Enabling engagement in everyday activities; 2. Dependency—a two-way street; 3. The pragmatics of choosing, using or declining assistive equipment. Participants were motivated to use assistive equipment when it optimised their function, enabled participation and supported their values, roles and interests. Conversely, use of assistive equipment could be met with ambivalence as it represented deterioration or could cause conflict within relationships. Caregivers found assistive equipment made it easier for them to provide physical care. Skilled proactive assistive equipment prescription and training by allied health professionals enhanced patient and caregiver confidence and capacity to engage in everyday activities.
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