Blogging at the end-of-life: Anticipatory grief, losses, and positive experiences in facing terminal illness

This paper explores the experiences of people who blog about their own terminal illness and dying through the lens of anticipatory grief. Anticipatory grief is a concept which is frequently applied to those people who will be bereaved by death, rather than those who are themselves dying. Ethnographic content analysis of terminal illness blogs of two Australian women clearly narrate experiences of loss and grief which can be understood through the frame of anticipatory grief. Yet they also document positive experiences of growth and connection which can be conceptualized as resilience rather than a demonstration of denial of death.

Relationship between self-disclosure and anticipatory grief in patients with advanced lung cancer: the mediation role of illness uncertainty

Objective

To study the relationship between self-disclosure, illness uncertainty (IU) and anticipatory grief (AG) in patients with advanced lung cancer.

Methods

This is a cross-sectional study using convenience sampling method, in which 316 patients with advanced lung cancer who were hospitalized in a tertiary hospital in Wuxi City, China, from November 2022 to April 2023 were sampled. The Preparatory Grief in Advanced Cancer Patients, Mishel Uncertainty in Illness Scale, and the Distress Disclosure Index Scale (DDI) were selected to analyse the status quo, correlations, and the mediating effect of illness uncertainty on the relationship between self-disclosure and anticipatory grief in advanced lung cancer patients.

Results

The total self-disclosure score of advanced lung cancer patients was (36.35 ± 9.25), the total score of IU was (56.92 ± 15.65), and the score of AG was (52.29 ± 9.08); the results of correlation analyses showed that IU was negatively correlated with self-disclosure in advanced lung cancer patients (p < 0.05) and positively correlated with AG (p < 0.05), and self-disclosure was negatively correlated with AG (p < 0.05);the mediating effect rate of IU between self-disclosure and AG in advanced lung cancer patients was 49%.

Conclusion

The AG of advanced lung cancer patients was at a medium-high level, and IU had a significant mediating effect between self-disclosure and AG of advanced lung cancer patients; by increasing the level of patients' self-disclosure, IU could be effectively alleviated, and ultimately the AG of the patients could be reduced.

The perception of life and death in patients with end-of-life stage cancer: A systematic review of qualitative research

PURPOSE

This study aims to clarify the perceptions on life and death among patients with the end-of-life stage cancer through a systematic review.

METHODS

The search strategy combined MeSH terminology with free text searches, and was applied to the PubMed, CINAHL, Embase, and ICHUSHI (Japan Medical Abstracts Society) databases covering from 2010 to 5/2022. To ensure the quality of the research included, the Critical Appraisal Skills Program Qualitative Studies Checklist was used. Data relating to the perceptions of life and death of patients with the end-of-life stage cancer was extracted and analyzed with reference to qualitative meta-synthesis methods.

RESULTS

Ultimately, 50 studies were included. Five themes were derived based on the perceptions of life and death of patients with the end-of-life stage cancer: despair, making sense of death, how to live the rest of life, special feelings for loved ones, and fluctuation. By making sense of death in their own way, and reconciling it with their current situation, patients with the end-of-life stage cancer, even in despair over their impending death, look ahead into the future and their surroundings and consider how they would live the remaining time they have. During this time, the special feelings they have for their loved ones make an impact.

CONCLUSIONS

An important new finding from this study lies in the fact that the patients' desire to live as ordinary people who were not patients were expressed as a face that they hid from their families. Further research is needed in low-income countries/regions.

The Complexity of Being a Parent in the Hospital and a Patient at Home: A Qualitative Study on Parenting Concerns and Challenges Among Parents With Cancer

BACKGROUND

Parents given a diagnosis of cancer must balance the demands of their illness and caregiving responsibilities. This can result in parental stress and have a negative impact on the well-being of the whole family. A greater understanding of the experiences of parents with cancer is necessary to provide adequate support.

OBJECTIVE

The aim of this study was to explore parenting concerns and challenges among parents with cancer who were caring for dependent children younger than 18 years.

METHODS

Semistructured interviews were carried out with 22 parents with cancer. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis.

RESULTS

Parental concerns and challenges affected parents in their parental role and their everyday family life. Three overarching themes described the struggles in balancing life as a parent and as a patient: navigating dual roles as a parent with cancer, impact of cancer on parenting, and impact on family life. Parents' primary focus was on their children's well-being, and they struggled to manage their own expectations of parenting and the demands on their role in the family.

