Between fate and fault: a qualitative study on the presence, absence and ambivalence of guilt in subjective theories of illness among patients with advanced cancer in palliative care.

OBJECTIVE

Patients' personal beliefs about illness shape how they experience the disease. This study explores how individuals with a terminal cancer diagnosis understand the nature and causes of their illness and whether their explanations include feelings of guilt or personal responsibility.

METHODS

This study employs a qualitative methodology. It comprises 23 semi-structured interviews with patients living with cancer admitted to the palliative care unit of a tertiary hospital in Austria. The interviews were recorded digitally and transcribed verbatim. The data were analyzed using thematic analysis and MAXQDA 2022 software.

RESULTS

Three main themes could be identified within the interviews: Patients shared their (1) understanding of the disease and its origin and their (2) self-evaluation in the context of guilt-being non-guilty or guilty or avoiding judgment when applying the possible causes to their individual situation. Finally, the interviews showed the participant's (3) agency and adaptation in response to causal attributions.

CONCLUSION

Some patients with advanced cancer at the end-of-life experience guilt and blame themselves. In palliative care settings, understanding beliefs on illness causation is essential for meaningful clinician-patient communication. Additionally, more emphasis needs to be placed on providing patients with information on the origins of oncological diseases early in the disease trajectory. Addressing patients' subjective theories of illness sensitively and being aware of them will enable clinicians to improve end-of-life care by adopting patient-centered strategies of care.