Integration of experiences of contingency in patients with advanced cancer supported by a multimodal art approach.

To support patients with cancer in a palliative treatment phase with the integration of experiences of contingency into their life narrative, we developed a multi-modal approach: In Search of Stories (ISOS). ISOS consists of the following elements: filling out the self-report RE-LIFE questionnaire, drawing of Rich Pictures, and reading an exemplary story with a spiritual counselor, followed by a co-creation process with a professional artist. In the current article we illustrate how patients moved through the process of integration of experiences of contingency during the meetings of ISOS by presenting two case descriptions.

Narrative meaning-making at the crossroads between life and death: a qualitative study into contemplating literary texts with advanced cancer patients.

Purpose: Advanced cancer patients may perceive their disease as an experience of contingency: a (sudden) disruption of the life-narrative evoking existential concerns such as loss of meaning and identity. The research project In Search of Stories aimed to investigate whether and how reading and discussing literary texts assisted participants in integrating their diagnosis as the experience of contingency into their life-narrative.

Methods: This qualitative study reports on interviews with 25 advanced cancer patients, who read a story from a curated collection of 10 literary texts.

Exploring resonance theory and uncontrollability during co-creative art making: A qualitative study among cancer patients.

Purpose: Co-creation, characterised by artists and patients creating a joint work of art, may support patients with the integration of life events, such as living with cancer, into their life story. In the process of co-creation, resonance relationships between patients, artists and material may evolve that support such integration. Using the framework of resonance theory, we aim to investigate if and how patients move through the three phases of resonance during a process of co-creation and explore the role of uncontrollability in this process.

The expression of ultimate life goals in co-creative art processes with palliative cancer patients.

Background: Co-creation, characterized by artists and patients creating a joint work of art, may support patients with the integration of disruptive life events into their life story, such as living with cancer. Focusing on experiences of contingency and life goals could support this process. The research questions are: (1) 'how are patient's ultimate life goals and experiences of contingency expressed in the work of art as created in a process of co-creation?'; (2) 'how do the four phases of integration of experiences of contingency unfold during co-creation?'

Methods: Ten patients who were in a palliative stage of cancer treatment completed co-creation processes.

Co-creative art processes with cancer patients from the artists' perspective: a qualitative study exploring resonance theory.

Purpose: Co-creation, characterised by artists and patients creating a joint work of art, may support patients with the integration of life events into their life story, such as living with cancer. In the process of co-creation, resonance relationships between patients, artists and material may evolve that support integration. We aim to investigate if and if so, how resonance relationships occur from the perspective of the artist.

Co-creative art processes with patients: A theoretical framework and qualitative study among artists.

A cancer diagnosis may be experienced as a contingent life event. Co-creation-in which artists together with patients create a work of art reflecting on aspects of the patients' life story-may be used to support patients to integrate such a contingent life event into their life story. We conducted a qualitative study in which we interviewed 10 professional artists to explore if co-creative art processes could facilitate integration of experiences of contingency in patients.

This is what life with cancer looks like: exploring experiences of adolescent and young adults with cancer using two visual approaches.

Introduction: Talking about illness experience can be challenging for adolescents and young adults (AYAs) with cancer. Visual tools, in addition to spoken language, might make this easier, such as rich pictures and photovoice. We aimed to obtain a comprehensive view of the cancer experience of AYAs by using rich pictures and photovoice.

Repeated use of rich pictures to explore changes in subjective experiences over time of patients with advanced cancer.

Background: The combination of verbal and visual tools may help unravel the experiences of advanced cancer patients. However, most previous studies have focused on a specific symptom, at only one moment in time. We recently found that a specific visual tool, originating from systems thinking, that is, rich pictures (RPs), could provide a more comprehensive view of the experiences of patients with advanced cancer.

Response shift after coronary revascularization.

Purpose: The aims of this study were to investigate (1) the extent to which response shift occurs among patients with coronary artery disease (CAD) after coronary revascularization, (2) whether the assessment of changes in health-related quality of life (HRQoL), controlled for response shift, yield more valid estimates of changes in HRQoL, as indicated by stronger associations with criterion measures of change, than without controlling for response shift, and (3) if occurrences of response shift are related to patient characteristics.

Methods: Patients with CAD completed the SF-36 and the Seattle Angina Questionnaire (SAQ7) at baseline and 3 months after coronary revascularization. Sociodemographic, clinical and psychosocial variables were measured with the patient version of the New York Heart Association-class, Subjective Significance Questionnaire, Reconstruction of Life Events Questionnaire (RE-LIFE), and HEXACO personality inventory.

Narrative recognition and identification: a qualitative pilot study into reading literary texts with advanced cancer patients.

Purpose: Patients with advanced cancer can experience their disease as a contingent life event. The sudden interruption of their life stories can obscure life goals and disrupt meaning making. In the context of the research project "In search of stories," we aim to investigate the reading and discussion of selected stories which present ways of dealing with a contingent life event.

Ecological momentary assessment versus retrospective assessment for measuring change in health-related quality of life following cardiac intervention.

