Understanding Experiences in Hospice: Exploring Temporal, Occupational, and Relational Dimensions Using Pictor Technique

Abstract

Temporality, occupation, and relationships are identified as discrete factors that impact quality of life for individuals at the end of life and those around them. However, scholars, practitioners, and educators require insights regarding whether and how interactions between these factors shape this quality of life. This study is framed by an understanding that meaning is negotiated between people through social interaction and occupational engagement in temporal contexts. We conducted in-depth interviews with 9 patients and 10 family members, incorporating the Pictor visual elicitation technique. Analysis was conducted through an iterative process involving open and selective coding. Findings are described as three main processes: (a) experiences of temporal rupture, (b) diminished significance of clock time, and (c) shifts in occupational priorities. Participants’ perspectives may help carers understand how to foster positive temporal experiences and quality of life for patients and those who love them.

Supported: Supporting, enabling, and sustaining homecare workers to deliver end-of-life care: A qualitative study protocol

“…The technique is derived from personal construct psychology [17] and has been used successfully with patients, carers, and clinicians in research exploring service provision around advanced disease and EoL. Pictor aids recall and explanation, and reduces the intensity of the interview experience because the focus is on the diagram rather than the interview participant [21][22][23]. It has also been used to overcome noted barriers in research participation by those with advanced disease [24].…”

Exploring pathways to optimise care in malignant bowel obstruction (EPOC): Protocol for a three-phase critical realist approach to theory-led intervention development for shared decision-making

“…The participant-led graphic elicitation technique, Pictor [40,41], is then introduced to elicit a narrative of a particular episode or series of episodes of communication around decision-making in malignant bowel obstruction, focused on an example of the interviewee's choice. Pictor uses arrows to represent PLOS ONE roles, relationships and interactions in the form of a diagram or 'chart', and has a history of use in encouraging rich data in research exploring collaborative processes in health care, including palliative care [42][43][44]. The technique has been chosen for its utility in representing complex events and/or episodic care in simple terms, and its focus on capturing the 'invisible' social mechanisms which influence communication [41].…”

Communicating uncertainty: contrasting the communication experiences of patients with advanced COPD and incurable lung cancer

“…GP and key professional interviews, including a 'Pictor Chart', covered the patient's support needs, illness trajectory and their perspectives of good quality care. Pictor is a patient-friendly visual elicitation technique where participants use a chart and arrow stickers laid out to show the patient and the people involved in their life indicating the features of their relationships 16 . Participants were offered a follow up interview 3 to 6 months after the first interview to check on any changes that might have taken place that they were interested in sharing with the researchers.…”