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Campbell K, Harris F, Stoddart K. The Hematology Cancer Patient Experience of "Facing Death" in the Last Year of Life: A Constructivist Grounded Theory Study. Cancer Nurs 2024; 47:132-140. [PMID: 36480369 DOI: 10.1097/ncc.0000000000001180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND For hematology cancer patients, the process of dying is described as "troublesome." Qualitative studies have focused on views of healthcare professionals and caregiver stakeholders. To date, there have been no studies from the patient's perspective on facing death while in the last year of life. OBJECTIVE The aim of this study was to develop an understanding of the hematology cancer patient's experience of the process of dying in the last year of life. METHODS The study method was constructivist grounded theory using semistructured interviews, a constant comparison technique, and memoing to collection and analysis of data. The 21 participants were attending a UK cancer center, a cancer unit, or a hospice. RESULTS This article describes 1 core category within the incurable hematology cancer illness trajectory through 4 subcategories: transitional phase, chronic phase, dying phase, and liminal phase. CONCLUSION This unique study illustrates that, although life can be prolonged, "facing death" still occurs upon hospitalization and relapse regularly over the illness trajectory. IMPLICATIONS FOR PRACTICE It is important that clinical practice acknowledges those participants in an incurable illness trajectory while living are focused on avoiding death rather than the ability to cure the disease. Services need to be responsive to the ambiguity of both living and dying by providing holistic management simultaneously, especially after critical episodes of care, to enhance the process of care in the last year of life, and assessment should incorporate the discussion of experiencing life-threatening events.
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Affiliation(s)
- Karen Campbell
- Author Affiliations: Edinburgh Napier University (Dr Campbell); Professor, University of West of Scotland (Dr Harris); and University of Stirling (Dr Stoddart), Scotland
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Walsh CA, Currin-McCulloch J, Faris NR, Nguyen TST, Al Achkar M. "Living with Loss": A qualitative exploration of existential fears among people with advanced lung cancer in online lung cancer support groups. Palliat Support Care 2024:1-6. [PMID: 38420708 DOI: 10.1017/s147895152400004x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
OBJECTIVES With targeted therapies, people are surviving longer with advanced lung cancer and engaging in online lung cancer support communities. While these groups provide a sense of community, witnessing the death of peers can lead to emotional distress. This qualitative study aims to (1) explore the experience of witnessing death in online cancer support groups; (2) identify factors that contribute to the emotional struggles of witnessing the death of peers; and (3) identify strategies/options for dealing with losses in the cancer community. METHODS We conducted a cross-sectional analysis of qualitative interviews exploring existential concerns with participants (n = 25) from oncogene-specific online lung cancer support groups. The principal investigator conducted study interviews between August 2018 and March 2019 where participants were asked about their cancer experiences and existential concerns. We used thematic analysis and NVIVO 11 software to examine and store the de-identified interview data. RESULTS Participants indicated that they had often witnessed their peers die and felt the pain of the loss. Factors that played a part in their struggle with witnessing others' death included the closeness of the relationship with the person, the age of the person who died, seeing oneself in the experience of the other dying, disparities in care, and losing touch in the final stages. Participants used varied coping strategies such as celebrating the life of the individual who died, engaging in advocacy efforts, not focusing on the loss, participating in therapy, and bringing self-preserving thoughts. SIGNIFICANCE OF RESULTS Our study highlights the importance of addressing existential fears in online lung cancer support groups and incorporating conversations about death in spaces that deal with cancer.
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Affiliation(s)
- Casey A Walsh
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | | | - Nicholas R Faris
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA
| | - Thu Suong Thi Nguyen
- School of Education, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA
| | - Morhaf Al Achkar
- Department of Family Medicine, University of Washington, Seattle, WA, USA
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Stenner P, De Luca Picione R. A Theoretically Informed Critical Review of Research Applying the Concept of Liminality to Understand Experiences with Cancer: Implications for a New Oncological Agenda in Health Psychology. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5982. [PMID: 37297586 PMCID: PMC10253067 DOI: 10.3390/ijerph20115982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/24/2023] [Accepted: 05/27/2023] [Indexed: 06/12/2023]
Abstract
Liminality was described more than 20 years ago as a major category explaining how cancer is experienced. Since then, it has been widely used in the field of oncology research, particularly by those using qualitative methods to study patient experience. This body of work has great potential to illuminate the subjective dimensions of life and death with cancer. However, the review also reveals a tendency for sporadic and opportunistic applications of the concept of liminality. Rather than being developed in a systematic way, liminality theory is being recurrently 're-discovered' in relatively isolated studies, mostly within the realm of qualitative studies of 'patient experience'. This limits the capacity of this approach to influence oncological theory and practice. In providing a theoretically informed critical review of liminality literature in the field of oncology, this paper proposes ways of systematizing liminality research in line with a processual ontology. In so doing, it argues for a closer engagement with the source theory and data, and with more recent liminality theory, and it sketches the broad epistemological consequences and applications.
