Abstract
BACKGROUND: Despite the general preference to die at home, many deaths occur in institutionalized settings. While biomedical interventions to ameliorate end-of-life (EoL) suffering have advanced, the end-of-life care (EoLC) environment is less understood as a means of palliative support. OBJECTIVE: This exploratory study considered the implications of clinical EoLC environments (facility buildings and their adjacent areas), aiming to understand how these designed spaces may be improved to better support experiences for patients, families, and staff. METHODS: Using an ethnography-driven approach, field observations (including participant commentaries) were captured at a standalone hospice and a palliative care ward at a general hospital. These were supplemented with semi-structured interviews. Content and thematic analyses were performed based on an interpretive-descriptive paradigm. Finally, informed by a review of field literature, analyses of all data were inter-related, and an interpretation was built to highlight key design considerations. RESULTS: Through the analysis, 6 socio-spatial dimensions of EoLC facilities were identified (locational contexts; service administration & management; common spaces; private spaces; in-between spaces; and nature-integrated spaces) as guiding concepts to appraise and improve such settings. CONCLUSION: Physical, emotional, and social wellbeing at the end of life is coalesced in and made visible by the designed environment. Therefore, evidence-based design serves as an important non-clinical intervention in such settings; however, patient involvement in such research remains difficult. Future scholarly research, new building schemes, and renovation projects should further examine the socio-spatial functions of clinical EoLC environments and investigate the challenges surrounding patient engagement within this domain.