Background: Measuring change in health-related quality-of-life (HRQoL) is important to assess the impact of disease and/or treatment. Ecological momentary assessment (EMA) comprises the repeated assessment of momentary HRQoL in the natural environment and is particularly suited to capture daily experiences. Our objective was to study whether change in momentary measures or retrospective measures of HRQoL are more strongly associated with criterion measures of change in HRQoL.

Gender differences in quality of life in coronary artery disease patients with comorbidities undergoing coronary revascularization.

In comparison to male patients with coronary artery disease, female patients suffer from more comorbidities, experience symptoms of coronary artery disease differently and report poorer health-related quality of life (HRQoL) after coronary revascularization. However, there is limited data on the impact of comorbidity burden on the recovery in HRQoL in female and male patients. We investigated the impact of comorbidity burden on the change in HRQoL following coronary revascularization in female patients versus male patients.

Influence of response shift and disposition on patient-reported outcomes may lead to suboptimal medical decisions: a medical ethics perspective.

Background: Patient-reported outcomes (PROs) are frequently used for medical decision making, at the levels of both individual patient care and healthcare policy. Evidence increasingly shows that PROs may be influenced by patients' response shifts (changes in interpretation) and dispositions (stable characteristics).

Main Text: We identify how response shifts and dispositions may influence medical decisions on both the levels of individual patient care and health policy.

Living with advanced cancer: Rich Pictures as a means for health care providers to explore the experiences of advanced cancer patients.

Background: To provide holistic care to patients with advanced cancer, health care professionals need to gain insight in patients' experiences across the different domains of health. However, describing such complex experiences verbally may be difficult for patients. The use of a visual tool, such as Rich Pictures (RPs) could be helpful.

The dynamics in health-related quality of life of patients with stable coronary artery disease were revealed: a network analysis.

Objective: Health-related quality of life (HRQoL) is a dynamic construct. Experience sampling methods (ESM) are becoming increasingly popular to capture within-person fluctuations in HRQoL. An emerging approach to analyze such momentary data is network analysis.

An assisted structured reflection on life events and life goals in advanced cancer patients: Outcomes of a randomized controlled trial (Life InSight Application (LISA) study).

Background:: Diagnosis and treatment of incurable cancer as a life-changing experience evokes difficult existential questions.

Aim:: A structured reflection could improve patients’ quality of life and spiritual well-being. We developed an interview model on life events and ultimate life goals and performed a randomized controlled trial to evaluate the effect thereof on quality of life and spiritual well-being.

Images of God and attitudes towards death in relation to spiritual wellbeing: an exploratory side study of the EORTC QLQ-SWB32 validation study in palliative cancer patients.

Background: When patients are facing the ends of their lives, spiritual concerns often become more important. It is argued that effective, integrated palliative care should include addressing patients' spiritual wellbeing. In 2002 the EORTC Quality of Life Group began an international study to develop an spiritual wellbeing measure for palliative patients (SWB).

Toward a Fully Fledged Integration of Spiritual Care and Medical Care.

In this article, we aimed to set out current problems that hinder a fully fledged integration of spiritual and medical care, which address these obstacles. We discuss the following five statements: 1) spiritual care requires a clear and inclusive definition of spirituality; 2) empirical evidence for spiritual care interventions should be improved; 3) understanding patients' experiences of contingency is paramount to deliver effective spiritual care; 4) attention to spiritual needs of patients is a task for every health care practitioner; 5) courses on spirituality and spiritual care should be mandatory in the medical curriculum. Current problems might be overcome by speaking each other's language, which is crucial in interdisciplinary research and in good interdisciplinary collaboration.

Relating to the Experience of Contingency in Patients With Advanced Cancer: An Interview Study in U.S. Patients.

Context: Being diagnosed with incurable cancer can be a life-changing experience, evoking different spiritual questions and needs. Confronting a serious life-threatening event occurs not only often unexpected but also can disrupt a person's self-image and ideals of their personhood. This confrontation makes it difficult for people to integrate it into their personal life story-otherwise referred to as an experience of contingency.

Narrative meaning making and integration: Toward a better understanding of the way falling ill influences quality of life.

Falling seriously ill is often experienced as a life event that causes conflict with people's personal goals and expectations in life and evokes existential questions. This article presents a new humanities approach to the way people make meaning of such events and how this influences their quality of life. Incorporating theories on contingency, narrative identity, and quality of life, we developed a theoretical model entailing the concepts life event, worldview, ultimate life goals, experience of contingency, narrative meaning making, narrative integration, and quality of life.

Modes of relating to contingency: An exploration of experiences in advanced cancer patients.

Objective: Throughout their lives, people are confronted with unexpected life events, which can be difficult to incorporate into their life narratives. Such a confrontation can result in an experience of contingency. Different ways of relating to contingency have been described by Wuchterl: denying, acknowledging, and "encounter with the Other.

The effect of spiritual interventions addressing existential themes using a narrative approach on quality of life of cancer patients: a systematic review and meta-analysis.

Objective: The aim of this study was to examine the effect of spiritual interventions on quality of life of cancer patients.

Methods: We conducted our search on June 6, 2014 in Medline, PsycINFO, Embase, and PubMed. All clinical trials were included that compared standard care with a spiritual intervention that addressed existential themes using a narrative approach.