Introduction
Patients with palliative care needs prefer to be cared for in an environment underpinned by a palliative approach but often receive care and bad news in the acute hospital environment which can be cold, clinical and busy. Delivering bad news continues to be difficult for many health professionals yet understanding the truth about their diagnosis/prognosis is essential for patients and their families to make informed decisions about their treatment and end-of-life care.
Aim
The study aimed to explore how environment and language affected patients admitted to the inpatient hospital environment with palliative care needs together with their family members.
Method
Participants were recruited via a flyer posted on social media between November 2021 to January 2022. Adult patients living in Gippsland, Victoria diagnosed with a life-limiting illness who had a diagnostic/prognostic conversation during an admission in the last 24 months were invited, together with a family member present during a diagnostic/prognostic conversation. Twelve individual semi-structured interviews were conducted via mobile phone or Zoom/TEAMS with eight patients and five family members (one dyad) lasting between 45 minutes to 2 hours. Data was thematically analysed through the lens of the Therapeutic Landscapes theory.
Results
Participants attended regional and metropolitan hospitals. Major themes relating to the built (aesthetics), natural, social (ambience, behaviour, language) and symbolic environments were deductively developed in line with the theory. All participants were deeply affected by the social environment in the acute hospital settings, which encompassed themes around the relationships with specialists, bad news delivery, telehealth, nursing care, poor communication, and lack of emotional support. Covid-19 rules negatively impacted person-centred care.
Discussion
Health professionals need to check for patient understanding, connect them and their family to supports and introduce palliative care early in order to care for the whole person. Telehealth appointments using video reduces costs, travel and waiting room time and patient exposure for regional participants and may be a preferred medium for prognostic appointments in the future.
Conclusion
Patients with palliative care needs and their family members were negatively affected by the environmental factors present within the acute hospital.
Conflict statement: There is no conflict of interest
Funding Statement: The first author is supported by an Australian Government Research Training Program (RTP) Stipend and RTP Fee-Offset Scholarship through Federation University.