Empirical Phenomenological Inquiry: Guidance in Choosing Between Different Methodologies.

Empirical phenomenological inquiry and analyses are of high relevance and applicability for nursing and health care. Phenomenology has clear roots in philosophy, which needs to be brought into an empirical phenomenological inquiry. However, all study of phenomena and experience does not qualify as phenomenological inquiry. The aim of this article is to provide guidance for how to relate different empirical phenomenological methodologies that are in play in the broader field of healthcare research, and thus support healthcare researchers in navigating between these methodologies. For pedagogical purposes, we present commonalities and differences as related to descriptive and interpretive phenomenological inquiries throughout the research process. The merits and criticisms of empirical phenomenological inquiry are commented on.

Person-centred conversations in nursing and health: A theoretical analysis based on perspectives on communication.

In this paper we use the concept of the person to examine person-centred dialogue and show how person-centred dialogue is different from and significantly more than transfer of information, which is the dominant notion in health care. A further motivation for the study is that although person-centredness as an idea has a strong heritage in nursing and the broader healthcare discourse, person-centred conversation is usually discussed as a distinct and unitary approach to communication, primarily related to the philosophy of dialogue-the philosophy of Martin Buber. In this paper we start with the concept of person to critically reflect on theoretical perspectives on communication to understand person-centred conversations in the context of nursing and health. We position the concept of the person through the use of Paul Ricoeur's philosophy and follow by distinguishing four theoretical perspectives on communication before reflecting on the relevance of each of these for person-centred communication. These perspectives are: a linear view of communication as transfer of information, communication as a relation in the sense of philosophy of dialogue, practice-based communication on constructionist grounds, and communication as a practice to create social community. In relation to the concept of the person, we do not find transfer of information relevant as a theoretical underpinning for person-centred conversations. From the other three perspectives that are relevant we distinguish five types of person-centred conversations pertinent to nursing and health: problem identifying conversations, instructive conversations, guiding and supportive conversations, caring and existential conversations, and therapeutic conversations. Through this analysis it is argued that person-centred communication and conversations are substantially different to transfer of information. We also discuss the significance of communication adjusted to specific situations, including emphasis on how we speak in relation to the aim or topic of a conversation.

Preparedness for colorectal cancer surgery and recovery through a person-centred information and communication intervention - A quasi-experimental longitudinal design.

To meet patients' information and communication needs over time in order to improve their recovery is particularly challenging for patients undergoing cancer surgery. The aim of the study was to evaluate whether an intervention with a person-centred approach to information and communication for patients diagnosed with colorectal cancer undergoing surgery can improve the patients' preparedness for surgery, discharge and recovery during six months following diagnosis and initial treatment. The intervention components involving a novel written interactive patient education material and person-centred communication was based on critical analysis of conventional information and communication for these patients. During 2014-2016, 488 consecutive patients undergoing elective surgery for colorectal cancer were enrolled in a quasi-experimental longitudinal study. In three hospitals, first a conventional care group (n = 250) was recruited, then the intervention was introduced, and finally the intervention group was recruited (n = 238). Patients' trajectories of preparedness for surgery and recovery (Preparedness for Colorectal Cancer Surgery Questionnaire-PCSQ) health related quality of life (EORTC QLQ-C30) and distress (NCCS Distress Thermometer) were evaluated based on self-reported data at five time points, from pre-surgery to 6 months. Length of hospital stay and patients' behavior in seeking health care pre- and post-surgery were extracted from patient records. Longitudinal structural equation models were used to test the hypothesized effects over time. Statistically significant positive effects were detected for two of the four PCSQ domains (patients searching for and making use of information, and making sense of the recovery) and for the role functioning domain of the EORTC QLQ-C30. Patients in the intervention group were also more likely to contact their assigned cancer "contact nurse" (a.k.a. nurse navigator) instead of contacting a nurse on duty at the ward or visiting the emergency department. In conclusion, the overall hypothesis was not confirmed. Further research is recommended on written and oral support tools to facilitate person-centred communication.

