Dissertation for the Degree Philosophiae Doctor (PhD) in psychology of religion
Sigrid Helene Kjørven Haug
Resumè
Short title: The illness experiences of older people with incurable cancer - Interactions
between daily living and existential meaning-making
Older people living with incurable cancer as a chronic disease represent an increasing
proportion of the patients receiving palliative care in specialized healthcare contexts in
Norway. However, little is known about how they experience living with the disease in
general and the psychological functions of existential meaning-making experiences in
particular. In this qualitative study 21 participants, 12 men and nine women aged 70-88, were
interviewed with a semi-structured guide. They were recruited from two somatic hospitals in
south-eastern Norway while receiving palliative care. The research question was: How do
older people experience living with incurable cancer in daily living - with special reference to
the psychological functions of existential meaning-making experiences? The question was
examined through three sub-questions, each being the focus of the study’s articles:
I: How do older people with incurable cancer experience daily living?
II: How do older people with incurable cancer experience the existential meaning-making
function in daily living from a life-span perspective?
III: How can cultural and existential meaning-making analyses contribute with an
understanding of the illness reframing process in an ethnic Norwegian majority population of
older people with cancer?
The study was placed within the hermeneutical research tradition in psychology due to
the focus on interpreting and understanding meaning phenomena in text material. The
interviews were analyzed with both inductive and deductive approaches. In Paper I, the
phenomenological descriptive method called “systematic text-condensation” was applied as
analytic strategy on the data material. In Paper II, a theoretical template was used for analysis
of the same interview material. The template was formed from an operationalized existential
meaning-making framework, derived from the data material, which was added to the model
‘selective optimization with compensation’ (SOC) from life-span developmental psychology.
In Paper III a theory-driven analysis was employed as well. Four participants, representing the
range of meaning-making expressions from the total sample, were analyzed with cultural- and
existential meaning-making analyses grounded in medical anthropology from Kleinman.
The main finding was that the participants reported a strong link to life in the present.
Existential meaning-making and resilience represented the overarching and interrelated
processes for understanding their adaptation process in daily living. Cultural- and existential
meaning-making analysis contributed to a more nuanced understanding of the participants’
varied interpretations and modifications of living with incurable cancer. The results point to
the need for including these types of analyses and its resulting information in the clinical
process for understanding patients’ frameworks of interpretations. To combine the SOC
model and the existential meaning-making framework with the resulting more comprehensive
approach to resilience, might provide a fruitful next step in both the theoretical and the
clinical developments for palliative care populations. Healthcare professionals can make use
of this information in treatment planning and for the identification of psychosocial, cultural,
and existential meaning-making resources to support older people and to strengthen the
person’s own life resources.