Relational and symbolic process: decisions regarding the place of death in the context of advanced cancer

Abstract

Objective: To construct a substantive theory regarding the meanings attributed to and the factors influencing the decision regarding the place of death in the context of advanced cancer. Methodology: Symbolic Interactionism and Grounded Theory were used as theoretical frameworks. Audio-recorded interviews, conducted in person or remotely between 2023 and 2024, were carried out with 96 participants from nine states located in four Brazilian regions, who were organized into five sample groups. Results: The hospital is perceived as a space offering protection, relief from pain and suffering, and relief from family burden, while the home is seen as an environment that promotes the patient’s dignity and autonomy and fosters emotional connection with family members, accompanied by uncertainty regarding the management of pain and suffering. Professional mediation and active listening facilitate the negotiation of meanings, while structural and communicational barriers limit the feasibility of choices. Final Considerations: The decision regarding the place of death constitutes a symbolic, relational, and dynamic process, shaped by family conflicts, limitations in the physical structure, and interactions among patients, family members, and the multidisciplinary team. It is important to implement public policies that enable choices consistent with the values of the person with a terminal illness.