In this paper, I employ a grounded theory approach to extend an existing theory. My starting point is the theory of awareness contexts, first formulated in 1965 by Strauss and Glaser. Using introspective ethnography, I illustrate that the way patients and relatives emotionally cope with terminal information defines the kind of awareness context. I therefore suggest that the open awareness context should be split into three different contexts.In the suspended open awareness context, the patient or kin ignores or disbelieves the message communicated by the physician.In the uncertain open awareness context, the patient or family member dismisses the bad parts of the message and hopes for the best outcome.In the active open awareness context, the patient or relative accepts the impending death and prepares for it. This revision reclaims the emotional power of terminal illness from the viewpoint of patients and relatives and adapts the theory to changed structural conditions.
IntrodiictitHiEven when patients are dying, they remain unpredictable and whimsical. I had that old lady whom I told everything and at first she understood but then the next day she cried and claimed she was getting better and didn't need chemo anymore. I talked her out of that and (. . .) she was back on chemo but then I heard that she would go on a cruise with her friend. Who understands? (Physician in interview, translated from Dutch).She didn't cry, but pushed it to the back of her mind and said 'what's for tea?' (A husband describing the reaction of his wife to the announcement of her terminal condition.) (Seale 1991b: 949)