Older people living alone at home with terminal cancer

Abstract

This study describes the lived experiences of older people coping with terminal cancer and living alone, focusing on how they face challenges of the biographical life changes from their disease progression. Face-to-face semi-structured interviews were conducted in two phases with palliative care clients of a community-based service in Western Australia (2009-2011): Brief interviews with 43 cancer patients who live alone and then in-depth interviews with 8 of them. Using biographical disruption as the analytical framework for interpreting the qualitative data, four main themes emerged: Biographical disruption: adjusting to change; Biographical continuity: preserving normality; Biographical reconstruction: redefining normality; and Biographical closure: facing the end. Biographical disruption was a suitable framework for analysis, permitting identification of the biographical disruptions of the individual's world and the reframing that is undertaken by the individual to maintain autonomy and independence while acknowledging and accepting their closeness to death. Understanding the factors associated with the individual's need to maintain their own identity will enable nurses working with this population to tailor support plans that meet the individuals' needs while maintaining or restoring the person's sense of self. Interventions that directly address end-of-life suffering and bolster sense of dignity and personhood need to be considered.

Concept analysis of dignity‐centered care for people with chronic progressive disease

“…Promotion of emotional resilience (Tong et al, ), early recognition of existential concerns and interventions (Vehling & Mehnert, ) and respecting and restoring the sense of personhood (Aoun et al, ) bolstered self‐esteem. To maintain one's personality (Nawa et al, ) by being valued (Delmar et al, ) and having respect for oneself (Hughes, ) affirmed one's self‐concept.…”

“…The vitalizing aspect of autonomy can be a driving force in patients' behaviors as they seek to sustain their self‐esteem and valuation as a person (Delmar et al, ). Therefore, bolstering self‐esteem is about maintaining or restoring the person's sense of self (Aoun et al, ), preserving self‐identity (Tong et al, ), and assuring and maintaining their self‐esteem (Helfand, ; Wadensten & Ahlström, ).…”

“…Reducing spiritual and psychological distress required support in both the psychosocial, and the spiritual dimensions (van Gennip et al, ). These interventions directly addressed end‐of‐life suffering (Aoun et al, ), focused on personal strengths and prevention of discouragement (Dager et al, ), and addressed psychological factors of depression (Skuladottir & Halldorsdottir, ).…”

Living with cancer: challenges across the lifespan

“…In this issue Aoun et al . () report on descriptive study of palliative care patients in Western Australia – important messages include the need to maintain identity and a ‘sense of self’ – the concepts of dignity and ‘personhood’ are emphasised. Schiphorst et al .…”

“…Further, as clinicians we need to be systematic in identifying needs in this group of patients; there are now screening tools available for older patients with cancer to help identify patients with a high risk of functional decline (Kenis et al 2014). In this issue Aoun et al (2016) report on descriptive study of palliative care patients in Western Australiaimportant messages include the need to maintain identity and a 'sense of self'the concepts of dignity and 'personhood' are emphasised. Schiphorst et al (2016) examine the role of geriatric assessment in cancer patients, and conclude that it can aid in complex treatment decisionsfurther, such assessments may facilitate a reduction in over-and under-treatment of elderly cancer patients.…”