Heideggerian researchers recognize that people and their worlds are coconstructed; people make sense of their world from within it, not detached from it. The presence of one's partner in a joint interview will therefore influence the experience of participants, and will also influence the descriptions they provide. In this article, we present a reflexive discussion of two studies in which we used Heideggerian hermeneutic phenomenology to explore people's experiences of sexuality and intimacy within the context of their illness. We present the Heideggerian concepts of Dasein, authenticity and truth, and draw on extracts from our interview transcripts to exemplify the different effects of joint and one-to-one interviews. We also discuss ethical considerations regarding these different interview approaches. Heidegger's philosophy does not preferentially support either method, but helps us to be clearer about the merits and limitations of each approach. Combining both approaches provides richer understanding of phenomena.
BackgroundCancer often has a profound and enduring impact on sexuality, affecting both patients and their partners. Most healthcare professionals in cancer and palliative care are struggling to address intimate issues with the patients in their care.
MethodsStudy 1: An Australian study using semi-structured interviews and documentary data analysis. Study 2: Building on this Australian study, using a hermeneutic phenomenological approach, data were collected in the Netherlands through interviewing 15 cancer patients, 13 partners and 20 healthcare professionals working in cancer and palliative care. The hermeneutic analysis was supported by ATLAS.ti and enhanced by peer debriefing and expert consultation.
ResultsFor patients and partners a person-oriented approach is a prerequisite for discussing the whole of their experience regarding the impact of cancer treatment on their sexuality and intimacy. Not all healthcare professionals are willing or capable of adopting such a person-oriented approach.
ConclusionA complementary team approach, with clearly defined roles for different team members and clear referral pathways, is required to enhance communication about sexuality and intimacy in cancer and palliative care. This approach, that includes the acknowledgement of the importance of patients' and partners' sexuality and intimacy by all team members, is captured in the Stepped Skills model that was developed as an outcome of the Dutch study.
There is currently no consensus about what the notion of death anxiety means. This commentary explores the complexity of death anxiety, asserts the distinction between anxiety and fear, and attempts a definition that encompasses the many facets associated with the term.
Intuition has traceable cognitive and physiological bases that help us understand how we use it as a basis for making complex clinical decisions. Experts, especially those working in acute and palliative care, where there are difficult ethical as well as clinical patients situations, can benefit from using intuitive ideas to arrive at complex decisions.
The recently published End of Life Care Strategy in the UK encourages people to talk openly about death and dying (Department of Health, 2008). The idea should not only be applicable to palliative care settings, but to other healthcare environments and the public sector. It is through talking that attitudes may shift and dismantle the taboo around death. There are numerous areas to consider, but for this commentary, one fascinating area of death is the meaning and impact of last offices.
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