Loredana Buonaccorso1, Silvia Tanzi2, Ludovica De Panfilis3, Luca Ghirotto4, Cristina Autelitano5, Harvey Max Chochinov6, Silvia Di Leo7, Gianfranco Martucci5. 1. Psycho-Oncology Unit, Azienda USL-IRCSS di Reggio Emilia, Reggio Emilia, Italy. Electronic address: loredana.buonaccorso@ausl.re.it. 2. Palliative Care Unit, Azienda USL-IRCSS di Reggio Emilia, Reggio Emilia, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy. 3. Bioethics Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy. 4. Qualitative Research Unit, Scientific Directorate, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy. 5. Palliative Care Unit, Azienda USL-IRCSS di Reggio Emilia, Reggio Emilia, Italy. 6. Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada; Research Institute in Oncology and Hematology, CancerCare Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada. 7. Psycho-Oncology Unit, Azienda USL-IRCSS di Reggio Emilia, Reggio Emilia, Italy.
Abstract
CONTEXT: Generativity is a process whereby patients nearing the end of life invest in those they will soon leave behind. In recent years, the trajectory of cancer has changed, as new therapies have prolonged survival and patients often live with metastatic disease for several years. For these patients and for the healthcare professionals who care for them it can be useful to understand if the concept of generativity is clinically salient. OBJECTIVES: To explore the meanings emerging from two dignity therapy questions, particularly salient to generativity, amongst cancer patients in different care settings. METHODS: We conducted a multicenter, retrospective, qualitative study in 1) home palliative care (life expectancy < 3 months); 2) specialized palliative care provided by team within an oncology hospital (life expectancy > 9-12 months); and 3) oncological day hospital (potentially curable disease). We thematically analyzed the answers of two dignity therapy questions. RESULTS: Three themes and related meanings emerged from 37 dignity therapy sessions with respect to the two questions: 1) Meanings concerning the present life and illness, including the experience of suffering; 2) Thoughts and actions towards the self, including ways in which the patients have felt alive; 3) Thoughts and actions towards significant others, especially values that are based mainly on love for oneself and for others. No notable differences across stages and care settings emerged in terms of the meanings emerging from two dignity therapy questions. CONCLUSION: Conversations about generativity could inform clinicians on how to communicate about existential and meaning-based issues across different stages of illness.
CONTEXT: Generativity is a process whereby patients nearing the end of life invest in those they will soon leave behind. In recent years, the trajectory of cancer has changed, as new therapies have prolonged survival and patients often live with metastatic disease for several years. For these patients and for the healthcare professionals who care for them it can be useful to understand if the concept of generativity is clinically salient. OBJECTIVES: To explore the meanings emerging from two dignity therapy questions, particularly salient to generativity, amongst cancerpatients in different care settings. METHODS: We conducted a multicenter, retrospective, qualitative study in 1) home palliative care (life expectancy < 3 months); 2) specialized palliative care provided by team within an oncology hospital (life expectancy > 9-12 months); and 3) oncological day hospital (potentially curable disease). We thematically analyzed the answers of two dignity therapy questions. RESULTS: Three themes and related meanings emerged from 37 dignity therapy sessions with respect to the two questions: 1) Meanings concerning the present life and illness, including the experience of suffering; 2) Thoughts and actions towards the self, including ways in which the patients have felt alive; 3) Thoughts and actions towards significant others, especially values that are based mainly on love for oneself and for others. No notable differences across stages and care settings emerged in terms of the meanings emerging from two dignity therapy questions. CONCLUSION: Conversations about generativity could inform clinicians on how to communicate about existential and meaning-based issues across different stages of illness.