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Affiliation(s)
- Paul Stenner
- School of Psychology and Counselling, The Open University, Walton Hall, Milton Keynes MK7 6AA, UK;
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Bolton LE, Seymour J, Gardiner C. Existential suffering in the day to day lives of those living with palliative care needs arising from chronic obstructive pulmonary disease (COPD): A systematic integrative literature review. Palliat Med 2022; 36:567-580. [PMID: 35176924 PMCID: PMC9006392 DOI: 10.1177/02692163221074539] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND The impact of living with palliative care needs arising from COPD disrupts an individual's existential situation. However, no comprehensive synthesis of existing research has been published to determine the presentation and impact of existential suffering. AIM To provide a synthesis of existing evidence on existential suffering for those living with palliative care needs arising from COPD. DESIGN This is an integrative review paper, undertaken using the methodological approach developed by Soares and reported in accordance with PRISMA guidelines. Data analysis was undertaking using an integrated convergent synthesis approach. DATA SOURCES Nine electronic databases were searched from April 2019 to December 2019. A second search was undertaken in January 2021 to identify recently published papers meeting the inclusion and exclusion criteria. No date restrictions were imposed. Only papers published in the English Language were considered for inclusion. Empirical research papers employing qualitative and/or quantitative methodologies and systematic literature reviews were included. Articles were accepted for inclusion if they discussed any component of existential suffering when living with COPD and palliative care needs. RESULTS Thirty-five papers were included within this review comprising of seven systematic reviews, 10 quantitative studies and 18 qualitative studies. The following themes relating to existential suffering were found: Liminality, Lamented Life, Loss of Personal Liberty, Life meaning and Existential isolation. The absence of life meaning, and purpose was of most importance to participants. CONCLUSIONS This review suggests existential suffering is present and of significant impact within the daily lives of those living with palliative care needs arising from COPD. The absence of life meaning has the most significant impact. Further research is required to understand the essential components of an intervention to address existential suffering for this patient group, to ensure holistic palliative care delivery.
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Affiliation(s)
| | - Jane Seymour
- Division of Nursing & Midwifery, University of Sheffield, Sheffield, UK
| | - Clare Gardiner
- Division of Nursing & Midwifery, University of Sheffield, Sheffield, UK
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Mau M, Nielsen DS, Jakobsen IS, Klausen SH, Roessler KK. Mental movements: How long-distance walking influences reflection processes among middle-age and older adults. Scand J Psychol 2021; 62:365-373. [PMID: 33719040 DOI: 10.1111/sjop.12721] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 01/29/2021] [Indexed: 12/20/2022]
Abstract
By providing a distinctive room for reflection, long-distance walks can help people similar to professional counselling. To understand reflection processes' influence on mental health, a framework focusing on personal transformations, specifically through the concept of liminality, can be used. Through nine semi-structured interviews with middle-aged and older long-distance walkers, this study answers the following question: How do middle-aged and older adults experience long-distance walking, and how do their experiences influence their reflective process? Four themes emerged during the analysis: (1) overcoming strain and achieving a sense of capability; (2) simplicity in obligations and having the time to pursue emotionally difficult experiences; (3) solitariness and reflection on oneself; and (4) calmness and embracing thoughts. These findings illustrate how going on long-distance walks may be similar to entering a liminal, or transformational, space. The findings show how long-distance walks can be helpful, or perhaps even therapeutic, in situations where personal transformation is required.
