Breaking the bad news: Experiences of contingency in advanced cancer patients.

Abstract

e19560 Background: The diagnosis of advanced cancer implies a radical change in a patient’s future outlook. The way patients interpret this change can be understood in terms of emotion and contingency theory. Events which seem to come out of the blue and augur unforeseen consequences are difficult to interpret and attribute meaning to. They can cause so-called experiences of contingency, in which the subject is in a state of being lost and faces an uncertain future fraught with vague and threatening possibilities. The aim of this study is to understand this experience that can affect a person’s fundamental beliefs. Methods: Patients with advanced cancer, not amenable to curative treatment, with a Karnofsky performance score of ≥ 70 and good command of the Dutch language were asked for participation. Patients were interviewed once, at their homes. The tape-recorded and transcribed interviews were analyzed within the framework of grounded theory. Codes were arranged along the dimensions of probability of the event and emotional impact, which influence each other. Results: 56 patients with an average age of 62 years were included in the study. Breast cancer, colorectal cancer and renal cell cancer were the most common cancer types. The average time since the diagnosis of advanced cancer was two years. 32 % of the patients were able to interpret the bad news and react calmly. However, for 68 % of the patients the event had a high emotional impact and the limits of their interpretation framework were exceeded, as evidenced by the spontaneous and highly frequent use of metaphors pointing towards the collapse of their reality. They perceived their existence as being contingent. Receiving the bad news unexpectedly shook the very foundations of their lives for reasons related to loss of confidence in life. Conclusions: The experience of contingency can be understood in terms of shaken confidence and implies an existential confrontation with life as a power which cannot always be controlled. Confidence in life can be regained after acknowledging one’s boundaries, accepting the new future perspective and finding a new attitude towards life.