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Designing dying well: towards a new approach to the co-production of palliative care environments for the terminally ill

Bellamy, Anne 2022. Designing dying well: towards a new approach to the co-production of palliative care environments for the terminally ill. PhD Thesis, Cardiff University.
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This thesis brings forth a new awareness of the in-patient hospice to enable shared understanding between architectural and healthcare professionals in the UK. A timely study, inasmuch that there continues to be a reliance on the third sector to provide end-of-life (EoL) and respite care for the terminally ill as the contextual landscape of UK in-patient hospices and the way Britons die rapidly changes. The architectural identity and approach to the design of in-patient hospices is little studied, particularly as a building type, with a relatively small literature base that has yet to be meaningfully translated into practice. Foregrounding architectural perspectives on the in-patient hospice, this thesis disseminates a shared understanding contributing to a new and empathetic approach to their design. Original research was informed by fieldwork undertaken in several Welsh hospices and founded upon the researcher’s personal experience of a hospice in England. The study deploys a mixed methods methodology and practice-led approach drawing upon methods from ethnography and design research, such as post-occupancy building observation and in-depth interviews. Here the presence of commonplace architectural design tools, such as physical models, facilitated research by breaking down disciplinary barriers, particularly between architectural and healthcare professions. Centred on the experiences of multiple hospice organisations in Wales, this study highlights vital clinical and non-clinical voices from a third-sector case study setting to inform the understanding of the requirements of the in-patient hospice. Contextual analysis of the evolution of the hospice typology, from historical predecessors to modern developments, informed design analysis observing that contemporary environments of palliative care are still heavily influenced by historic models that cannot cater for the shifting context and delivery of contemporary hospice care. A scoping study of three in-patient hospices in Wales uncovered diverse impressions of the role and subsequent value of architectural professionals, with each establishing a range of distinctive relationships and strategies with their respective architects. Where genuine co-production manifested, typical design practice was challenged for the better. The central case study explores a setting that is typical of ‘everyday’ palliative care environments, as opposed to an architectural exemplar or new build; it presents a dichotomy between those whose care practice supported patients and the hospice building itself. The perspectives of rarely consulted members of staff emphasised hidden expertise and a sense of duty. Furthermore, it exposed the significant issue of tension between design approaches for short- and long-term change, and the preparedness of meeting changing requirements set out by national guidance for EoL. Substantial ethical challenges in gaining access to palliative care environments required the researcher to radically modify their language and tone to fit in, thus highlighting vital methodological lessons for not only inter-disciplinary research, but architectural practitioners during early stages of the design process. The study emphasises the power of empathy - within not only architectural research but practice - advocating it as a crucial skill to move beyond the assumption of design as a ‘silver bullet’. To avoid architectural tropes or clinical inefficiencies this thesis posits a new approach for the design of palliative care environments that must be based on the premise of co-production to share both architectural and healthcare insights. This thesis is therefore a provocateur - challenging first, architects to critically engage with the ethical practices of hospice organisations as stakeholders and active participants in the design process, and secondly healthcare professionals to embrace meaningful inter-disciplinary discourse and collaboration

Item Type: Thesis (PhD)
Date Type: Completion
Status: Unpublished
Schools: Architecture
Subjects: B Philosophy. Psychology. Religion > BJ Ethics
N Fine Arts > NA Architecture
R Medicine > RZ Other systems of medicine
Uncontrolled Keywords: key words: dying, hospice care, co-production, architectural ethics
Date of First Compliant Deposit: 26 July 2022
Last Modified: 05 Oct 2022 09:21

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