Designing the physical environment for inpatient palliative care: a narrative review

Abstract

BackgroundIt is essential that the physical environments in which inpatient palliative care is provided support the needs of patients and the facilitate the multidimensional delivery of palliative care. This review aims to identify the features and characteristics of inpatient palliative care environments that enhance or detract from the patient experience; and identify opportunities for progress within this field.MethodThree databases were searched: MEDLINE (1946–2020), PsycINFO (1806–2020) and CINAHL (1937–2020). Articles were screened by title and abstract with included studies read in full for data extraction. Data synthesis involved thematic analysis informed by the findings of the included literature. Inclusion criteria were studies with empirical methodology examining adult palliative care in the hospital, hospice or nursing home environment. Studies that examined palliative care delivered within the emergency department, ICU or within the home were excluded, as were those related to paediatric palliative care.ResultsFour main themes were identified: the provision of privacy, facilitating interactions with family, facilitating comfort through homeliness and connections to nature.ConclusionsThe board acceptance of single rooms as the preeminent design solution for supporting privacy, dignity and family interaction, alongside current conceptions of homeliness that typically focus on matters of interior design, are limiting possibilities for further design innovation within palliative care settings. Research that investigates a broader set of design strategies through which the built environment can support care, alongside enhanced interdisciplinary collaboration, could positively contribute to patient and family experiences of inpatient palliative care.

Designing Palliative Care Facilities to Better Support Patient and Family Care: A Staff Perspective

“…In a recent review, Wong et al (2021) highlight two limitations within the extant literature for the design of palliative care environments: the assumption that a private room is the best architectural solution to upholding patient dignity and the risk of reducing homeliness to simple matters of interior design (also see McLaughlan & Kirby, 2021). Privacy, as the staff perceptions reported above make evident, is a design concern that reaches far beyond the bedroom and bathroom.…”

“…A reliance on design evidence from other healthcare settings may be exacerbating this problem. A recent review identified only a dozen studies that expressly examined the design of palliative care settings (Wong et al, 2021). This limitation of available research means design evidence from other healthcare settings is often adopted for use (see, e.g., Irish Hospice Foundation, 2009; Zadeh et al, 2018).…”

Unburdening expectation and operatingbetween: architecture in support of palliative care

“…2015). Precisely what constitutes the attainment of homeliness, however, or even the particular design strategies for obtaining it, is nowhere explicitly defined (Wong et al . 2021).…”

“…While participants acknowledged the importance of soft furnishings, and of mitigating the appearance of medical equipment, they also spoke of comfort in terms of sensory experience, accessibility, recognising the need for individual choice and alleviating situational unease. This suggests that what is missing from much of the evidence-based design literature for palliative care is an expanded definition of comfort; one that is more explicit about the fact that there is more to homeliness than soft furnishings (also refer Wong et al . 2021).…”

“…McGann’s use of the term ‘dis-identified’ highlights how easily a patient’s self-identity can be threatened in the face of terminal illness and hospitalisation. The extension of dignity to patients within palliative care, as Wong et al (2021) have recently highlighted, is often reduced to concerns of privacy, and conflated with the provision of single (as opposed to shared) rooms. Guo and Jacelon (2014, 935) offer a definition of dignity that includes, among its considerations, ‘being self’—that is ‘the continuity of the individual self, in spite of one’s advancing illness’.…”