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Affiliation(s)
- Martin Mau
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,Health, Social Work and Welfare Research, UCL University College, Odense, Denmark.,Health Sciences Research Centre, UCL University College, Odense, Denmark
| | - Dorthe S Nielsen
- Migrant Health Clinic, Odense University Hospital, Odense, Denmark.,Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - Ida Skytte Jakobsen
- Health, Social Work and Welfare Research, UCL University College, Odense, Denmark
| | - Søren H Klausen
- Department for the Study of Culture, University of Southern, Odense, Denmark
| | - Kirsten K Roessler
- Department of Psychology, University of Southern Denmark, Odense, Denmark
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Fox JA, Rosenberg J, Ekberg S, Langbecker D. Palliative care in the context of immune and targeted therapies: A qualitative study of bereaved carers' experiences in metastatic melanoma. Palliat Med 2020; 34:1351-1360. [PMID: 32338133 DOI: 10.1177/0269216320916154] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Immune and targeted therapies continue to transform treatment outcomes for those with metastatic melanoma. However, the role of palliative care within this treatment paradigm is not well understood. AIM To explore bereaved carers' experiences of immune and targeted therapy treatment options towards end of life for patients with metastatic melanoma. DESIGN An interpretive, qualitative study using a social constructivist framework was utilised. Interviews were recorded, transcribed and analysed using grounded theory methods. SETTING/PARTICIPANTS Participants (n = 20) were bereaved carers of patients who had received some form of immune and/or targeted therapy at one of three Australian metropolitan melanoma treatment centres. RESULTS Carers struggled to reconcile the positive discourse around the success of immune and targeted therapies in achieving long-term disease control, and the underlying uncertainty in predicting individual responses to therapy. Expectations that immune and targeted therapies necessarily provide longer-term survival were evident. Difficulty in prognostication due to clinical uncertainty and a desire to maintain hope resulted in lack of preparedness for treatment failure and end of life. CONCLUSION Immune and targeted therapies have resulted in increased prognostic challenges. There is a need to engage, educate and support patients and carers to prepare and plan amid these challenges. Educational initiatives must focus on improving communication between patients, carers and clinicians; the differences between palliative and end-of-life care; and increased competency of clinicians in having goals-of-care discussions. Clinicians must recognise and communicate the benefit of collaborative palliative care to meet patient and family needs holistically and comprehensively.
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Affiliation(s)
- Jennifer A Fox
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - John Rosenberg
- University of the Sunshine Coast, Caboolture, QLD, Australia
| | - Stuart Ekberg
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, Australia
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Gullick J, West S. Heideggerian hermeneutic phenomenology as method: modelling analysis through a meta-synthesis of articles on Being-towards-death. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2020; 23:87-105. [PMID: 31264089 DOI: 10.1007/s11019-019-09911-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
While the richness of Heideggerian philosophy is attractive as a healthcare research framework, its density means authors rarely utilise its fullest possibilities as an hermeneutic analytic structure. This article aims to clarify Heideggerian hermeneutic analysis by taking one discrete element of Heideggerian philosophy (Being-towards-death), and using it's clearly defined structure to conduct a meta-synthesis of Heideggerian phenomenological studies on the experience of living with a potentially life-limiting illness. The findings richly illustrate Heidegger's philosophy that there is either an inauthentic positioning towards death, or an authentic positioning towards death with a proposition that (1) death is certain; (2) death is indefinite; (3) death is non-relational; and (4) death is not-to-be-outstripped. None of the 29 included studies on the experience of a confrontation with death fully utilised this framework, despite claiming a grounding in Heideggerian thought. This demonstrates the value in modelling how Heideggerian existential structures can be used proactively as analytical 'hooks' for data in research claiming a basis in this philosophy and/or method. By modelling the potential application of an important Heideggerian philosophical construct to published qualitative data, this meta-synthesis has revealed new domains and more nuanced understandings of the temporal structure of Being-towards-death. Such an approach helps to more fully unveil the existential concerns of people at the core of interpretative phenomenological enquiry and may provide a blueprint to map either primary or synthesised data to other key ontological existentials.
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Affiliation(s)
- Janice Gullick
- A4:32, MO2, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
- International Institute of Qualitative Methods, University of Alberta, Edmonton, AB, Canada.
| | - Sandra West
- A5:11, MO2, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Preparation for the end of life and life completion during late-stage lung cancer: An exploratory analysis. Palliat Support Care 2017; 15:554-564. [DOI: 10.1017/s1478951516001012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
ABSTRACTObjective: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.
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Zimmermann C, Swami N, Krzyzanowska M, Leighl N, Rydall A, Rodin G, Tannock I, Hannon B. Perceptions of palliative care among patients with advanced cancer and their caregivers. CMAJ 2016; 188:E217-E227. [PMID: 27091801 PMCID: PMC4938707 DOI: 10.1503/cmaj.151171] [Citation(s) in RCA: 228] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Early palliative care is increasingly recommended but seldom practised. We sought to examine perceptions of palliative care among patients with advanced cancer and their caregivers. METHODS After conducting a cluster randomized controlled trial of early palliative care versus standard care for patients with advanced cancer, we approached patients and their caregivers to participate in semistructured interviews seeking to assess, qualitatively, their attitudes and perceptions about palliative care. We used the grounded theory method for data collection and analysis. RESULTS A total of 48 patients (26 intervention, 22 control) and 23 caregivers (14 intervention, 9 control) completed interviews. Participants' initial perceptions of palliative care in both trial arms were of death, hopelessness, dependency and end-of-life comfort care for inpatients. These perceptions provoked fear and avoidance, and often originated from interactions with health care professionals. During the trial, those in the intervention arm developed a broader concept of palliative care as "ongoing care" that improved their "quality of living" but still felt that the term itself carried a stigma. Participants in the intervention group emphasized the need for palliative care to be reframed and better explained by health care professionals. Participants in the control group generally considered it pointless to rename palliative care, but many in the intervention group stated emphatically that a different name was necessary in the early outpatient setting. INTERPRETATION There is a strong stigma attached to palliative care, which may persist even after positive experiences with an early palliative care intervention. Education of the public, patients and health care providers is paramount if early integration of palliative care is to be successful.
