Demonstrating the importance of cultural considerations at end of life utilizing the perspective of Indian patients with cancer

A qualitative meta-synthesis examining spirituality as experienced by individuals living with terminal cancer

“…The experience of spiritual distress was identified by participants of several included studies, as they attempted to make sense of dying. When faced with the reality of living with terminal illness, participants in four studies struggled with being confronted with their mortality ( Chittem et al, 2022 ; Ellis et al, 2015 ; Willig 2015 ; Yoon Sun Kim, 2021 ) and in another study, participants suffered from existential angst ( Egan et al, 2017 ). Some participants from other included studies also experienced feelings of injustice at the unfairness of having a terminal illness, with questions of ‘why me?’ and ‘why now?’ ( Egan et al, 2017 ; McTiernan and O’Connell, 2015 ; Reeve et al, 2010 ; Reeve et al, 2012 ; Thompson et al, 2009 ).…”

“…Many participants in included studies feared suffering associated with death ( Eun et al, 2017 ; Sherman et al, 2018 ). Participants of several studies not only experienced a fear of dying, but also feared and grieved leaving behind family members and friends ( Cao et al, 2020 ; Chittem et al, 2022 ; Egan et al, 2017 ; Liu et al, 2021 ; Maiko et al, 2019 ; Thompson et al, 2009 ; Tuck et al, 2012 ; Yoon Sun Kim, 2021 ). Feelings of loneliness and loss were experienced by participants in further studies, which they perceived as difficulties experienced with family members ( Maiko et al, 2019 ; Thompson et al, 2009 ; Tuck et al, 2012 ) and friends who were fearful of their illness and ceased the friendships ( Aoun et al, 2016 ).…”

“…Hope was noted by the authors of some studies an as important inner resource used by participants to help themselves to keep positive throughout the course their illness. In five studies, participants continued to ‘keep fighting’ in the hope of overcoming their illness, despite knowing the prognosis ( Bentur et al, 2014 ; Chittem et al, 2022 ; Hughes et al, 2015 ; Tuck et al, 2012 ; Yoon Sun Kim, 2021 ). Participants in further studies expressed the need for faith and positivity in the hope of living longer ( Adorno and Brownell, 2014 ; Alcorn et al, 2010 ; Eun et al, 2017 ).…”

“…The experience of feeling a connection to a higher power was found to be an important way of finding meaning in illness, in gaining acceptance and finding peace within among participants in included studies. This feeling of a connection to a higher power through religious and spiritual beliefs had a significant influence on how participants lived with their illness across many included studies ( Alcorn et al, 2010 ; Aoun et al, 2016 ; Best et al, 2014 ; Chittem et al, 2022 ; Egan et al, 2017 ; Ellis et al, 2015 ; Elsner et al, 2012 ; Ginter, 2020 ; Lee and Ramaswamy, 2020 ; Lee et al, 2013 ; Li et al, 2014 ; Liu et al, 2021 ; Maiko et al, 2019 ; McTiernan and O’Connell, 2015 ; Meisenhelder et al, 2016 ; Mok et al, 2010 ; Nedjat-Haiem et al., 2020 ; Nilmanat et al., 2015 ; Reeve et al, 2012 ; Sherman et al, 2018 ; Tuck et al, 2012 ; Yoon Sun Kim, 2021 ). In three studies, participants reported initial feelings of anger and disappointment for being let down or abandoned by God ( Maiko et al, 2019 ; McTiernan and O’Connell, 2015 ; Reeve et al, 2012 ), while in another study, participants reported that they were being tested by God ( Nilmanat et al, 2015 ).…”

“…In five studies, participants reported that a relationship with God provided them with an important source of comfort during their illness as they prepared for end of life ( Alcorn et al, 2010 ; Ellis et al, 2015 ; Lee and Ramaswamy, 2020 ; Sherman et al, 2018 ; Yoon Sun Kim, 2021 ). Religious beliefs were reported by participants of further studies to help participants to live with terminal illness ( Alcorn et al, 2010 ; Chittem et al, 2022 ; Lee et al, 2013 ; Maiko et al, 2019 ) and to find peace within ( Mok et al, 2010 ). ‘Having faith in God’s will’ assisted participants of one study to gain peace of mind in the face of death ( Nilmanat et al, 2015 ).…”