CONCLUSION

The results highlight the complexity of being a parent with cancer while caring for dependent children. To support parents during the cancer journey, it is important to understand the consequences of their illness on their parental role and the family.

IMPLICATIONS FOR PRACTICE

Supporting parents to feel secure in their parental role and providing support to them during their cancer journey should be integrated into routine cancer care, where parenting concerns and challenges are addressed.

Anticipatory grief during COVID-19: a commentary

The diagnosis of potentially fatal diseases, such as COVID-19, may cause many critical reactions in dying patients and their relatives. Grief and fear of anticipatory death are natural, especially in the case of COVID-19. Although several studies have been conducted on anticipatory grief (AG) caused by cancer and dementia, the outbreak of COVID-19 could potentially intensify the AG rate among dying patients, their families and healthcare professionals. Therefore, mental health support, palliative and psychiatric care, and similar strategies should be taken into account when planning the treatment process and allocating resources during the COVID-19 pandemic. This commentary highlights the importance of addressing anticipatory grief during the COVID-19 pandemic and provides some recommendations for grief management for healthcare professionals.

Resolving anticipatory grief and enhancing dignity at the end-of life: A systematic review of palliative interventions

Anticipatory grief is the experience of grief symptomatology prior to loss. This study is a systematic review of empirical interventions or interventional components that were observed to lessen or adaptively direct the experience of anticipatory grief for patients at the end of life and their family members. A search of 5 major databases found 13,718 articles, of which 10 high-quality randomized controlled trials were included for final review. Lebow's "adaptational tasks of anticipatory mourning" was employed as a working model on the efficacy of the interventions. The interventions exhibited some positive outcomes but none addressed anticipatory grief directly. Recommendations for future research are discussed.

A Nonheroic Cancer Narrative: Body Deterioration, Grief, Disenfranchised Grief, and Growth

This longitudinal nonheroic narrative study allows familiarity with personal and societal transitions in the self-identity of individuals with life-threatening cancer. The theoretical anchor is Bion's container-contained theory. Five interviews with a terminally ill hospitalized male in his 30s were conducted along intervals of between 6 and 8 weeks, up to 2 months before his death. Data were analyzed using the selection mechanisms method. Findings provide insights about the hospitalization experience, his grief, and disenfranchised grief. A rigid mode of container-contained relationships with clinicians created disenfranchised grief. Reflection and coherence among self-identities lead to inner strength and emotional growth despite the body's deterioration. Clinicians have a role in holistic identity transitions of individuals with cancer. Findings illuminate practical recommendations that clinicians may adopt to improve the experience of individuals suffering from cancer at the chronic and terminal phase of illness.

A Pilot Study on the effectiveness of Anticipatory Grief Therapy for Elderly Facing the end of Life

This pilot study evaluates the benefits of anticipatory grief therapy (AGT) for day hospice patients and long-term care (LTC) residents with cancer and non-malignant chronic diseases. Twenty-six elderly people (69.2 percent female; average age 81.8 years) participated in experiential, expressive activities and discussions during AGT. The McGill Quality of Life Questionnaire-Hong Kong version and the 15-item Geriatrics Depression Scale (Chinese version) were administered immediately before and after AGT, and at a four-week follow-up. Focus groups were held to collect qualitative feedback. Significant post-AGT improvements were found in physical (Z=-2.12, p<0.05), psychological (Z=-2.22, p<0.05), and total quality of life measures (Z=-2.66, p<0.01), and in depression levels (Z=-2.49, p<0.05). Emergent qualitative themes included grief and existential concerns, pros and cons of reminiscence, reflection and affirmation of meaning through expressive art, perceived benefits of AGT, and comments and suggestions for improving AGT in the future. We conclude that AGT delivered in both day hospice and LTC settings could be acceptable, feasible, and useful for elderly people facing the end of life.

An interpretative phenomenological analysis of the experience of living with colorectal cancer as a chronic illness

AIMS AND OBJECTIVES

The aim of this study was to explore the lived experiences of patients living with cancer as a chronic illness.

BACKGROUND

Due to recent advances in detection and treatment, cancer is now regarded as a chronic illness. However, living with cancer as a chronic illness can lead to a number of physical and psychosocial consequences all of which can lead to uncertainty over how patients view and plan for their future.

DESIGN

A longitudinal qualitative study.

