“I'm Not Trying to Be Cured, So There's Not Much He Can Do for Me”: Hospice Patients’ Constructions of Hospice's Holistic Care Approach in a Biomedical Culture

Abstract

The hospice philosophy was founded on a mission to provide comprehensive and holistic services to individuals at the end of life. Hospice interdisciplinary teams work together to offer therapies such as spiritual services, comfort care, and massage therapy to meet patients' physical, psychological, emotional, and spiritual needs. Although the hospice philosophy is guided toward patient-centered care, limited research has examined how patients understand holistic care services. Through a social constructionist lens and qualitative interviews, we examined hospice patients' understandings of holistic care and argue that these perceptions of care are constructed through the biomedical model of medicine.

Utilization of Music Therapy in Palliative and Hospice Care

“…2 Hospice use by Medicare recipients alone has grown dramatically over the past decade. 4 However, when cure is no longer possible, hospice care offers a treatment approach that encompasses the physical, emotional, and spiritual needs of patients, using a patient-centered, culturally competent approach. By 2007, this percentage had increased to 30.1%.…”

Patients' spirituality perspectives at the end of life: a qualitative evidence synthesis

“…The majority of studies were conducted in North America (n=26),19–44 with 11 from Europe,45–55 7 from Oceania4 56–61 and 6 from Asia 62–67. Participants were sampled from hospice settings (inpatient and hospice at home) in 27 studies,4 19 25 26 28–35 38–40 45–47 53 54 56–58 60–62 66 acute and long-term care settings in 9,22 27 44 55 59 63–65 67 general practices settings in 3,42 48 52 cancer centres in 4,23 24 36 37 a mix of settings in 3 studies21 49 50 and palliative care centres in 2 studies 43 51. One study provided no details on where participants were recruited from 41.…”

“…For 10 datasets, studies were included where they reported that the majority of patients (ie, ≥50%) had died within a year or before study completion 23 24 26 27 31 34 36 39 46 59 61. Twenty-one datasets included participants with a mix of chronic conditions,19 21 25 28–33 39–45 47–50 53 54 56–58 61 18 datasets included only participants with cancer,4 20 23 24 26 27 34–37 46 51 52 59 60 62–67 and 1 dataset included participants with only neurodegenerative diseases 55. Two datasets did not specify participants’ conditions 22 38…”

The final chapter

“…That is, discourses of death denial and biomedical tendencies toward cure are still circulating in the midst of the hospice movement (Whittington, 2011). This continued focus on survival and overcoming death is evidenced by the fact that the length of time patients are enrolled in hospice is decreasing to a mere 19 or fewer days (U.S. General Accounting Office, 2000), which Pederson and Emmers-Sommer (2012) argue is due to the pervasive biomedical construction of health which opposes hospice's holistic mission and likely impedes early referrals to hospice programs. Furthermore, the total health care cost in the last two months of life is greater than the budget of the Department of Homeland Security or the Department of Education, despite the fact that twenty to thirty percent of these procedures are futile (Kroft, 2010).…”

“…As discussed in chapter one, the modernist approach legitimizes biomedical knowledge as truth. As Frank (1995) argues, the modernist agenda regards the doctor's chart as the "official story of the illness" (p. 5 (Pederson & Emmers-Sommer, 2012), patients referred to hospice staff when asked about their health care providers, suggesting that patients see hospice as medical intervention.…”