Exploration of dynamics in a complex person-centred intervention process based on health professionals' perspectives.

BACKGROUND: The assessment and evaluation of practical and sustainable development of health care has become a major focus of investigation in health services research. A key challenge for researchers as well as decision-makers in health care is to understand mechanisms influencing how complex interventions work and become embedded in practice, which is significant for both evaluation and later implementation. In this study, we explored nurses' and surgeons' perspectives on performing and participating in a complex multi-centre person-centred intervention process that aimed to support patients diagnosed with colorectal cancer to feel prepared for surgery, discharge and recovery. METHOD: Data consisted of retrospective interviews with 20 professionals after the intervention, supplemented with prospective conversational data and field notes from workshops and follow-up meetings (n = 51). The data were analysed to construct patterns in line with interpretive description. RESULTS: Although the participants highly valued components of the intervention, the results reveal influencing mechanisms underlying the functioning of the intervention, including multiple objectives, unclear mandates and competing professional logics. The results also reveal variations in processing the intervention focused on differences in using and talking about intervention components. CONCLUSIONS: The study indicates there are significant areas of ambiguity in understanding how theory-based complex clinical interventions work and in how interventions are socially constructed and co-created by professionals' experiences, assumptions about own professional practice, contextual conditions and the researchers' intentions. This process evaluation reveals insights into reasons for success or failure and contextual aspects associated with variations in outcomes. Thus, there is a need for further interpretive inquiry, and not only descriptive studies, of the multifaceted characters of complex clinical interventions and how the intervention components are actually shaped in constantly shifting contexts.

Prepared for surgery - Communication in nurses' preoperative consultations with patients undergoing surgery for colorectal cancer after a person-centred intervention.

AIMS AND OBJECTIVES: To describe preoperative communication after a person-centred intervention in nurses' consultations with patients undergoing surgery for colorectal cancer. BACKGROUND: Patients all over the world scheduled for surgery are referred to preoperative consultations with healthcare professionals. The goal is to assess the risk of perioperative complications, improving quality of care and enabling patients to be prepared for surgery and recovery. A person-centred intervention was developed, which consisted of an interactive written patient education material and person-centred communication. DESIGN: An explorative quantitative and qualitative study based on 18 audio-taped transcriptions. METHODS: Eighteen patients preoperative nursing consultations at three Swedish hospitals were analysed quantitatively regarding structure: words, time, phases, questions, discursive space, and qualitatively: topics and how the person-centred communication appeared in the consultations. RESULTS: The median time for consultations was 27 min (range 13-64 min). The nurses used two-thirds of the discursive space in the consultations with the patients. The patient education material was used as a support to structure the consultation and discuss sensitive and difficult issues. Seven topics were discussed during the consultation. Two different approaches to communication were identified: Talking with the patient versus Talking to the patient. Talking with the patient (seen as person-centred communication) was defined as: listening to the narrative and confirming each other, raising difficult topics, seeing each other as persons, building on strengths and resources, preparing for surgery and asking open questions. CONCLUSION: Ways of communicating influence how the preoperative consultation develops. Talking with the patient could be seen as person-centred communication in the preoperative care, and when using this approach, the intervention purpose of person-centred communication was met. RELEVANCE TO CLINICAL PRACTICE: Education in person-centred communication is important for nurses to improve their skills in performing preoperative consultations.

Remaining in the nursing profession: The relevance of strong evaluations.

