A phenomenological study of routine, independence, and help-seeking in home hospice patients living alone with terminal illness.

BACKGROUND: Patients living alone with terminal illness in home hospice face challenges distinct from those living with caregivers. While prevailing research describes patterns of service use, less is known about the lived meanings that shape how these patients organize their days and decide when to seek assistance. This study describes the lived experience of solo-dwelling adults receiving home hospice care and the conditions under which help is sought or refused. This addresses a gap that limits person-centred planning for patients who wish to remain at home.

METHODS: Twelve patients of a home-hospice programme in Singapore who lived alone without caregivers were purposively recruited via clinician referral and partook in semi-structured, audio-recorded interviews. Transcripts were analysed using reflexive thematic analysis.

RESULTS: Four themes were identified: (I) independence functioned as a cognitive stance to reject a dependent identity and maintain personal agency; (II) daily routine served as a lifeline and a filter for interventions; support was accepted if it integrated into the existing physical rhythm without disrupting it; (III) patients organised relationships through obligation avoidance, preferring paid or low-demand community sources to protect dignity and control; and (IV) rather than by medical prognosis, help-seeking was conditional and time-bound, typically activated when key elements of their physical function could no longer be maintained.

CONCLUSIONS: Findings describe a selective, purposeful negotiation of solo-dwelling with terminal illness. Care planning should begin by mapping the patient's routine, then add supports that extend it and minimise obligation. Plans should include patient-defined thresholds for escalation when routine fails.