End-of-life care at home as a therapeutic landscape within a compassionate communities approach

Abstract

This article argues that a compassionate communities approach towards the end of life is a type of therapeutic landscape with particular characteristics. The emergence of public health approaches within palliative and end-of-life care has gained momentum internationally, with the concept of compassionate communities as one of its components. This qualitative case study explored the lived experiences of compassionate communities towards the end of life from the perspective of key actors at three different research sites providing palliative care, two of which were hospice settings and one a community organisation. The data collection methods included semi-structured interviews, focus groups, and contact diaries of people living towards the end of life (primary participants), their family members, friends, as well as volunteer befrienders and health professionals. Although there were differences in the compassionate communities approach across all three sites this study identified shared characteristics. First, home as the preferred place of care with physical, social, and psychological symbolic meanings; second, formal and informal care interfacing within and across inner and outer circles of care; third, the essential role of volunteer befrienders within the inner circle of care which strengthened the interface between the formal and informal care. The relational aspect between formal and informal care was considered to be significantly important. The characteristics of compassionate communities approaches within a home-based setting, meet the criteria for a type of therapeutic landscape, a place of maintaining well-being towards the end of life.