Focusing on nostalgia can improve quality of life of people facing death

Disease and treatment 21. apr 2021 2 min Clinical Nurse Specialist Malene Missel Written by Josefine Topsøe

Confronting the prospects of shortened life expectancy usually accompanies incurable cancer. This can be a prominent risk factor for developing existential anxiety and depressive disorders. Researchers emphasize that nursing care can support a soothing feeling of nostalgia in this situation, thereby creating better quality of life of people facing death.

Suddenly developing incurable cancer may break people’s sense of continuity and may shatter their lifelong assumptions about the meaning and value of life. Based on stories from 18 people who received palliative care for incurable oesophageal cancer, researchers mapped how nostalgia can promote soothing feelings that make it easier for these people to inhabit the borderline between past, present and future.

“We consider existential anxiety as a symptom and therefore a call to action. Patients say that getting other people to listen to what has been important in their lives, to their humanity and to what has been important to them creates a nostalgic dimension. This contributes to re-establishing their connection to the past and they thereby regain a feeling of being home in their own body,” explains main author Malene Missel, Clinical Nurse Specialist, The Heart Centre, Rigshospitalet, Copenhagen.

The limiting nature of human existence

Existential anxiety is a prerequisite for being human and resides in all of us. However, for people with an incurable disease, these existential concerns are amplified as they directly confront the underlying condition of human existence, since they are acutely aware that they will die from the disease. The researchers tried to obtain insight into how these people experience existential anxiety by encouraging them to talk about their lives with an incurable disease.

“Having to live with your disease and with the anxiety about your situation, your overall perspective is influenced by the feeling that you view the world through this lens of anxiety, which can create the sense of being-in-the-world in an unhomelike way, “ says Malene Missel.

Nostalgia for coping with existential anxiety

The study describes how the feeling of being home could be re-established among these people through supportive conversations about important aspects of their life story, incorporating a nostalgic dimension. Since existential anxiety is an underlying condition of human existence, the purpose of nostalgia is not to directly eliminate this existential anxiety but rather that these people can learn to live alongside anxiety.

“One response to coping with anxiety might be nostalgia, which aims to restore familiarity and continuity by seizing the world through an already formed lens instead of through a lens of anxiety,” explains Malene Missel.

Care with an existential focus

The patients in the study all received palliative care focusing on alleviating symptoms, since treatment could not improve their underlying disease. Palliative care covers relieving physical pain and discomfort but also focuses on the existential and mental dimensions of the disease. Malene Missel explains how healthcare systems often primarily focus on relieving physical symptoms and treating side-effects, whereas these findings elucidate how care should be based more on patients’ actual situation. The researchers therefore recommend that healthcare professionals, as part of palliative care, encourage an everyday dialogue with patients about who they are and who they have been.

“The task in general palliative care is to create a framework that provides optimal conditions for a life toward death that is shaped by the mood of homelikeness by focusing on nostalgia,“ concludes Malene Missel.

Understanding existential anxiety and the soothing nature of nostalgia in life with incurable esophageal cancer – a phenomenological hermeneutical investigation of patient narratives” has been published in Cancer Nursing. In 2017, the Novo Nordisk Foundation awarded a grant to co-author Heidi Bergenholtz for the project The Difficult, but Necessary, Conversation at the End of Life – a Research Study of End-of-life Conversations in an Acute Hospital.

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