Alleviating existential distress of cancer patients: can relational ethics guide clinicians?

Abstract

Most people have a heightened awareness of death at the moment they receive a cancer diagnosis. Medical treatment attempts to demystify and manage death, yet surprisingly, care that alleviates existential distress is the least provided psychosocial care. A review of empirical research [quantitative and qualitative studies (n = 85) and seven literature reviews] was conducted to explore the experiences of clinicians (primarily nurses) working with cancer patients who experience existential distress. This paper summarizes clinicians' experiences with cancer patients who face the threat of mortality. Given that the majority of literature was found to be in nursing, emphasis in this paper tends to be on nurses' experiences. However, findings are suggested to have implications for other clinicians who deal with similar concerns. A lens of relational ethics was inductively found to organize and highlight problems and gaps that originate from interpersonal concerns. This paper describes four themes requiring further research and education related to existential distress: engagement, embodiment, environment and mutual respect. Implications for oncology care are suggested at the micro-, meso- and macro-levels to encourage clinicians to ethically respond to patients' existential distress needs.

Venous access: the patient experience

“…Many eventually felt they were able to explain to the clinicians what they could and could not tolerate. Although the literature suggests that patients take a passive role [18][19][20] in healthcare decision-making, this study reaffirms their wishes to more actively contribute to care decisions [6,21]. Most of the participants offered suggestions for improving the experience of cannulation.…”

“…The aim of medical treatment, including nursing care, and the attitudes of all health professionals is to create a positive experience and outcomes for the patient. A patient's health issue can create a sense of vulnerability in regard to treatment options, leaving the patient with little choice as they perceive that some procedures just 'have to be done' [1][2][3][4][5][6]. Historically, before the advent of modern healthcare and the concept of patient-centredness, patients were often exposed to physical and/or emotional injury during the delivery of treatments-mainly as a result of lack of knowledge or skills on the part of the healthcare practitioner [7].…”

Existential encounters: Nurses' descriptions of critical incidents in end-of-life cancer care

“…(McSherry and Cash, 2004;Strang et al, 2002). In a review of the literature concerning the ability of staff to alleviate existential distress, it was found that although clinicians are sometimes aware of their lack of knowing what to say and or do when patients experience existential distress, they are often aware of existential distress or spiritual meaning as being part of their work (Leung and Esplen, 2010). In order to meet patients' needs to express existential concerns, nurses have been found to develop relationships of trust through effective communication skills (Mok and Chiu, 2004;Johnston and Smith, 2006).…”

Existential challenges experienced by lymphoma survivors: Results from the 2010 LIVESTRONG Survey

“…Survivor characteristics most related to existential concerns (for example, being female and younger) could allow supportive services provided by pastoral care or mental health professionals to be targeted to these subgroups. It is important that health care providers become aware of these concerns, even in long-term survivors, so that they may be addressed (Leung and Esplen, 2010). Although often overlooked in psychological interventions for cancer patients (Lindemalm et al, 2012), some evidence suggests that addressing existential concerns in cancer populations in general (Breitbart et al, 2012), and specifically in lymphoma survivor populations, would likely contribute to improved well-being and quality of life (Henoch and Danielson, 2009).…”