Forgiveness and Reconciliation Processes in Dying Patients With Cancer

Abstract

This article studies forgiveness and reconciliation (F/R) in patients with cancer. It focuses on the end of life, when family conflicts resurface and unfinished business challenges patients and causes spiritual distress. Forgiveness and reconciliation may intensify patient–family relationships and facilitate peace of mind and peaceful death. Existing forgiveness models and interventions focus on coping in life, yet no study has examined F/R processes until death. Our mixed-method exploratory study hypothesized that F/R processes occur in phases, repeatedly, and are spurred by approaching death. Three interdisciplinary units at a major Swiss hospital observed 50 dying patients with cancer experiencing severe conflicts with relatives, themselves, and/or with fate/God. Participant observation was combined with interpretative phenomenological analysis and descriptive statistical analysis. A semi-structured observation protocol was developed based on a 5-phase model. The protocol included space for notes (emotions, interventions, effects on dying processes). It was assessed by 20 professionals for 1 year. Analysis was supported by international interdisciplinary experts. We found that conflicts were complex and involved relational, biographical, and spiritual layers. In 62% of patients, F/R processes occurred repeatedly. Many patients died after finding F/R (22 within 48 hours). Patients indicated that imminent death, a mediating third party, acceptance, and experiences of hope motivated them to seek F/R. Although deep relationships may support F/R processes, our limited data on near-death experience/spiritual experiences restrict interpretation. Forgiveness and reconciliation processes oscillate between 5 phases: denial, crisis, experience of hope, decision, and finding F/R. Understanding F/R processes, empathy, hope, and a neutral third party may support patients in seeking forgiveness.

The Emmaus Project: Aging, Illness, and Dying Among Older Christians—A Qualitative Study

“…Many participants cited the value of having family accompany them through the process of aging. Others mentioned the importance of reconciling with family members, echoing recent literature (Renz et al 2020). Furthermore, multiple participants referenced the on-going experience of grieving deceased family members.…”

“…Finally, a majority of patients enrolled were white, and Christians of varying diversity may have distinct experiences of faith at the end of life. Although these extensive limitations prohibit any meaningful representational generalizations, useful insights can be made about this small group of participants (Carminati 2018; Ritchie and Lewis 2003). Furthermore, that participants referenced a diverse array of lifetime experiences in their questionnaire responses is encouraging of potential transferability to other populations and settings (Ritchie and Lewis 2003).…”

Meaning of Life Therapy: a Pilot Study of a Novel Psycho-Existential Intervention for Palliative Care in Cancer

“…As human beings' spiritual needs, forgiveness and reconciliation have been the subjects of innumerous studies about PC as they offer clinical relevance and critical points for reflection and intervention among patients and family members. Studies on spiritual care at the end of life (Leget, 2020;Renz et al, 2019) highlight forgiveness as an important topic to be addressed and managed to reduce personal suffering and guilt, strengthen relationships, and create peace of mind.…”