Existential concerns among patients with cancer and interventions to meet them: an integrative literature review

Objectives: An integrative literature review was undertaken to explore existential concerns among patients with cancer with respect to components, related concepts and targets of interventions. Methods: Comprehensive searches in MEDLINE, CINAHL, PsychINFO, Social Citation Index, SweMed+, Eurethics, NLM Gateway, Faculty of 1000 Medicine, Cochrane Library, EMBACE were undertaken. Each paper was read and classified according to design as descriptive qualitative, descriptive quantitative or interventional. Main themes, interventions and outcomes were identified. Results: The searches yielded a total of 162 articles, of which 109 met inclusion criteria. Existential components from the qualitative studies were divided into two main themes: struggle to maintain self-identity and threats to self-identity. Quantitative studies mainly concerned relationships between existential concerns and other concepts. Interventions and assessed outcomes were consistent with components and relationships found in the descriptive studies. Relationships concerned physical and psychological domains; however, few interventions were evaluated against physical outcomes. No interventions applicable to everyday health-care practice were found. Conclusion: Interventions targeted and evaluated concepts related to existential concerns found in the descriptive studies. Gaps in research on existential concerns in patients with cancer include the need to clarify the concept; how patients' existential well-being may best be supported by health-care professionals in everyday practice; effects of existential interventions on physical symptoms; and stability of results of interventions. Copyright (C) 2008 John Wiley & Sons, Ltd.