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Medicina
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Existential Suffering in Palliative and Supportive Care Settings
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Existential Suffering in Palliative and Supportive Care Settings

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Psychiatry".

Deadline for manuscript submissions: closed (30 September 2021) | Viewed by 14486

Special Issue Editor

Prof. Dr. Christopher Lo

E-Mail Website
Guest Editor
Department of Psychiatry, University of Toronto, Toronto, ON, Canada
Interests: existential; life course; aging; culture and self; palliative and supportive care

Special Issue Information

Dear Colleagues,

Concepts of existential meaning and suffering have risen again to the forefront of public awareness. There are many reasons. In part, there has been a cultural shift as an aging population nears the end of life, with all their attendant psychological and medical needs. Palliative care has been recognised as a field of medicine within its own right, and psychological care an early and integral part of palliative medicine. Changes in health care policy in Canada now allow for Medical Assistance in Dying (MAID) to afford more control over the circumstances of one’s death and to relieve unbearable suffering in the context of incurable medical illness. The shadow of the 1960s has faded and there has been renewed interest in the study of psychedelics to alleviate existential distress in the terminally ill. On a broader scale, our society has been dealt several existential threats. The threat of mortality posed by climate change and the global pandemic has resulted in a mental health crisis in which meaning-related concerns loom large. In the present call for papers, we would welcome any research, case studies, and clinical perspectives that examine existential suffering/meaning in palliative and supportive care settings. We mean to be broadly inclusive when referring to palliative and supportive care populations. Although this may often refer to patients (and families) coping with advanced disease near the end of life, we would welcome any papers that examine existential suffering in the context of psychological or medical illness and infirmity, regardless of the proximity of death.

Prof. Dr. Christopher Lo
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Existential suffering
  • Life meaning
  • Medical illness
  • Psychological illness
  • Palliative and supportive care
  • Aging
  • Frailty and infirmity
  • Mortality salience
  • Quality of life
  • Death and dying

Published Papers (5 papers)

