Background The impact of hospice design on health outcomes and the satisfaction and wellbeing of patients, visitors and staff has received scarce attention (Adams. Change Over Time. 2016;6(2):248–63). In particular, views of patients and their families are often absent from qualitative studies (Bellamy. Designing dying well: Towards a new approach to the co-production of palliative care environments for the terminally ill [PhD thesis]. Cardiff University; 2022). Homelike design is recommended for hospice settings internationally (Verderber, Refuerzo. Innovations in hospice architecture. Taylor & Francis Group; 2010) but its suitability and acceptability to hospice users in England is unknown.

Aim To explore the views of hospice users and staff in England on the suitability and acceptability of homelike design in hospice buildings.

Methods Ethnographic field work in two hospices with adult in-patient units in England including, i) non-participatory observation, ii) individual in-depth, semi-structured interviews with patients (n=8), family members (n=7) and staff (n=13), and iii) focus groups with staff (n=9). Observational diaries and transcripts were analysed in NVivo using thematic analysis. Data analysis was informed by critical geography of architecture approaches (Lees. Ecumene. 2001;8(1),51–86).

Results Three themes were identified, with homelike hospice design viewed as: desirable; inappropriate; difficult/impossible to achieve. Staff who described homelike design as desirable saw it facilitating palliative care delivery and a welcoming atmosphere; others expressed concerns that it sent the wrong message about standards of care and desired length of inpatient stay. Patients and families were most likely to describe homelike design as difficult/impossible to achieve, many having rejected homemaking practices. Concerns across participant groups focused on practicalities, infection control, and differing homelike design preferences across demographic groups, including suggestions that homelike hospice design prioritised preferences of white management staff, or could be ‘too posh’. Participants differentiated between literally homelike design, and creating homely atmospheres, most favouring the latter.

Conclusion The diversity of views expressed show homelike hospice design to be a contested issue for hospice users and staff. Literally homelike design should not be recommended for hospices in England without establishing whether concerns about potential exclusivity can be mitigated.