Internet Images of Palliative Care: A Visual Content Analysis

Palliative care is often misunderstood as end-of-life care. The internet may shape public understanding.

To describe the visual content of internet images of palliative care.

We conducted a visual content analysis of internet images retrieved using the term "palliative care". Searches were conducted on April 1, 2022, in Toronto, Canada, using six search engines; the first 150 photographic images from each engine were included. Image characteristics were coded by two independent coders using a standardized codebook. Coded characteristics were quantified and compared using Chi-square tests. Two investigators independently reviewed the coded data and original images, and identified overarching themes.

After deduplication, 335 unique images from 377 websites were analyzed. Websites were mostly from the US (173/369 [46.9%]) or Canada (92/369 [24.9%]); 160/369 (43.4%) were affiliated with hospice/palliative care programs. Four themes emerged: hand-holding, enclosed setting, cheerful comfort care, and passive dependency. Hand-holding appeared in 203/335 images (60.6%). Most identifiable settings were indoors (162/171 [94.7%]); of 67 hospital scenes, 47 (70.1%) were at the bedside and 4 (6.0%) outpatient. Healthcare providers and family members (73.3% and 73.8% women, respectively) cheerfully provided comfort care (e.g., offered food/drink). Compared to healthcare providers, patients were more often older adults (2/157 [1.3%; 0.2%-4.5%] vs. 136/157 [86.6%; 80.3%-91.5%]) who were lying/sitting; only 2/157 (1.3%, 0.2%-4.5%) patients were standing, compared to 68/157 (43.3%, 35.4%-51.5%) healthcare providers.

Internet images reinforce stereotypes and misperceptions about palliative care as passive end-of-life care. Changing internet imagery may help reframe perceptions and enable more timely palliative care.