Monday, January 18, 2021

Understanding Existential Anxiety and the Soothing Nature of Nostalgia in Life With Incurable Esophageal Cancer: A Phenomenological Hermeneutical Investigation of Patient Narratives

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Background Research has identified how people living with incurable esophageal cancer experience existential concerns. Objective The aim of this study was to examine the phenomenon of existential anxiety when living with esophageal cancer in the context of receiving general palliative care in a hospital setting. Methods This qualitative study is inspired by phenomenological and hermeneutical aspects of the philosophies of Ricoeur and Heidegger. Applying Heidegger's theory of existential anxiety and nostalgia, we interpreted the narratives of 18 patients receiving palliative care due to incurable esophageal cancer. Results The patients experienced existential anxiety at the loss of a future and homeliness when receiving palliative care. Their existence was reduced to the present, with a break in temporal continuity. An anxious mood permeated their entire being-in-the-world in an unhomelike way. Despite this, patients initiated a restoration of home and meaning expressed as a soothing sense of nostalgia that served as an atmospheric, safe space allowing them to inhabit the borderline between past, present, and future. Conclusions The study suggests an empirical interpretation of the existential anxiety patients experience when receiving palliation for incurable esophageal cancer. It sheds light on how these patients would benefit from healthcare professionals inviting them to narrate significant aspects of their life stories in which the soothing presence of nostalgia can be supported. Implication for Practice Providing care conditions for a life heading toward death, where the patient can live alongside anxiety, involves focusing on "being with" the patient and on incorporating a nostalgic dimension to facilitate soothing restoration of home for patients. The work was supported by Copenhagen University Hospital Research Fund, Rigshospitalet, Denmark; Danish Nursing Council Research Fund, Denmark; Copenhagen University Hospital Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Denmark. The authors have no conflicts of interest to disclose. All authors contributed to the concept and design of the study. All authors performed the analysis and interpretation. M.M. performed drafting of the article. All authors read, critically reviewed, and approved the article. Correspondence: Malene Missel, PhD, MScN, RN, Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet Blegdamsvej 9, 2100 Copenhagen, Denmark (malene.missel@regionh.dk). Accepted for publication October 25, 2020. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved
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