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Affiliation(s)
- Camilla Zimmermann
- Division of Medical Oncology (Zimmermann, Krzyzanowska, Leighl, Tannock, Hannon), Department of Medicine, Department of Psychiatry (Zimmermann, Rodin), University of Toronto; Department of Supportive Care (Zimmermann, Swami, Rydall, Rodin, Hannon), Department of Medical Oncology (Krzyzanowska, Tannock), The Campbell Family Cancer Research Institute (Zimmermann, Rodin, Tannock), Princess Margaret Cancer Centre, University Health Network, Toronto, Ont.
| | - Nadia Swami
- Division of Medical Oncology (Zimmermann, Krzyzanowska, Leighl, Tannock, Hannon), Department of Medicine, Department of Psychiatry (Zimmermann, Rodin), University of Toronto; Department of Supportive Care (Zimmermann, Swami, Rydall, Rodin, Hannon), Department of Medical Oncology (Krzyzanowska, Tannock), The Campbell Family Cancer Research Institute (Zimmermann, Rodin, Tannock), Princess Margaret Cancer Centre, University Health Network, Toronto, Ont
| | - Monika Krzyzanowska
- Division of Medical Oncology (Zimmermann, Krzyzanowska, Leighl, Tannock, Hannon), Department of Medicine, Department of Psychiatry (Zimmermann, Rodin), University of Toronto; Department of Supportive Care (Zimmermann, Swami, Rydall, Rodin, Hannon), Department of Medical Oncology (Krzyzanowska, Tannock), The Campbell Family Cancer Research Institute (Zimmermann, Rodin, Tannock), Princess Margaret Cancer Centre, University Health Network, Toronto, Ont
| | - Natasha Leighl
- Division of Medical Oncology (Zimmermann, Krzyzanowska, Leighl, Tannock, Hannon), Department of Medicine, Department of Psychiatry (Zimmermann, Rodin), University of Toronto; Department of Supportive Care (Zimmermann, Swami, Rydall, Rodin, Hannon), Department of Medical Oncology (Krzyzanowska, Tannock), The Campbell Family Cancer Research Institute (Zimmermann, Rodin, Tannock), Princess Margaret Cancer Centre, University Health Network, Toronto, Ont
| | - Anne Rydall
- Division of Medical Oncology (Zimmermann, Krzyzanowska, Leighl, Tannock, Hannon), Department of Medicine, Department of Psychiatry (Zimmermann, Rodin), University of Toronto; Department of Supportive Care (Zimmermann, Swami, Rydall, Rodin, Hannon), Department of Medical Oncology (Krzyzanowska, Tannock), The Campbell Family Cancer Research Institute (Zimmermann, Rodin, Tannock), Princess Margaret Cancer Centre, University Health Network, Toronto, Ont
| | - Gary Rodin
- Division of Medical Oncology (Zimmermann, Krzyzanowska, Leighl, Tannock, Hannon), Department of Medicine, Department of Psychiatry (Zimmermann, Rodin), University of Toronto; Department of Supportive Care (Zimmermann, Swami, Rydall, Rodin, Hannon), Department of Medical Oncology (Krzyzanowska, Tannock), The Campbell Family Cancer Research Institute (Zimmermann, Rodin, Tannock), Princess Margaret Cancer Centre, University Health Network, Toronto, Ont
| | - Ian Tannock
- Division of Medical Oncology (Zimmermann, Krzyzanowska, Leighl, Tannock, Hannon), Department of Medicine, Department of Psychiatry (Zimmermann, Rodin), University of Toronto; Department of Supportive Care (Zimmermann, Swami, Rydall, Rodin, Hannon), Department of Medical Oncology (Krzyzanowska, Tannock), The Campbell Family Cancer Research Institute (Zimmermann, Rodin, Tannock), Princess Margaret Cancer Centre, University Health Network, Toronto, Ont
| | - Breffni Hannon
- Division of Medical Oncology (Zimmermann, Krzyzanowska, Leighl, Tannock, Hannon), Department of Medicine, Department of Psychiatry (Zimmermann, Rodin), University of Toronto; Department of Supportive Care (Zimmermann, Swami, Rydall, Rodin, Hannon), Department of Medical Oncology (Krzyzanowska, Tannock), The Campbell Family Cancer Research Institute (Zimmermann, Rodin, Tannock), Princess Margaret Cancer Centre, University Health Network, Toronto, Ont
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