Understanding the impact of a new public health approach to end-of-life care: A qualitative study of a community led intervention
THE LANCET | Online – 23 February 2017 – Social isolation is recognised for its substantial impact on mortality, ranking above many established public health threats. The end of life (EoL) can compound this problem; with escalating acute care costs due to poor social support and rising numbers of deaths, new solutions are needed. Examples of peers providing social support exist within EoL care, but have not been well characterised. The authors aimed to understand the impacts and facilitative processes of a home visiting intervention. Data included 21 in-depth interviews, 19 episodes of participant observation, and 19 documents. Three central impacts emerged. Participants stated that peer-support filled a gap in social support that neither professionals nor family could meet. Participants described becoming socially connected and linked this connection to increased wellbeing. Volunteers viewed themselves and those they visited as peers, despite differences in age or diagnosis. This view explained how compassion could be expressed, instead of a more detached form of empathy. A key facilitative process was the development of a relationship based on mutuality rather than passivity and dependence. On this basis, the relationship could be reconstructed outside the professional domain and could develop a depth and sustainability beyond the formal intervention. This study highlights the role of social networks in promoting wellbeing at the EoL. For sustainable changes to occur, relationships must be reciprocal rather than passive. These findings have important implications for how social care interventions are structured at the EoL. Peer support networks are a sustainable and appropriate care model, and this study provides evidence of their utility and sheds light on the fundamental components of compassionate care.