For whom the bell tolls : meaning making at the end of life among Chinese terminal cancer patients in Hong Kong

Abstract

In addition to alleviating pain and physical symptoms, caring for the psychosocial, spiritual and existential needs of terminal cancer patients is very important. Existential issue such as meaning is one of their major concerns. Meaning making can be a powerful mean to enhance the well being of these patients at their end of life. There is limited research on the meaning and meaning making experiences among the Chinese population. This study aims to examine the sources of meaning of these patients and illuminate how they make meaning at the end of life. Cultural features associated with meaning and meaning making at the end of life are explored as well.

The current study adopted a constructivist grounded theory approach. Purposive sampling was used to recruit twenty terminal cancer patients from the palliative care unit. Semi-structured interviews and brief life review exercise were conducted with the patients. Forty-three interviews were produced and provided a foundation for the data, along with field notes, interview memos and journals.

This study revealed that sources of meaning among the Chinese terminal cancer patients were derived from four major domains. They were self domain, relational domain, physical domain and spiritual domain. These domains were interrelated and having dynamic interactions with each other. A proposed model of meaning making at the end of life also emerged from the collected data. It consisted of four processes: sense making, self constructing, script creating and experiencing sense of connectedness (The 4S Model). Meaning making at the end of life was found to be a cognitive, affective and relational process. Findings revealed the significant role culture and family play in the meaning and meaning making processes of Chinese terminal cancer patients.

Knowledge generated from this study informs the development of clinical intervention and practice to improve the well being of patients at the end of life. Implication for the development of meaning measurement and family intervention are suggested. Healthcare practitioners are equipped to move further on the path of developing a holistic care model at palliative care. This study also shed lights on promoting life education in the local community. Life can be brimmed with meaning even in the toughest hours.