Meaning-centeredness in adult cancer patients in remission

Abstract

This study explores how cancer patients in remission derive meaning in their lives. A need for social work intervention was identified with cancer survivors, especially those patients who are in remission and who have to continue their lives, in spite of the incurable status of their cancer. In line with literature, the researcher, in her role as social worker at a radiation oncology clinic, observed that patients often report that they find benefit in the cancer experience. The framework for conducting this study is based on the existential theory and the ultimate concern of human existence, that life has meaning under all circumstances. Meaning and meaning-centeredness is described. The role of a meaning-centered approach to oncology social work was argued. The Meaning-Centered Counselling and Therapy (MCCT) model was described from a literature perspective, and proposed as an intervention model. MCCT offers a model that includes the existential domain in interventions. Within the context of this study, remission refers to the period that the cancer is under control. It may be that there is no indication of the cancer, but the cancer is expected to recur, or that some of the symptoms have disappeared, or that the progression of the cancer has slowed down. During remission, patients are under surveillance only, or on maintenance treatment. Thus, they do not have regular contact with the oncology team. Patients live with uncertainty and ambiguity, resuming activities, responsibilities, careers and relationships that were influenced by the cancer diagnosis and treatments. The demands of living in remission are described. This research study explores the quest for meaning in patients who are living with incurable, recurrent cancer. The goal of this research study was to explore meaning-centeredness in adult cancer patients who are in remission. This research study was guided by the following research question: “Does meaning-centeredness play a role in adult cancer patients’ coping with remission?” The research population included oncology patients who are in remission, and have experienced one or more recurrences, and where the cancer has metastasised. A qualitative approach was followed, using the collective case study design. The research was conducted at the Radiation Clinic, Sandton Oncology Centre in Morningside, Johannesburg. Data was collected using an interview schedule to guide 4 focus group interviews, totalling 21 participants, who were selected by means of purposive sampling. All participants gave voluntary and informed consent to take part, and the focus group interviews were voice-recorded, with their permission. The researcher transcribed these recordings. Creswell’s steps for qualitative data analysis were implemented. From the findings, the following themes and sub-themes were identified, demonstrating the search for meaning amongst these participants who are in remission and answering the research question: Theme 1: Meaning-construal associated with attribution with the sub-themes of hope, spirituality, and death awareness and a foreshortened future. Theme 2: Meaning-construal associated with appraisal, with the sub-themes of benefit finding, growth, relationships, and an increased appreciation of life, and prioritising. Theme 3: Meaning-construal associated with reappraisals, with sub-themes of sense of self, sense of coherence, assumptive world, adapting to new normal, and transcendence. The findings demonstrated that a perspective that provided the participants with the means to explore their unique meanings, purposes, and life tasks helped them to cope with remission and the fear or reality of recurrence or metastases. Participants were able to derive meaning in their lives despite living with incurable cancer. Participants, who had integrated the knowledge that their cancer is incurable and recurrent into their meaning-system, were able to adapt and adjust to living in remission. They had a sense of purpose and maintained realistic hope. Their hopes were proportional to the prognosis. They did not dwell on their own death, but focused on what life offers them each day. They developed a new normal that incorporates the knowledge of a foreshortened future, coping with side effects and late effects of treatment, and the uncertainty that the cancer is expected to recur or metastasise again. They were aware of their life tasks, and embraced life to the full. Intervention strategies, based on the existential oriented proposition that life has meaning under all circumstances, were recommended. This included the Meaning-Centered Counselling and Therapy (MCCT) model for integration in oncology social work. Recommendations in this study include enhancing the understanding of members of the trans-disciplinary team regarding the needs and experiences of patients in remission. Furthermore, a better understanding of the role of meaning-centeredness intervention amongst oncology social workers can improve interventions, specifically for patients in remission.