Abstract
BackgroundExistential and spiritual concerns are fundamental issues in palliative care and patients frequently articulate these concerns. The purpose of this study was to understand the process of engaging with existential suffering at the end of life.MethodsA grounded theory approach was used to explore processes in the context of situated interaction and to explore the process of existential suffering. We began with in vivo codes of participants' words, and clustered these codes at increasingly higher levels of abstractions until we were able to theorize.ResultsFindings suggest the process of existential suffering begins with an experience of groundlessness that results in an overarching process of Longing for Ground in a Ground(less) World, a wish to minimize the uncomfortable or anxiety-provoking instability of groundlessness. Longing for ground is enacted in three overlapping ways: by turning toward one's discomfort and learning to let go (engaging groundlessness), turning away from the discomfort, attempting to keep it out of consciousness by clinging to familiar thoughts and ideas (taking refuge in the habitual), and learning to live within the flux of instability and unknowing (living in-between).ConclusionsExistential concerns are inherent in being human. This has implications for clinicians when considering how patients and colleagues may experience existential concerns in varying degrees, in their own fashion, either consciously or unconsciously. Findings emphasize a fluid and dynamic understanding of existential suffering and compel health providers to acknowledge the complexity of fear and anxiety while allowing space for the uniquely fluid nature of these processes for each person. Findings also have implications for health providers who may gravitate towards the transformational possibilities of encounters with mortality without inviting space for less optimistic possibilities of resistance, anger, and despondency that may concurrently arise.
Highlights
Existential and spiritual concerns are fundamental issues in palliative care and patients frequently articulate these concerns
Research on existential concerns has slowly emerged in recent years, there remains a scarcity of studies about how existential issues are understood, managed and treated in palliative care settings [1]
We did not begin with a definition of existential suffering, but instead, sought participants’ understanding of what it meant for them
Summary
Existential and spiritual concerns are fundamental issues in palliative care and patients frequently articulate these concerns. As the metaphoric landscape of palliative care shifts and the field matures within a broader context of technological and scientific advances aimed at prolonging and enhancing quality of life [2], palliative care is increasingly concentrated on medicalization [3]. This focus presents the complex issue of existential suffering as a Existential distress or suffering has been described as a condition where morbid suffering in patients may include concerns related to hopelessness, futility, meaninglessness, disappointment, remorse, death anxiety, and a disruption of personal identity [5]. Wilson et al.’s study [12] employed a combination of a comparative-correlational design and a content analysis of semistructured interviews to examine suffering in patients with advanced cancer
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