The Nature of Suffering and its Relief in the Terminally Ill: A Qualitative Study

Abstract

The essential mandate of medicine is the relief of suffering. However, the quest for an integrated model towards a conceptualization of suffering is still ongoing and empirical studies are few. Qualitative inquiry using 31 in-depth interviews and content analysis was carried out between 1999 and 2001 in 26 patients diagnosed with terminal cancer. The suffering experience was described through a multiplicity of heterogenous elements from the physical, psychological, and social spheres. Systematic synthesis of interview material yielded three apparently irreducible core dimensions. Respondents defined their suffering in terms of 1) being subjected to violence, 2) being deprived and/ or overwhelmed, and 3) living in apprehension. Cassell wrote, in 1991, that to know the suffering of others demands an exhaustive understanding of what makes them the individuals they are (1). Our model can be of use in structuring and eliciting this necessary information. Understanding how a particular patient feels harmed, deprived or overburdened, and overtaken by fear, provides a lever for action tailored to the specifics of that person's experience.

The Autonomy Experience of Patients in Palliative Care

“…Living without temporal reference points and with a fear that unexpected events might surface at any time can be a frustrating experience 21 and may become a source of suffering. 15 This certainly makes any future planning all the more difficult. In this respect, Chochinov et al 14 report that the ability to live in the present moment helps avoid apprehension about the future and helps maintain a sense of dignity.…”

“…[8][9][10][11][12][13] The idea of control associated with autonomy influences a person's sense of dignity, represents a source of hope, and helps relieve suffering and improve quality of life. 10,[14][15][16] Expressing and respecting autonomy are undeniably important factors in promoting the well-being of people near the end of life. This notion is indeed prevalent in documents guiding palliative care practice in Canada.…”

Narratives in specialist palliative medicine

“…Usually their condition is such that they seek medical attention as sufferers, and not merely as bearers of symptoms 4. Doctors can provide patients with this opportunity by encouraging them to tell their narrative, allowing the potential dialogue time to develop.…”

Bereaved family members' perspectives on suffering among older rural cancer patients in palliative home nursing care: A qualitative study

“…The alleviation of suffering is also a central goal in palliative care (Wilson et al., ), and for persons suffering from advanced cancer, physical, psychological, social and spiritual dimensions can be distinguished (Daneault et al., ; Ferrell & Coyle, ; Wilson et al., ). Yet, the scope of research has primarily encompassed types of suffering and not so much the experience of suffering, and the field continues to be dominated by quantitative studies (Beng et al., ; Ellis et al., ).…”