Patients experience major changes in life and significant others struggle with caregiving during the course of incurable cancer: a systematic review and meta-synthesis

Aim: The aim of this review was to explore experiences of patients and significant others concerning  existential, psychosocial and organisational transitions during the course of incurable cancer. Methods: The search was based on 5 databases (PubMed, CINAHL, Scopus, PsycInfo and Embase) and 50 studies were finally included and critically appraised. The review was inspired by the methods of Joanna Briggs Institute, Kvale and Brinkmann and illustrated with effect size, inspired by Sandelowski and Barroso. Results: Based on experiences from 496 patients and 320 significant others, 3 main themes with  3 subthemes each were identified and, from these, a meta-synthesis was developed. Patients experience major changes in life and significant others struggle with caregiving during the course of incurable cancer. Main themes: 1. Patients living with incurable cancer experience major changes in life; 2. Patients’ experiences of both living and dying; 3. Significant others living and loosing. Relating findings to the theory of Irvin D. Yalom revealed that patients and significant others experience transitioning into living most of life in an ontological mode of existence. Conclusion: This review underlines the complexity within planning individualised palliative care and contributes with evidence-based knowledge relevant to healthcare professionals in palliative cancer care.