BACKGROUND:: Why nurses remain in the profession is a complex question. However, strong values can be grounds for their remaining, meaning nurses evaluate the qualitative worth of different desires and distinguish between senses of what is a good life. RESEARCH QUESTION:: The overall aim is to explore and argue the relevance of strong evaluations for remaining in the nursing profession. RESEARCH DESIGN:: This theoretical article based on a hermeneutical approach introduces the concept strong evaluations as described by the Canadian philosopher Charles Taylor and provides examples of nurses' experiences in everyday nursing care drawn from a Norwegian empirical study. PARTICIPANTS AND RESEARCH CONTEXT:: Data collected in the original study consisted of qualitative interviews and qualitative follow-up interviews with 13 nurses. The research context was the primary and secondary somatic and psychiatric health service, inside as well as outside institutions. ETHICAL CONSIDERATION:: The article uses data from an original empirical study approved by the Norwegian Social Science Data Services. Information was given and consent obtained from the participants. FINDINGS:: Remaining in the nursing profession can be understood as revolving around being a strong evaluator. This has been concretized in issues of being aware of different incidents in life and having capacities as a nurse. DISCUSSION:: Why nurses remain is discussed in relation to how nurses have shaped themselves by reflecting on what is of significance in their life. However, being a strong evaluator cannot be seen as the casual condition for remaining. CONCLUSION:: Remaining in the nursing profession is obviously not a contingent matter, rather it is a matter concerned with the qualitative worth of different desires and values. Nurses' awareness of a life choice impacts on whether they remain or not. Consequently, nurses may need to articulate and reflect on their priorities for remaining.

Confronting one's vulnerability - patients with chest pain participating in a high-intensity exercise programme.

AIMS AND OBJECTIVES: To explain the transitional process that individuals with unexplained chest pain undergo while participating in an exercise training programme over time. BACKGROUND: Angina-like chest pain in patients with no obstructive coronary artery disease is a growing problem. Functional limitations, restricted daily activities and reduced quality of life are reported. In addition, physical activity is avoided in this population. DESIGN: The study follows a qualitative classic grounded theory (Glaser ). METHODS: Three times a week for 12 weeks, twelve patients with no obstructive coronary artery disease participated in a high-intensity aerobic exercise training programme supervised by physiotherapists and nurses. The data collection was based on diaries and interviews about the experience and analysed according to the principles of classic grounded theory. RESULTS: The core category was identified as 'confronting one's vulnerability' and included three subcategories: 'balancing existential uncertainty', 'transforming bodily perceptions' and 'becoming a more capable person'. CONCLUSION: The transition was described as a process of becoming more capable. Health professionals should be aware of the significance of high-intensity exercise training for people with unexplained chest pain and of the underlying dimension of vulnerability. RELEVANCE TO CLINICAL PRACTICE: Understanding the transition process that people with unexplained chest pain undergo while participating in a high-intensity exercise training programme promotes a person-centred approach. Taking this substantive theory into consideration will improve the prerequisites for establishing person-centred care.

Topics and structure in preoperative nursing consultations with patients undergoing colorectal cancer surgery.

BACKGROUND: The preoperative education, which occurs in preoperative patient consultations, is an important part of the surgical nurse's profession. These consultations may be the building blocks of a partnership that facilitates communication between patient and nurse. AIM: The aim of the study was to describe topics and structure and documentation in preoperative nursing consultations with patients undergoing surgery for colorectal cancer. METHOD: The study was based on analysis of consultations between seven patients and nurses at a Swedish university hospital. The preplanned preoperative consultations were audio-recorded and transcribed verbatim. The structure of the consultations was described in terms of phases and the text was analysed according to a manifest content analysis RESULTS: The consultations were structured on an agenda that was used variously and communicating different topics in an equally varied manner. Seven main topics were found: Health status, Preparation before surgery, Discovery, Tumour, Operation, Symptoms and Recovery after surgery. The topic structure disclosed a high number of subtopics. The main topics 'Discovery', 'Tumour' and 'Symptoms' were only raised by patients and occupied only 11% of the discursive space. Documentation was sparse and included mainly task-oriented procedures rather than patients' worries and concerns. CONCLUSION: There was no clear structure regarding preoperative consultation purpose and content. Using closed questions instead of open is a hindrance of developing a dialogue and thus patient participation. Preoperative consultation practice needs to be strengthened to include explicit communication of the consultations' purpose and agenda, with nurses actively discussing and responding to patients' concerns and sensitive issues. The results of the study facilitate the development of methods and structure to support person-centred communication where the patient is given space to get help with the difficult issues he/she may have when undergoing surgery.

Relationship-based nursing care and destructive demands.

