• Renske Kruizinga, Najmeh Jafari, Michael Scherer-Rath, Hans Schilderman, Jennifer Bires, Christina Puchalski, and Hanneke van Laarhoven.
• Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Electronic address: r.kruizinga@amc.uva.nl.
• J Pain Symptom Manage. 2018 Mar 1; 55 (3): 913-921.

ContextBeing diagnosed with incurable cancer can be a life-changing experience, evoking different spiritual questions and needs. Confronting a serious life-threatening event occurs not only often unexpected but also can disrupt a person's self-image and ideals of their personhood. This confrontation makes it difficult for people to integrate it into their personal life story-otherwise referred to as an experience of contingency.ObjectivesDifferent modes of relating to the contingent life event of having cancer have been studied in a Dutch patient population. Here we present an interview study in an U.S. population with advanced cancer patients.MethodsWe included eight American patients with advanced cancer from the George Washington University Cancer Center. All patients were interviewed twice discussing their life events and life goals using a semistructured interview model. All interviews were transcribed and analyzed focusing on how patients described the way they related to the experience of having advanced cancer. The constant comparative method with a directed content analysis approach was used to code the themes in the interviews.ResultsThe analyses show that the four modes of relating to contingency that we found in the Dutch study population can also be found in an American advanced cancer patient population. Differences were found in the extended way American patients described the fourth mode of "receiving."ConclusionThis study ensures a broader and deeper understanding of relating to the experience of contingency in having incurable cancer, which is crucial in developing accurate spiritual care in the palliative phase of patients.Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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