BEYOND THE WALLS - Designing human-centred palliative environments through architectural-rich users’ experiences

Abstract

This dissertation, Beyond the walls: designing human-centred palliative environments with architectural-rich users’ experiences, highlights the significance of designing human-centred palliative environments to positively impact the well-being and experiences of residents, family, healthcare professionals, and volunteers. It also offers insight into the spatial aspects and architectural atmospheres that can create a meaningful impact. The concept of ‘beyond the walls’ was chosen as it encompasses multiple layers of meaning. A human-centred design hinges on practitioners (architects, in co-creation with healthcare organisations, who act as the clients for the palliative environment) to move beyond unconcious walls of assumptions and intuition, developing an empathic understanding of users’ spatial experiences to guide innovative design solutions. This entails ‘looking through users’ eyes or putting themselves in their shoes’ when designing palliative environments and combining this with introspection, whereby practitioners break down their own walls to connect with their own values and feelings and gain a deeper empathic understanding of palliative care users’ diverse and changing needs.

This dissertation introduces the concept of ‘architectural-rich users’ experiences’ (ARUE) to explore the intersection between users’ experiences and the physical character of palliative environments and nurture empathic understanding. This innovative concept goes beyond walls by transcending mere physical, visual or tangible elements, emphasising the importance of experiential qualities as well. These architectural-rich users’ experiences can be collected through various means, such as field immersion or utilising existing research findings, methods or tools. However, there appears to be a practice-research gap where existing academic insights, methods, and tools may not be directly applicable to the design process, this barrier or ‘wall’ seems to hinder the integration of academic research into architectural practice. Additionally, palliative environments are non-commonplaces, which makes it challenging for architects to understand what happens beyond the walls of these buildings. As a result, architects cannot always rely on their often intuitive ‘designerly ways of knowing’. Furthermore, tension arises between gathering relevant architectural-rich users’ experiences for the design process and ensuring that the research does not unnecessarily burden users. These are just a few challenges encountered in this PhD.

This PhD aims to enhance understanding of the relationship between architectural design and its influence on the experiences of various users in palliative care while supporting practitioners in designing human-centred palliative environments. This involves two key aims: (1) gathering architectural-rich users’ experiences in palliative environments to inform design practice and (2) addressing the practice-research gap by identifying barriers practitioners face in gathering and understanding architectural-rich users’ experiences and by proposing empathic design methods and tools to overcome some of these barriers. This dissertation presents seven ‘empathic design methods and tools’ drawing from interdisciplinary insights (e.g., architecture, palliative care, design research, and social science).

One of these is the ‘Designerly Scoping Review’, an innovative methodology tailored to provide practitioners with a more relevant and designer-friendly approach to gathering research insights. This review identified thirteen spatial aspects categorised into four architectural atmospheres (proximity, support, engagement, comfort) and connected them to real users’ experiences within palliative environments. However, this study found that existing literature often lacks ‘architectural richness’ due to (too) abstract knowledge and the absence of visualisations. Moreover, users’ experiences were often considered subjective, multi-dimensional, and sometimes contradictory, highlighting the need for future research on architectural-rich users’ experiences to adopt a multi-perspective approach and consider the diverse user population in palliative environments.

To gather more architectural-rich users’ experiences from a multi-perspective approach, this dissertation presents findings from an ethnographic study conducted in three palliative environments in Flanders, Belgium: a day-care centre for palliative care, a hospice, and a palliative care unit. By employing empathic design methods like participatory observations, photo-elicitation interviews, and a research journal, this dissertation not only presents research findings but also provides guidance and inspiration for researchers and practitioners navigating sensitive and unfamiliar environments such as palliative care. As an architect-researcher, I seek to shed light on the complexities and nuances of conducting research in these environments, aiming to provide valuable insights for future endeavours in this field.

The ethnographic study produced a practical framework comprising four architectural atmospheres (the same as discovered in the Designerly Scoping Review) and seventeen spatial aspects, supplemented with tangible stories of users represented through quotes, annotated photographs, floorplans, and field notes. This framework, accompanied by three overarching insights, serves as a narrative-based empathic design tool for designing human-centred palliative environments, contextualising research findings, and facilitating communication with users, the client or other stakeholders. Additionally, an empathic design workshop was developed and tested, which encourages introspection and facilitates the sharing of stories. Its purpose was to enhance participants’ empathic understanding of how the physical characteristics of a palliative environment can impact various users.

In sum, this dissertation advocates for using visual stories and considering users’ multiple perspectives to support empathic understanding and address stereotypes, assumptions and target group thinking during the design process of palliative environments. It also highlights the potential of empathic design methods and tools for collecting architectural-rich users’ experiences in palliative environments and addressing the practice-research gap. Finally, this dissertation underscores the necessity of an interdisciplinary network as a crucial seventh empathic design method to exchange insights on ‘architectural-rich users’ experiences’ and support the design of human-centred palliative environments.