Supporting the Integration of the Existential Dimension Into Clinical Practice

BACKGROUND: The existential dimension is a key aspect of palliative care but is often insufficiently integrated in clinical practice. We developed a structured meaning-making conversation for patients living long-term with incurable cancer led by a spiritual counsellor to support patients' meaning-making process. To support the integration of the existential dimension, a synopsis of patient's sources of meaning and existential needs was shared afterwards with the referring health care provider (HCP) via the electronic health record. AIMS: This study explored HCPs' experiences with this meaning-making synopsis and its impact on patient care. The findings will inform further refinement of the intervention to enhance perceived benefits. METHODS: Semi-structured interviews were conducted with HCPs who referred patients for a meaning-making conversation. A reflexive thematic analysis was performed. RESULTS: The following themes were constructed from the interviews with HCPs (n = 10): providing potentially useful existential information to HCPs, supporting personalised, value-based care through the synopsis and barriers and facilitators for using the synopsis. HCPs appreciated the synopsis for its insight into patients' sources of meaning and existential needs, for its ability to initiate conversations about meaning and its potential impact on discussing treatment options. For half of them, it helped deliver more personalised care. For some it provided reassurance that the treatment aligned with patients' wishes. The most frequently mentioned barriers to starting a conversation about meaning were lack of contact due to disrupted continuity of care and limited time. CONCLUSIONS: HCPs appreciated the meaning-making synopsis and recognised the (potential) impact on enhancing personalised care. The synopsis can assist HCPs in integrating the existential dimension into clinical care.