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Research

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19 pages, 518 KiB  
Article
Pathways to Acceptance in Participants of Advanced Cancer Online Support Groups
by Christina Francesca Pereira, Kate Cheung, Elyse Alie, Jiahui Wong, Mary Jane Esplen and Yvonne W. Leung
Medicina 2021, 57(11), 1168; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57111168 - 27 Oct 2021
Cited by 2 | Viewed by 2322
Abstract
Background and Objectives: Individuals with cancer, especially advanced cancer, are faced with numerous difficulties associated with the disease, including an earlier death than expected. Those who are able to confront and accept the hardships associated with the disease in a way that [...] Read more.
Background and Objectives: Individuals with cancer, especially advanced cancer, are faced with numerous difficulties associated with the disease, including an earlier death than expected. Those who are able to confront and accept the hardships associated with the disease in a way that aligns with their beliefs benefit from more positive psychological outcomes compared to those who are aware of their diagnosis but are unable to accept it. To date, there is limited research exploring factors contributing to illness and death acceptance in the context of advanced cancer in group therapy settings. Materials and Methods: The current study used a Directed Content Analysis approach on transcripts of online advanced cancer support groups to investigate if and how Yalom’s existential factors played a role in the emergence of acceptance. Results: The online support group platform, combined with the help of facilitators, offered supportive environments for individuals seeking help with cancer-related distress by helping patients move towards acceptance. Some participants had already begun the process of accepting their diagnosis before joining the group, others developed acceptance during the group process, while a few continued to be distressed. Our analysis revealed the emergence of four themes related to illness acceptance: (1) Facilitator-Initiated Discussion, including sub-themes of Mindfulness, Relaxation and Imagery, Changing Ways of Thinking, and Spirituality; (2) Personal attitudes, including sub-themes of Optimism and Letting Go of Control; (3) Supportive Environment, including the sub-themes of Providing Support to Others and Receiving Support from Others; and (4) Existential Experience, which included sub-themes of Living with the Diagnosis for an Extended Amount of Time, Legacy and Death Preparations, and Appreciating life. Conclusions: With a paradigm shift to online delivery of psychological services, recognizing factors that contribute to acceptance when dealing with advanced cancer may help inform clinical practices. Future studies should explore patient acceptance longitudinally to inform whether it emerges progressively, which has been suggested by Kübler-Ross. Full article
(This article belongs to the Special Issue Existential Suffering in Palliative and Supportive Care Settings)
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11 pages, 313 KiB  
Article
Associations of Spiritual Well-Being and Hope with Health Anxiety Severity in Patients with Advanced Coronary Artery Disease
by Rasoul Heshmati, Eisa Jafari, Tahereh Salimi Kandeh and Marie L. Caltabiano
Medicina 2021, 57(10), 1066; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57101066 - 06 Oct 2021
Cited by 6 | Viewed by 1812
Abstract
Background and Objectives: Health anxiety is one of the most common problems in patients with coronary artery disease. The present study tested whether health anxiety severity could be predicted by spiritual well-being and hope in patients with advanced coronary artery disease. Materials and [...] Read more.
Background and Objectives: Health anxiety is one of the most common problems in patients with coronary artery disease. The present study tested whether health anxiety severity could be predicted by spiritual well-being and hope in patients with advanced coronary artery disease. Materials and Methods: In a cross-sectional study, 100 patients with advanced coronary artery disease were recruited from hospitals and healthcare centers in Iran. Patients completed self-report scales, including the Spiritual Well-Being Scale, Adult Hope Scale, and Short Health Anxiety Inventory. Hierarchical multiple regression analyses were used to empirically explore the relations among variables. Results: Results indicated that patients who reported higher levels of hope (β = 0.42, p < 0.01) and spiritual well-being (β = 0.20, p < 0.05) reported lower levels of health anxiety. Agency (β = 0.58, p < 0.01) scores were a significant negative predictor of health anxiety severity. Additionally, religious spirituality scores (β = 0.28, p < 0.01) were shown to significantly negatively predict health anxiety level. However, the pathways components of hope and existential spirituality were not significant predictors. Conclusion: The findings of the present study indicate that spiritual well-being and hope could be important factors in determining health anxiety for adults with coronary artery disease, and their role is worthy of further exploration to help improve health anxiety for patients with coronary artery disease. Full article
(This article belongs to the Special Issue Existential Suffering in Palliative and Supportive Care Settings)
10 pages, 290 KiB  
Article
Perceived Positive and Negative Life Changes in Testicular Cancer Survivors
by Sigrun Vehling, Karin Oechsle, Michael Hartmann, Carsten Bokemeyer and Anja Mehnert-Theuerkauf
Medicina 2021, 57(9), 993; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57090993 - 20 Sep 2021
Cited by 5 | Viewed by 1813
Abstract
Background and objectives: Despite a generally good prognosis, testicular cancer can be a life-altering event. We explored perceived positive and negative life changes after testicular cancer in terms of frequency, demographic and disease-related predictors, and associations with depression and anxiety. Materials and methods: [...] Read more.
Background and objectives: Despite a generally good prognosis, testicular cancer can be a life-altering event. We explored perceived positive and negative life changes after testicular cancer in terms of frequency, demographic and disease-related predictors, and associations with depression and anxiety. Materials and methods: All testicular cancer survivors receiving follow-up care at two specialized outpatient treatment facilities were approached at follow-up visits or via mail. We assessed a total of N = 164 patients (66% participation rate, mean time since diagnosis: 11.6 years, SD = 7.4) by the Posttraumatic Growth Inventory (PTGI, modified version assessing positive and negative changes for each of 21 items), Patient-Health-Questionnaire-9 (PHQ-9), and Generalized-Anxiety-Disorder-Scale-7 (GAD-7). We conducted controlled multivariate regression analyses. Results: Most survivors (87%) reported at least one positive change (mean number: 7.2, SD = 5.0, possible range: 0–21). The most frequent perceived positive changes were greater appreciation of life (62%), changed priorities in life (62%), and ability rely on others (51%). At least one negative change was perceived by 33% (mean number of changes: 1.1, SD = 2.5). Negative changes were most frequent for decreases in self-reliance (14%), personal strength (11%), and ability to express emotions (9%). A higher socioeconomic status was associated with more positive changes (β = 0.25, 95% CI 0.08 to 0.42); no other association with demographic and disease-related predictors emerged. While positive life changes were not associated with depression (β = −0.05, 95% CI −0.17 to 0.07) and anxiety (β = 0.00, 95% CI −0.13 to 0.13), more negative life changes were significantly associated with higher depression (β = 0.15, 95% CI −0.03 to 0.27) and anxiety (β = 0.23, 95% CI 0.11 to 0.36). There was no significant interaction of positive and negative changes on depression or anxiety. Conclusions: Although positive life changes after testicular cancer are common, a significant number of survivors perceive negative changes in life domains that have been primarily investigated in terms of personal growth. Early identification of and psychosocial support for patients who perceive predominantly negative changes may contribute to prevention of prolonged symptoms of anxiety and depression. Full article
(This article belongs to the Special Issue Existential Suffering in Palliative and Supportive Care Settings)

