Goals Set in the Land of the Living/Dying: A Longitudinal Study of Patients Living with Advanced Cancer

Abstract

A longitudinal qualitative research study was undertaken to provide an understanding of a prolonged experience of advanced cancer, as seen through the eyes of dying individuals. Using a variant of the grounded theory method, the authors theoretically sampled, from outpatient clinics in a large comprehensive cancer treatment center, 27 patients with either advanced lung or gastrointestinal cancer who had an expected survival of up to 2 years. The authors conducted a total of 54 interviews with these patients to learn of their experience of advanced cancer. The authors represent their experience with the core category: striving to grow in the land of the living/dying, symbolizing their sense of finding themselves in a borderland between life and death where their efforts focused on 3 common goals. controlling dying, valuing life in the present, and creating a living legacy. They provide a longitudinal account of how these goals were addressed throughout the illness trajectory and discuss the theoretical and clinical implications of this understanding for the experience of dying from advanced cancer.

Men’s strategies for preserving emotional well-being in advanced prostate cancer: An interpretative phenomenological analysis

“…Specific themes found in other research are echoed here, including lack of control over bodies (Chapple & Ziebland, 2002;Kelly, 2008), bodily changes as warnings of impending death Sand et al, 2009), uncertainty and unknowing during the palliative care stage (Nissim, et al, 2012), feelings of social separation ( Koffman et al, 2012) and existential loneliness (Strang & Sand, 2006). Similarly, other research has found that cancer survivors and those living with advanced cancer show an increased awareness of time, difficulty in reflecting on future time and sense of a receding future (Cecil et al, 2010;Rasmussen & Elverdam, 2007).…”

“…It adds to the existing literature through its focus on those living at home with advanced cancer. In contrast previous studies have tended to concentrate on hospice settings without taking into account those who may be living for years with the knowledge of their terminal prognosis (Nissim et al, 2012).…”

“…Nissim et al's (2012) longitudinal, qualitative research also showed that patients with advanced cancer set themselves goals, enhancing fulfilment during the time they had left. The authors note the conservative nature of some of these goals, echoing the use of short-term goals as stepping stones to the future as utilised by some of our participants.…”

“…However, exploring a eudaimonic approach to assess the emotional well-being of men with advanced prostate cancer could ensure that issues such as sense of purpose and social connectedness are not overlooked. In general, health professionals could encourage men to explore their own resilience and coping strategies and help them re-interpret purpose, for example through new activities that will be personally meaningful (Nissim et al, 2012).…”

An Exploration of the Relative Influence of Patient's Age and Cancer Recurrence Status on Symptom Distress, Anxiety, and Depression Over Time

“…These patients may benefit from tailored interventions that help them adjust specifically to the recurrence with emphasis on identifying ways to maintain participation in life events. Planning treatment or expected fatigue around everyday events such as children's activities or work hours may allow these people to transition to living with cancer or "reclaim" meaningful aspects of their lives after a period of treatment (Nissim et al, 2012). In either case, patients and their families may be able to retain some normalcy and mitigate the effects of the illness experience.…”