Malcolm Payne, Honorary Professor, Kingston University/St George’s University of London, Faculty of Health, Social Care and Education, UK, explains the background to his longer article that is published in the September/October issue of the European Journal of Palliative Care.
Why be concerned about ‘meaning’ as an issue in end-of-life care? I came to write about it in the European Journal of Palliative Care as someone who comes from a background in social work, and therefore started out with an academic training in sociology and social policy, leavened with a little psychology. Coming to work in palliative care about ten years ago, I found it strange that issues of meaning were seen as the province of spiritual care professionals.
An important strand of sociology is social construction: how we all interpret the world through coming to everyday unstated agreement with others about what we see and experience. The psychological end of psychosocial care reminded me of another understanding of meaning: how we perceive and process events around us and interpret them in accordance with our expectations. Colin Murray Parkes’s (1975) ideas about our ‘assumptive world’ in bereavement are an example. Bereavement disturbs our assumptions about how our life is, and in this view part of the process of going through bereavement is creating new assumptions.
In one of his thoughtful discussions of spiritual care, Peter Speck (2004) points out that the spiritual care concern with meaning is mainly about existential meaning: why do I exist (since I’m told that soon I will cease to exist)?
So I went off to look in more detail at wider concerns about meaning in the palliative care literature. One of the reasons that early thinking focused on spiritual meaning, for example in Dame Cicely Saunders’s (1964) writings, is the perception that searching for meaning in our lives as we approach death will guard against fear of death and demands for assisted suicide and euthanasia.
However, research on searching for meaning at the end of life suggests that while some people faced with adversity do search for existential meaning and gain satisfaction from their thinking, not everyone reacts in this way. More recently, several interventions, using both group and individual treatments, to help people explore meaning have been tried at different stages in end-of-life care.
These include mainly medical and nursing interventions concerned with patients and relatives’ understanding of their symptoms and the progression of their medical condition at the outset of palliative care. Other interventions have been concerned with helping people cope with reactions to impending death and with bereavement.
In the paper, I have classified different approaches to meaning based on different disciplines contributing to end-of-life care and drawn together a number of the interventions that have been evaluated. I argue that we need to have a broader and differentiated view of meaning and how to deal with it.
Parkes, C.M.1975. Determinants of outcome following bereavement. Omega, 6, 303-23.
Saunders, C. (1964) The depths and possible heights. In Saunders, C. (2006) Cicely Saunders: Selected Writings: 1958-2004. Oxford University Press, Oxford, pp. 67-70.
Speck, P. 2004. Spiritual concerns, in Sykes, N., Edmonds, P., Wiles, J. (Eds.) Management of Advanced Disease, Arnold, London, pp. 471-81.
To read a copy of the full article…
This post relates to a longer article, ‘Meaning in end-of-life care practice’, by Malcolm Payne, which is published in the September/October 2014 issue of the European Journal of Palliative Care (vol. 21.5). If you have a web-based subscription to the journal you can download this issue, plus all articles in the journal archive. You can also browse the archive and download articles by taking a 10-minute or 30-minute subscription. Members of the EAPC receive discounted subscription rates to the journal – click here to subscribe online.