BACKGROUND: The relationship between the nurse and the patient is understood as fundamental in nursing care. However, numerous challenges can be related to the provision of relationship-based nursing care. Challenges exist when nurses do not respond adequately to the patient's appeal for help. Moreover, challenges arising in the nurse-patient relationship can be understood as more destructive demands from the patient to the nurse, thus begging inquiry into such a relationship. RESEARCH QUESTION: The overall aim is to explore and argue the relevance of problematizing destructive demands evident within relationship-based nursing care. RESEARCH DESIGN: This theoretical article explores destructive demands based on the phenomenological philosophy of the Danish theologian and philosopher Knud E. Løgstrup and provides examples of nurses' experiences in everyday nursing care. The examples are drawn from a Norwegian empirical study based on a hermeneutical research design. Participants and research context: Data consisted of qualitative interviews and qualitative follow-up interviews with 13 nurses with varying work experience within the primary and secondary somatic and psychiatric health service, from inside as well as outside institutions. Ethical consideration: The original empirical study was approved by the Norwegian Social Science Data Services. Information was given and consent was obtained from the participants. FINDINGS: Two themes are described: strong impressions formed in meetings with patients and persistent concern over the burden of work and ability to endure. DISCUSSION: Destructive demands related to relationship-based nursing care are discussed along two lines, first, by further elucidating nurses' everyday experiences connected to destructive demands and, second, by highlighting the significance of including destructive demands within the relationship-based nursing care. CONCLUSION: Including destructive demands related to relationship-based nursing care is of particular significance in enabling the proposition that radical, one-sided demands are based on relationality, reciprocity and thereby expectations of life. In short, both the nurse and the patient are human beings in need of love and goodness.

Longitudinal person-centered measurement: A psychometric evaluation of the Preparedness for Colorectal Cancer Surgery Questionnaire (PCSQ).

OBJECTIVE: The Preparedness for Colorectal Cancer Surgery Questionnaire (PCSQ) was previously developed in Swedish to assess patients' knowledge seeking and sense making capabilities. Aiming to measure preparedness at different phases during the pre-surgery and recovery period, the objectives were to (a) evaluate psychometric properties of the longitudinal PCSQ, (b) establish measurement invariance over time, and (c) describe change in preparedness. METHODS: Elective colorectal cancer surgery patients completed a questionnaire at five time points from pre-surgery until 6 months post-surgery (n=250). The longitudinal PCSQ consists of 23 items measuring four domains: Searching for and making use of information, Understanding and involvement in care, Making sense of recovery, Support and access to care. Psychometric analyses, including confirmatory factor analysis, were applied to evaluate internal consistency reliability and ascertain invariance over time of the measurement structure and parameters. RESULTS: The psychometric analyses revealed good fit of the measurement models, high internal consistency reliability (≥.94), and support for configural, metric and scalar measurement invariance of the four PCSQ domains. Patients reported lower levels of preparedness after surgery than pre-surgery. CONCLUSION: The adapted version of the PCSQ can be used for longitudinal analyses. PRACTICE IMPLICATIONS: The measurement of preparedness is important for evaluating person-centred outcomes before and during recovery from colorectal cancer surgery.

How can students contribute? A qualitative study of active student involvement in development of technological learning material for clinical skills training.

BACKGROUND: Policy initiatives and an increasing amount of the literature within higher education both call for students to become more involved in creating their own learning. However, there is a lack of studies in undergraduate nursing education that actively involve students in developing such learning material with descriptions of the students' roles in these interactive processes. METHOD: Explorative qualitative study, using data from focus group interviews, field notes and student notes. The data has been subjected to qualitative content analysis. RESULTS: Active student involvement through an iterative process identified five different learning needs that are especially important to the students: clarification of learning expectations, help to recognize the bigger picture, stimulation of interaction, creation of structure, and receiving context- specific content. CONCLUSION: The iterative process involvement of students during the development of new technological learning material will enhance the identification of important learning needs for students. The use of student and teacher knowledge through an adapted co-design process is the most optimal level of that involvement.

