Overview

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Existential distress of terminally ill cancer patients has been categorised as relating to: relationship related concerns, loss of control, burden on others, loss of continuity, uncompleted life task, hope / hopelessness, and acceptance / preparation. [1] Cultural factors can create important differences in the level of suffering.

What is known
Empirical studies have named a number of experiences that can be described as patient existential plight or distress. [2- 5] Between 25%-50% of patients with cancer report unmet spiritual / existential needs.[6] Pre occupation with existential issues does not necessarily mean existential suffering. [7] Among outpatients with heart failure, greater spiritual well being, particularly meaning / peace, was strongly associated with less depression. [8] 
 
There is little investigation of the family caregiver’s experience. [9] But for families where genetic cancer risk exists, a parallel ‘existential plight’ has been identified following the cancer diagnosis and beginning of treatment. [10] 
 
The Japanese Spiritual Care Task Force has recently offered a definition of ‘psycho-existential suffering’ as "the pain caused by the potential extinction of one’s being and the meaning of the self." [11] Their conceptual framework suggests psycho-existential suffering is caused by the loss of three essential components:

• Loss of relationships (with others) 
• Loss of autonomy (independence, control over future, continuity of self)
• Loss of temporality (the future).

There is some evidence from empirical studies that fostering patients’ perception of meaning in their life is an essential aspect of palliative care. However there is no evidence as yet as to who best responds to existential interventions. It is suggested there are no general solutions. [12] 

What it means for practice
A focus on existential well-being as part of daily palliative care assists in addressing potential distress. A suggested probe for health carers of dying patients is to ask 'Are you at peace?'  [13]

Meaning-centred group therapy is one approach that has been used in end-of-life care to help patients find meaning and purpose in living until death. [14]
 
The multidisciplinary team needs to explore within its own organisation the best way to address patients’ existential needs.[15] ([18] Recent research identifying stress in teams related to existential issues confirms that individual, group, institutional and cultural forces influence individual experience.[16-19] 

Finding out more

1. Chochinov HC Dying, Dignity, and New Horizons in Palliative End-of-Life Care CA Cancer J Clin 2006;56;84-103
2. Breitbart W, Gibson C, Poppito SR, Berg A Psychotherapeutic interventions at the end of life; a focus on meaning and spirituality Canadian Journal of  Psychiatry. 2004 Jun; 49(6):366-72.
3. Viktor Franckl Institute of Logotherapy

Related CareSearch Pages
Suffering
Dignity conserving care

References

1. Morita T, Kawa M, Honke Y, Kohara H, Maeyama E, Kizawa Y, et al.  Existential concerns of terminally ill cancer patients receiving specialized palliative care in Japan. Supportive Care in Cancer. 2004 Feb;12(2):137-40.  
2. Weisman AD, Worden JW. The existential plight in cancer: significance of the first 100 days.  International Journal of Psychiatry in Medicine 1976-77;7(1):1-15.  
3. Kissane DW. Psychospiritual and existential distress: the challenge for palliative care. Australian Family Physician 2000 Nov;29(11):1022-5.
4. Bolmsjo I. Existential issues in palliative care: interviews of patients with amyotrophic lateral sclerosis. Journal of  Palliative Medicine 2001 Winter;4(4):499-505.  
5. Moadel A, Morgan C, Fatone A, Grennan J, Carter J, Laruffa G, et al.  Seeking meaning and hope: self-reported spiritual and existential needs among an ethnically-diverse cancer patient population.  Psychooncology 1999 Sep-Oct;8(5):378-85.
6. Blinderman CD, Cherny NI. Existential issues do not necessarily result in existential suffering: lessons from cancer patients in Israel.  Palliative Medicine 2005 Jul;19(5):371-80. 
7. Bekelman DB, Dy SM, Becker DM, Wittstein IS, Hendricks DE, Yamashita TE, et al. Spiritual well-being and depression in patients with heart failure. Journal of General Internal Medicine 2007 Apr;22(4):470-7. 
8. Raveis VH, Pretter S. Existential plight of adult daughters following their mother’s breast cancer diagnosis.  Psycho-Oncology 2005 Jan;14(1):49-60.  
9. Murata H, Morita T; Japanese Task Force.  Conceptualization of psycho-existential suffering by the Japanese Task Force: the first step of a nationwide project.  Palliative & Supportive Care 2006 Sep;4(3):279-85.  
10. Bolmsjo I, Hermeren G, Ingvar C. Meeting existential needs in palliative care–who, when, and why? Journal of Palliative Care 2002 Fall;18(3):185-191.  
11. Steinhauser KE, Voils CI, Clipp EC, Bosworth HB, Christakis NA, Tulsky JA. "Are you at peace?": one item to probe spiritual concerns at the end of life. Archives of Internal Medicine 2006 Jan 9;166(1):101-5.  
12. Ekedahl M, Wengström Y. Nurses in cancer care--stress when encountering existential issues. European Journal of Oncology Nursing 2007 Jul;11(3):228-37  
13. Ekedahl M, Wengström Y. Nurses in cancer care—coping strategies when encountering existential issues. European Journal of Oncology Nursing 2006 Apr;10(2):128-39  
14. Ekedahl M, Wengström Y.  Coping processes in a multidisciplinary healthcare team: a comparison of nurses in cancer care and hospital chaplains. European Journal of Cancer Care (Engl). 2008 Jan;17(1):42-8  
15. Nyström M. A patient-oriented perspective in existential issues: a theoretical argument for applying Peplau's interpersonal relation model in healthcare science and practice.  Scandinavian Journal of Caring Sciences 2007 Jun;21(2):282-8. 
16. Landmark BT, Strandmark M, Wahl AK. Living with newly diagnosed breast cancer--the meaning of existential issues. A qualitative study of 10 women with newly diagnosed breast cancer, based on grounded theory.  Cancer Nurs. 2001 Jun;24(3):220-6
17. Breitbart W, Gibson C, Poppito SR, Berg A Psychotherapeutic interventions at the end of life; a focus on meaning and spirituality Canadian Journal of  Psychiatry. 2004 Jun; 49(6):366-72.
18. Boston PH, Mount BM The caregiver’s perspective on existential and spiritual distress in palliative care Journal of Pain and Symptom Management 2006 32(1): 13-26
19. Albinsson L, Strang P Existential concerns of families of late-stage dementia patients: questions of freedom, choices, isolation, death, and meaning. Journal of Palliative Medicine. 2003 Apr;6(2):225-35

This page was created on 14 May 2008 and is due for review in May 2010
Last updated 26 May 2008