Bradley, Natasha 
ORCID: 0000-0003-0768-9819
(2020)
Social Support in Palliative Care: A Realist Exploration of Hospice Day Services.
PhD thesis, University of Liverpool.
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Abstract
Hospices offer psychosocial support for people with incurable illness, and those approaching death or bereavement. This project uses mixed methods and realist evaluation principles to extend understanding of social support in palliative care. It aims to describe practice and function of social support in hospice day services, to develop appropriate methods for future effectiveness and cost-effectiveness research. A systematic review summarises available quantitative evidence on effectiveness of palliative care interventions that facilitate social support. There is some evidence of short-term benefits to patients in psychological and physical domains, however consistent difficulties in method are reported, and social support is underexplored as an outcome of intervention. An online survey of hospice day service managers in the UK & ROI establishes an overview of services that facilitate social support for people living in the community with life-limiting illness. These are: multi-component interventions, activity groups, formal support groups, befriending, and informal social activities. The survey documents a diverse and evolving sector that is active in facilitating social support. A longitudinal cohort study observed patient outcomes using validated measures of perceived social support, loneliness, depression, and health-related quality of life. Participants (n=30) are recruited across four locations, but attrition is high. The outcome measures appeared acceptable to patients, and sensitive to change. Improvement is observed in emotional support (a subscale) and in loneliness (n=19). Qualitative investigation included nineteen interviews with hospice service-providers. Analysis using realist principles provides explanation of how patient and hospice context might interact to produce beneficial mechanisms that lead to outcomes beyond the hospice. Reciprocity and honesty within the group could be enabled through autonomy and familiarity. These processes could reduce distress and improve acceptance of change and mortality. This thesis proposes an initial programme theory that can be extended or developed. It suggests how, in some contexts, social opportunities lead to changes in emotions and behaviour, that might ultimately increase personal and practical resources to cope with illness and death. Hospices might seek to foster beneficial social support, and collective opportunities to acknowledge mortality.
| Item Type: | Thesis (PhD) |
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| Divisions: | Faculty of Health and Life Sciences |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 08 Feb 2022 14:14 |
| Last Modified: | 01 Jan 2024 02:30 |
| DOI: | 10.17638/03133166 |
| Supervisors: |
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| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3133166 |
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