Unexplained Chest Pain and Physical Activity: Balancing Between Existential Uncertainty and Certainty.

Chest pain is one of the most common complaints in medical settings, but the majority of cases have no detectable cause. Physical activity is recommended, but is one of the major avoidance behaviors in patients with coronary heart disease. The article aims at achieving an understanding of the meaning of physical activity for people with unexplained chest pain. Fifteen people were interviewed using a phenomenological hermeneutic approach, with the results revealing four themes: "awareness of the influence of previous life experiences on the decision to be physically active," "unanswered questions related to physical activity and unexplained chest pain," "intertwinement of body and mind," and "physical activity as a source of personal growth." Comprehensive understanding was formulated as "Being physically active while living with unexplained chest pain means balancing between existential uncertainty and certainty." The results are discussed in relation to capability. It is suggested that health professionals adopt a person-centered approach.

Nursing students' perceptions of factors influencing their learning environment in a clinical skills laboratory: A qualitative study.

BACKGROUND: The mastery of clinical skills learning is required to become a trained nurse. Due to limited opportunities for clinical skills training in clinical practice, undergraduate training at clinical skills laboratories (CSLs) is an essential part of nursing education. In a sociocultural learning perspective learning is situated in an environment. Growing student cohorts, rapid introduction of technology-based teaching methods and a shift from a teaching- to a learning-centered education all influence the environment of the students. These changes also affect CSLs and therefore compel nursing faculties to adapt to the changing learning environment. OBJECTIVES: This study aimed to explore students' perceptions of their learning environment in a clinical skills laboratory, and to increase the knowledge base for improving CSL learning conditions identifying the most important environmental factors according to the students. DESIGN: An exploratory qualitative methodology was used. PARTICIPANTS: Nineteen second-year students enrolled in an undergraduate nursing program in Norway participated in the study. They took the same clinical skills course. Eight were part-time students (group A) and 11 were full-time students (group B). METHODS: Focus group interviews and content analysis were conducted to capture the students' perception of the CSL learning environment. RESULTS: The study documents students' experience of the physical (facilities, material equipment, learning tools, standard procedures), psychosocial (expectations, feedback, relations) and organizational (faculty resources, course structure) factors that affect the CSL learning environment. CONCLUSION: Creating an authentic environment, facilitating motivation, and providing resources for multiple methods and repetitions within clinical skills training are all important for improving CSL learning environments from the student perspective.

Disclosing discourses: biomedical and hospitality discourses in patient education materials.

Patient education materials have the potential to strengthen the health literacy of patients. Previous studies indicate that readability and suitability may be improved. The aim of this study was to explore and analyze discourses inherent in patient education materials since analysis of discourses could illuminate values and norms inherent in them. Clinics in Sweden that provided colorectal cancer surgery allowed access to written information and 'welcome letters' sent to patients. The material was analysed by means of discourse analysis, embedded in Derrida's approach of deconstruction. The analysis revealed a biomedical discourse and a hospitality discourse. In the biomedical discourse, the subject position of the personnel was interpreted as the messenger of medical information while that of the patients as the carrier of diagnoses and recipients of biomedical information. In the hospitality discourse, the subject position of the personnel was interpreted as hosts who invite and welcome the patients as guests. The study highlights the need to eliminate paternalism and fosters a critical reflective stance among professionals regarding power and paternalism inherent in health care communication.

Norwegian nurse-midwives' perspectives on the provision of antenatal diabetes care in an outpatient setting: A qualitative study.

