Life Meaning in Patients Diagnosed With End-Stage Liver Cancer: An Interpretive Phenomenological Approach
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Purpose: The purpose is to present a synthesized review of the literature regarding the occurrence of existential needs for meaning and purpose in end stage liver cancer patients.
Methods: Meaning in life, liver cancer, cancer, end of life, palliative, hospice were key words used to search for the English research articles in CINAHL, EBSCOHost, Medline, and Medscape. Ninety peer-reviewed publications of cancer patients with respect to life’s meaning were found, none in end stage liver cancer patients. Based from the inclusion and exclusion criteria, forty-seven studies were eliminated in the search. The remaining forty-three peer-reviewed articles were included in the synthesis that met the inclusion criteria: cancer patients that are terminally diagnosed who are seeking purpose and meaning in life.
Phenomenology brings to the fore the perceptions of human persons regarding essential truths that are grounded in the lived experience. Interpretive Phenomenology allows for the description of the phenomena surrounding human existence and facilitates the understanding of persons’ internally experienced and processed meaning. The focus is not on the objective measures but on the uniqueness of one’s experience and its corresponding meaning or meanings. The French Existentialist Gabriel Marcel (1189-1973) envisions the human person as homo viator, one who is on a journey, a traveler, a pilgrim. Life is a kind of pilgrimage that goes beyond the present world and ultimately leads to God. This is transcendence. As a philosopher of transcendence, Marcel professes that the intrinsic value of the human life is a gift of God that is meant to be shared with others. The human person thus, makes a personal choice for an intimate communion with God and for the genuine dialogue with others in an inter-human relationship. While the human is very much present in the world, he/she recognizes the reality of something more than what this world and life can offer. Death is not the end. Authentic existence here on earth gives human person hope, a bridge to go beyond a deeper and fuller intimacy in the afterlife with the Divinity. But at the same time the human person is not on a journey alone. For Marcel, to exist is to co-exist. Existence thus means presence for others and for the Other. He/she is a being-in-the-world- with others, totally engaged in an actual and conscious communion with Being (God) and with other human beings through love, hope, fidelity, and availability.
Jean Watson’s Caring Science exemplifies the act of caring in an interpersonal way, stands for values that honor and respect human capacity, preserving human dignity, spirituality, and wholeness in the midst of threats and crises of life and death. All of which transcend illness, diagnosis, condition, setting that were, and remain enduring and timeless across time and space, and changes in systems, society, civilization, and science.
- One of the basic assumptions of Jean Watson’s Caring Science is the intersubjective human-to-human process that teaches the individual to be human by identifying oneself with others, whereby the humanity of one is reflected in the other.
- The caring moment becomes transpersonal when two persons (nurse and other/patient) together with their unique life stories and phenomenal field (perception) become a focal point in time, from which the moment has a field of its own that is greater than the occasion.
- This conveys a concern for the inner world and subjective meaning of another who is fully embodied and goes beyond the ego self and the given moment, thereby reaching to the deeper connections of the spirit and the broader universe.
- It also implies the uniqueness of self and others, of the moment and the coming together as mutual and reciprocal, each fully embodied and capable of transcending the moment and being open to new possibilities.
- Nurses participate in the patient’s realm of experience in finding meaning and purpose, in a way that the patient and nurse are “in tune” with each other and are aware of the uniqueness of each other.
Patient care necessitates not only the knowledge of the medical condition but one must be able to look beyond the patient’s diagnosis, see the person as a whole, and understand the meaning that the experience holds for him/her. The search for meaning in life can contribute to the development of meaning-based interventions in the context of cancer. The knowledge generated can be used in the planning of holistic care services; and this may increase the awareness among healthcare professionals in honoring the remaining precious moments of dying patients by respecting their humanity, preserving dignity, ensuring comfort, and advocating optimum palliative care. Such knowledge may empower healthcare providers to assist individuals that are approaching death and their families to do so in a way that is meaningful rather than simply tolerable. Nurses and other healthcare providers may assist patients for necessary referrals to counselors and chaplains who could provide strength and comfort during life’s final stages.
Results: Meaning in life is a multi-dimensional concept involving the value and purpose of life, and the motivation to find both. It is a matter of living authentically, that is, with a certain quality, depth, abundance, and intensity thus, making life worth living. The way a person becomes aware of the changed circumstances of his/her life, as being diagnosed with liver cancer for instance, and how he/she deals with this awareness is decisive for the way the individual continues to live. Hope has been found to be a dominant component when terminally ill patients describe their lived experience. A higher sense of meaning has been associated with greater social, psychological, emotional adjustments, and has exhibited to have a positive impact on the quality of life of these patients. Existential meaning-focused interventions have also shown to effectively improve well-being. A successful search for meaning may contribute to one’s ability to cope with suffering. Regardless of the coping mechanism, patients attempt to find meaning, inner peace, and hope during the uncertainty inherent to the fight against cancer.
Understanding how individuals attach meaning to their experience would enable the nurses to help patients adjust to difficult situations such as approaching death in liver cancer patients. Research findings can contribute to the identification of concepts and subsequent development of quantitative tool to measure identified constructs in patients with same illness and prognosis and profile. The results can aid in future clinical research related to the meaning in life and the predictive factors in patients with cancer. Findings of this type of research can be used to develop continuing education programs for nurses and healthcare providers related to the meaning in life.
Conclusion: Life’s meaning is a multi-dimensional concept associated with greater social, psychological, and emotional adjustments that relate to the quality, depth, abundance, and intensity of life. Hence, the best supportive care for end-stage liver cancer patients should include efforts to assist them in search for meaning.
Considering the meaning in life for the dying patients as the essence of this research and intuiting that the end stage liver cancer patients would in general be affirming the value of hope and the greater purpose in continuing to live despite inevitability of death, Marcel’s existential phenomenological approach is a fitting philosophical framework that can dialogue with Jean Watson’s nursing framework in caring for the dying.