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Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor emeritus George Agich, Bowling Green State University, US
- Second opponent: Associate Professor Kristian Jansen, UiB - University of Bergen, Norway
- Third member and chair of the evaluation committee: Professor Ragnhild Hellesø, University of Oslo
Chair of the Defence
Professor Anne Marit Mengshoel, University of Oslo
Principal Supervisor
Professor emerita, Reidun Førde, University of Oslo
Summary
This thesis contributes to the discussion about how to enhance patient autonomy in the case of advanced cancer posing an existential threat to all aspects of being.
The aim was to explore 1) what existential concerns patients with advanced cancer disclose during routine hospital visits and how they communicate such concerns, 2) how physicians respond to patients’ existential concerns, and 3) how next-of-kin accompanying the patient contribute to the information exchange.
We employed a qualitative research design, studying video-recorded routine outpatient hospital visits involving patients with advanced cancer, using analytic principles from “microanalysis of clinical interaction”.
Most patients disclosed existential concerns during the consultation. However, existential concerns were hesitant, subtle, and indirect, typically hidden in biomedical terms. The physicians habitually responded to these concerns by keeping the agenda around biomedical aspects, resulting in that the existential issues remained unaddressed. In most consultations, the patient was accompanied by a next-of-kin, whom the physicians mostly related to as a “supporter on the sidelines” rather than addressing the couple as a team. When claiming the floor, next-of-kin contributed to securing information that would otherwise have been missing. Next-of-kin provided personal and contextual information that can help the physician when aiming to tailor information and care to the individual patient.
The thesis points to a potential existential neglect in the physician and in the medical culture. It argues that a narrow focus on patient choice and decision-making may be inadequate, as it does not consider that persons are vulnerable, dependent, and relational. Insights from this thesis can inform the discussion about how physicians can play a role in attending to existential concerns and restoring autonomy in collaboration with the patient, next-of-kin, and the interdisciplinary team.
Additional information
Contact the research support staff.