BACKGROUND: There is limited research related to nurse-midwives' accounts of their provision of antenatal diabetes care in hospital outpatient settings. This study explored the perspectives and experiences of eight Norwegian nurse-midwives regarding the provision of the midwifery aspect of an antenatal consultation as part of the diabetes specialist team. METHODS: A qualitative descriptive study was used. Eight nurse-midwives aged between 37 and 58 years, representing four Norwegian hospital outpatient clinics, participated in individual interviews. Transcribed interviews were analysed in accordance with a qualitative thematic analysis. RESULTS: Three main themes were developed: "Approaching the women as persons in order to frame strengths and normalcy", "Managing different tasks judiciously" and "Balancing conflicting values". Some of the barriers were found to be related to the organisation of care, such as short timeframes with a medical focus, which overshadowed or forced the normalcy aspects of childbearing into the background. Managing risk and evidence-based knowledge were demanding tasks to fulfil in a judicious way. Some midwives experienced ambiguity while being forced to prioritise medical factors over woman-focused care while running others' errands, an act of balancing conflicting values. CONCLUSIONS: The contextual conditions related to the organisation present barriers for pregnant women to receive woman-focused care beyond the medical approach. The midwifery contribution in this care setting should be clearly recognised and defined so that women can capitalise on the different professionals and their expert competencies and contributions in this setting.

Registered Nurses' Patient Education in Everyday Primary Care Practice: Managers' Discourses.

Nurses' patient education is important for building patients' knowledge, understanding, and preparedness for self-management. The aim of this study was to explore the conditions for nurses' patient education work by focusing on managers' discourses about patient education provided by nurses. In 2012, data were derived from three focus group interviews with primary care managers. Critical discourse analysis was used to analyze the transcribed interviews. The discursive practice comprised a discourse order of economic, medical, organizational, and didactic discourses. The economic discourse was the predominant one to which the organization had to adjust. The medical discourse was self-evident and unquestioned. Managers reorganized patient education routines and structures, generally due to economic constraints. Nurses' pedagogical competence development was unclear, and practice-based experiences of patient education were considered very important, whereas theoretical pedagogical knowledge was considered less important. Managers' support for nurses' practical- and theoretical-based pedagogical competence development needs to be strengthened.

Perpetuating 'New Public Management' at the expense of nurses' patient education: a discourse analysis.

This study aimed to explore the conditions for nurses' daily patient education work by focusing on managers' way of speaking about the patient education provided by nurses in hospital care. An explorative, qualitative design with a social constructionist perspective was used. Data were collected from three focus group interviews and analysed by means of critical discourse analysis. Discursive practice can be explained by the ideology of hegemony. Due to a heavy workload and lack of time, managers could 'see' neither their role as a supporter of the patient education provided by nurses, nor their role in the development of nurses' pedagogical competence. They used organisational, financial, medical and legal reasons for explaining their failure to support nurses' provision of patient education. The organisational discourse was an umbrella term for 'things' such as cost-effectiveness, which were prioritised over patient education. There is a need to remove managerial barriers to the professional development of nurses' patient education. Managers should be responsible for ensuring and overseeing that nurses have the prerequisites necessary for providing patient education as well as for enabling continuous reflective dialogue and opportunities for learning in practice.

The nursing discipline and self-realization.

BACKGROUND: It is obvious from literature within the nursing discipline that nursing is related to moral or moral-philosophical related ideas which are other-oriented. The socio-cultural process of change in modern society implies that more self-oriented ideas have been found to be significant. AIM: The overall aim of this article is to highlight self-oriented moral or moral-philosophical related ideas as an important part of the nursing discipline. This is achieved by (a) exploring self-realization as a significant self-oriented moral or moral-philosophical related idea based on a philosophical anthropological perspective, (b) demonstrating how moral or moral-philosophical related ideas are expressed by nurses, (c) discussing the relevance of self-realization for the nursing discipline, and (d) pointing out possible consequences for the future development of the discipline of nursing. RESEARCH DESIGN: This theoretical study draws empirical examples from interviews. PARTICIPANTS AND RESEARCH CONTEXT: Data consisted of interviews with 13 nurses with varying work experience within the primary and secondary somatic and psychiatric health service, from inside as well as outside institutions. ETHICAL CONSIDERATIONS: The empirical study was approved by the Norwegian Social Science Data Services. Information was given and consent was obtained from the study participants. FINDINGS: Findings are presented in two themes: (a) other-oriented ideas and (b) self-oriented ideas. More concretely, the findings show that nurses hope to make life as good as possible for the patient and they have a wish to improve themselves as human beings, to become better persons. DISCUSSION: The relevance of self-realization for the nursing discipline is discussed along two lines, first, by connecting nurses' self-understanding to a horizon of identity and second, by considering what self-realization could offer. CONCLUSION: It is of ultimate concern for the nursing discipline to highlight self-realization connected to the positive view of freedom understood as an exercise-concept. Further identifying and articulating the contribution of self-realization to nurses and nursing practice is of particular importance.