METHODS

Individuals attending oncology follow-up clinics with their clinical nurse specialist at a hospital in the North East of England were invited to participate in two semistructured interviews over a 6-month period. A total of six individuals consented to participate, of whom two were women. One participant could not be contacted for the second interview, resulting in 11 interviews. Interviews were audio recorded, transcribed verbatim and analysed using interpretative phenomenological analysis.

RESULTS

Two super-ordinate themes emerged from the analysis: physical and psychological consequences of cancer and adapting to life after treatment.

CONCLUSION

The experience of future disorientation was common among participants; however, this was impacted on by a number of factors such as functional impairment and fear of recurrence. Furthermore, future disorientation does not appear to be stable and may ease as patients begin to adjust to the uncertainty of living with colorectal cancer as a chronic illness.

Is Higher Acceptance Associated With Less Anticipatory Grief Among Patients in Palliative Care?

CONTEXT

Patients in palliative care can experience substantial psychological suffering. Acceptance-based interventions from approaches such as Acceptance and Commitment Therapy have demonstrated effectiveness in helping people cope with a range of life challenges. However, there is a dearth of research examining mechanisms of therapeutic change for patients in palliative care.

OBJECTIVES

To assess the relationships between acceptance, anticipatory grief, anxiety, and depression among patients in palliative care.

METHODS

A cross-sectional survey was verbally administered to inpatients (N = 73) receiving palliative care.

RESULTS

Correlations revealed that acceptance had a strong relationship with anticipatory grief, anxiety, and depression. A hierarchical regression analysis on anticipatory grief showed that acceptance was the largest predictor and accounted for an additional 13% of variance in anticipatory grief over and above anxiety and depression.

CONCLUSION

The present study provides preliminary data suggesting that interventions that target acceptance may be indicated in patients in palliative care.

Preparation for the end of life and life completion during late-stage lung cancer: An exploratory analysis

Objective:

Our aim was to explore preparation for the end of life (EoL) and life closure among persons with advanced metastatic lung cancer. Understanding quality of life through the lens of preparation and completion is important since the trajectory of lung cancer can be relatively short, often leading to application of cancer-directed therapies near death without the opportunity for advance planning or palliative care. Clinical research is needed to understand the kinds of distress specific to older adults with advanced lung cancer that are amendable to palliative care interventions.

Method:

We employed an exploratory cross-sectional design to examine psychosocial and existential concerns among a purposive sample (N = 30) of advanced lung cancer patients using the “end-of-life preparation” and “life completion” subscales of the Quality of Life at the End of Life (QUAL–E) questionnaire. Nonparametric methods were employed to analyze preparation, completion, global quality of life (QoL), and the associations among depressive symptoms, preparation, completion, and global QoL.

Results:

Higher scores on life completion were associated with better global QoL, and with items related to transcendence, communicative acts, and interpersonal relationships demonstrating important contributions. The perception of being a future burden on family members was the greatest concern within the preparation domain. Depressive symptoms were not associated with preparation, completion, or global QoL.

Significance of Results:

Psychosocial and existential issues contribute to QoL at the EoL among older adults with late-stage lung cancer during cancer-directed therapy, concurrent care, and hospice. The role of preparation, especially self-perceived burden, merits further research early on in the oncological setting. The preparation and life completion subscales of the QUAL–E are feasible clinical tools for facilitating dyadic communication about sensitive topics in the palliative care setting.

Grief & depression at the end of life

People may experience grief and depression with serious illness at the end of life or as a loved one who survives. While grief is a normal reaction to loss, complicated grief and depression are not. Accurate diagnosis, treatment, and referral are essential clinical tools for practitioners managing this population.

Exerting control and adapting to loss in amyotrophic lateral sclerosis

People with amyotrophic lateral sclerosis (ALS) engage with a broad range of health care services from symptom onset to end-of-life care. We undertook a grounded theory study to identify processes that underpin how and why people with ALS engage with health care services. Using theoretical sampling procedures, we sampled 34 people from the Irish ALS population-based register during September 2011 to August 2012. We conducted in-depth interviews with participants about their experiences of health care services. Our study yielded new insights into how people with ALS engage with services and adapt to loss. People with ALS live with insurmountable loss and never regain what they have already lost. Loss for people with ALS is multidimensional and includes loss of control. The experience of loss of control prompts people with ALS to search for control over health care services but exerting control in health care services can also include rendering control to service providers. People with ALS negotiate loss by exerting control over and rendering control to health care services. Our findings are important for future research that is attuned to how people with terminal illness exert control in health care services and make decisions about care in the context of mounting loss.