A look at the hospice concept: An example of Germany and a proposal for the model of hospice in Turkey

The question about how to provide medical and psychosocial care for patients who are foreseen to be in the last period of their life and who have a poor prognosis with a chronic course is gradually becoming important in Turkey and other parts of the world. The end- of -life period described as difficult for patients and their families is crucial because of the required procedures for care. Those who are provided with care are the patient and his/her family. Therefore, the patient and his/her family are at the center of the adopted type of care. The patients' and their families' care in this period is provided by the institutions known as hospice whose concept is different from palliative care centers. Hospice care is a system providing a palliative care for terminally ill patients with a limited life expectancy who need an extensive biomedical, psychosocial, and moral support. In this system, as the patient gets closer to the end of life, the members of the family are supported to overcome complex results. Besides, a grief therapy is administered to the family after the patient's death. There are not any institutions and organizations associated with the hospice concept in Turkey. However, a hospice system with some particular standards exists in Germany. In this research, the relationship between hospice care and the value of life, protection of human life, and death with dignity was studied. Thus, the research subject was examined in the natural environment. How the participants make sense of life and death in different contexts and how they perceive the hospice care were investigated. "Grounded theory" was preferred among the qualitative research designs in accordance with the aims of the research. Additionally, "theoretical sampling method" which is specific to "grounded theory" was used in the research. The data was collected with semi-structured interviews, focus group discussions, observations and photographs. There are two study groups in the research. The first study group includes focus group discussions and individual interviews conducted with 39 participants. The second study group consists of 9 hospice institutions where observational interviews were conducted in Germany. "Maxqda 2" computer program was used for data analysis. The data was analyzed according to open, axial, and selective coding and categories were formed. As a result of the research, in the light of observations and interviews carried out regarding the implementation of hospice care into the life-end care practices, we have come to the conclusion that there are conceptually socio-cultural, psychological and economical hospice categories. Defining the relationship between these categories brings out the most important category as well. This is named as "core category". The core category of the implementation of the hospice care at the end of life-end period emerges out of necessity. We have come to conclusion that, the observation-based interviews gathered from hospices with certain standards and interviews from our country where hospice practices don't exit for the time being, show that hospice care is vital when evaluated in terms of human rights, right to live, right of health of the patients approaching their end of life-spans and their acquaintances. In addition, hospices are regarded as "death houses" because hospice care is offered at end of one's life-end period. In consideration of the observations, we have reached the conclusion that hospices are not "death houses" but rather are houses where one holds on to life till the very end of it.