Communicating bodily changes: physicians' ways of enabling patient understanding in gastrointestinal cancer consultations.

OBJECTIVE: To explore how physicians communicatively enable patients' understanding of bodily changes in gastrointestinal cancer care consultations. METHOD: Two datasets were used. The first consisted of transcribed video-recorded palliative care consultations with three oncologists and six patients diagnosed with advanced gastrointestinal cancer, in the context of outpatient palliative care. The second dataset was audio-recorded transcriptions from diagnostic consultations with six surgeons and seven patients diagnosed with colorectal cancer, in the context of cancer surgery. An inductively driven and iterative analysis of interaction was performed, guided by Wetherell et al. (2001). RESULTS: Two overarching communicative strategies were identified: (1) "visualizing strategies," with the dimensions: visible strategies (visualizing with what you actually or potentially can see), sensory strategies (visualizing with what is possible to feel), and imaginative strategies; and (2) "contrasting strategies," with the dimensions: contrasting subjective experiences and contrasting between the patient and other people. SIGNIFICANCE OF RESULTS: The visualizing and contrasting communicative strategies form parts of physicians' tacit and experience-based knowledge. The strategies employed by physicians reveal clear potentials to enable patients' understanding and sense making of bodily changes. However, these strategies need to be explicated and problematized as parts of both consultation practice and basic medical education. By means of increased awareness, physicians can more easily identify turning points in patients' levels of understanding, thereby enriching ordinary medical consultations with reflected pedagogical strategies and skills in how to dialogue in a person-centered manner.

Meanings of existential uncertainty and certainty for people diagnosed with cancer and receiving palliative treatment: a life-world phenomenological study.

BACKGROUND: Many people around the world are getting cancer and living longer with the disease. Thanks to improved treatment options in healthcare, patients diagnosed with advanced gastrointestinal cancer can increasingly live for longer. Living with cancer creates existential uncertainty, but what does this situation mean for the individual? The purpose of the study is to interpret meanings of existential uncertainty and certainty for people diagnosed with advanced gastrointestinal cancer and receiving palliative treatment. METHODS: This study is part of a larger project in which 7 men and 7 women aged between 49 and 79 participated in a study of information and communication for people with advanced gastrointestinal cancer. A total of 66 interviews were conducted with participants who were followed up over time. The narrative interviews were transcribed verbatim and the texts were analysed in three steps: naive reading, structural analysis and interpreted whole by utilizing a phenomenological life-world approach. RESULTS: THIS STUDY HAS IDENTIFIED DIFFERENT SPHERES IN WHICH PEOPLE DIAGNOSED WITH ADVANCED GASTROINTESTINAL CANCER VACILLATE BETWEEN EXISTENTIAL UNCERTAINTY AND CERTAINTY: bodily changes, everyday situations, companionship with others, healthcare situations and the natural environment. Existing in the move between existential uncertainty and certainty appears to change people's lives in a decisive manner. The interview transcripts reveal aspects that both create existential certainty and counteract uncertainty. They also reveal that participants appear to start reflecting on how the new and uncertain aspects of their lives will manifest themselves -a new experience that lays the foundation for development of knowledge, personal learning and growth. CONCLUSIONS: People diagnosed with advanced gastrointestinal cancer and receiving palliative care expressed thoughts about personal learning initiated by the struggle of living with an uncertain future despite their efforts to live in the present. Their personal learning was experienced through a changed life for themselves and having to confront their own pending death and develop self-insight regarding finality of life. Healthcare professionals can try to support people receiving palliative treatment for cancer by diversifying avenues for their personal growth, thus helping them manage their existential uncertainty and gravitate towards greater existential certainty.