Vulnerability and resilience : Phenomenological analysis of cancer patients value directives

Journal article


Michael, Natasha, Symons, Xavier, Mendz, George L. and Kissane, David. (2022). Vulnerability and resilience : Phenomenological analysis of cancer patients value directives. Journal of Pain and Symptom Management. 64(5), pp. 438-448. https://doi.org/10.1016/j.jpainsymman.2022.07.015
AuthorsMichael, Natasha, Symons, Xavier, Mendz, George L. and Kissane, David
Abstract

Context
Personal values are individual conceptions of the desirable appraisals and actions that guide our attitudes and behaviour. Advance care planning (ACP) now emphasises the consideration of personal life goals and values expressed as a Values Directive (VD) to guide discussions concerning medical treatment.

Objective
To investigate the diversity of values, experiences and adaptations expressed in cancer patients VDs.

Methods
Contents of the VDs of ACPs of cancer patients who participated in a randomised control trial comparing a video intervention showing values communication between cancer patient-caregivers with usual care were analysed. Qualitative phenomenological content analysis was used to understand how participants made meaning of their lived experiences.

Results
Forty-two participants completed an ACP (37.2% response rate), with 97.6% of these completing a VD (57.1% female, mean age 72 years, 30.1% gastrointestinal cancer). Participants described diverse adjustments to frailty and adaptive coping with deteriorating functionality. Emotional and financial concerns were eased through experiencing benevolence and trust established through family and friendship bonds and reciprocation of care. Death anxiety and ambivalence were expressed concurrently with the experiential acceptance of dying. Secular and sacred rituals featured as an affirmation of their faith or beliefs.

Conclusion
Cancer patients seek to make meaning of their experiences, concurrently posturing vulnerability and resilience, despite conflicting emotions and experiences. Given that the choices people make as they approach dying relate to their most deeply held values, ACP conversations should explore how patients draw from their values and life goals to optimise their adaptations to illness.

Keywordsadvance care planning; cancer; qualitative research; palliative care; value directives
Year2022
JournalJournal of Pain and Symptom Management
Journal citation64 (5), pp. 438-448
PublisherElsevier Inc.
ISSN0885-3924
Digital Object Identifier (DOI)https://doi.org/10.1016/j.jpainsymman.2022.07.015
PubMed ID35932954
Scopus EID2-s2.0-85137068083
Page range438-448
FunderBethlehem Research Foundation Grant
Cabrini Foundation Medical Oncology Research Grant
Publisher's version
License
All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online04 Aug 2022
Publication process dates
Accepted27 Jul 2022
Deposited24 Jul 2023
Grant ID1709
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These values are for the period from 19th October 2020, when this repository was created.

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