Review

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8 pages, 307 KiB  
Review
Existential Insights in Cancer: Meaning in Life Adaptability
by David F. Carreno and Nikolett Eisenbeck
Medicina 2022, 58(4), 461; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina58040461 - 22 Mar 2022
Cited by 6 | Viewed by 2695
Abstract
Previous research demonstrated that the cancer diagnosis and treatment evoke existential concerns, especially ones related to meaning in life and meaning-making processes. The cancer experience is a vital challenge that often entails changes in what is personally important in life. Firstly, this paper [...] Read more.
Previous research demonstrated that the cancer diagnosis and treatment evoke existential concerns, especially ones related to meaning in life and meaning-making processes. The cancer experience is a vital challenge that often entails changes in what is personally important in life. Firstly, this paper collects evidence supporting that meaning adaptability, the way people adapt their meaning in life to the cancer experience, is a central element in the mental health of cancer patients. Various theories that could account for this meaning adaptability are introduced. Secondly, the paper provides a compilation of studies showing how people change what is significant in their lives within the course of cancer. Finally, the paper presents the available psychological therapies directed to facilitate meaning adaptability in this population. Meaning-centered interventions have been demonstrated to be effective in alleviating the suffering related to the cancer experience and promoting personal growth. Full article
(This article belongs to the Special Issue Existential Suffering in Palliative and Supportive Care Settings)
21 pages, 2571 KiB  
Review
Existential Suffering in Palliative Care: An Existential Positive Psychology Perspective
by Paul T. P. Wong and Timothy T. F. Yu
Medicina 2021, 57(9), 924; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57090924 - 01 Sep 2021
Cited by 7 | Viewed by 4924
Abstract
The COVID-19 pandemic has exposed the inadequacies of the current healthcare system and needs a paradigm change to one that is holistic and community based, illustrated by the healing wheel. The present paper proposes that existential positive psychology (PP 2.0) represents a promising [...] Read more.
The COVID-19 pandemic has exposed the inadequacies of the current healthcare system and needs a paradigm change to one that is holistic and community based, illustrated by the healing wheel. The present paper proposes that existential positive psychology (PP 2.0) represents a promising approach to meet the rising needs in palliative care. This framework has a twofold emphasis on (a) how to transcend and transform suffering as the foundation for wellbeing and (b) how to cultivate our spiritual and existential capabilities to achieve personal growth and flourishing. We propose that these objectives can be achieved simultaneously through dialectical palliative counselling, as illustrated by Wong’s integrative meaning therapy and the Conceptual Model of CALM Therapy in palliative care. We then outline the treatment objectives and the intervention strategies of IMT in providing palliative counselling for palliative care and hospice patients. Based on our review of recent literature, as well as our own research and practice, we discover that existential suffering in general and at the last stage of life in particular is indeed the foundation for healing and wellbeing as hypothesized by PP 2.0. We can also conclude that best palliative care is holistic—in addition to cultivating the inner spiritual resources of patients, it needs to be supported by the family, staff, and community, as symbolized by the healing wheel. Full article
(This article belongs to the Special Issue Existential Suffering in Palliative and Supportive Care Settings)
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