Relational experiences and meaning-making with significant others in patients with hematopoietic malignancies at end of life: A phenomenological study.

PURPOSE: Patients with hematopoietic malignancies face uncertain disease trajectories and meaning-making through relationships at end of life (EOL), but this remains underexplored. This study aimed to describe how patients (N = 18) with recurrent or refractory hematopoietic malignancies experience living with significant others at EOL and to elucidate the essential structures of these relational experiences.

METHODS: Semi-structured interviews were conducted with 18 patients (aged 40-79 years) with recurrent or refractory hematopoietic malignancies between April and September 2017. Data were analyzed using Giorgi's descriptive phenomenological method. Ethical approval was obtained from Chiba University.

RESULTS: Eight themes emerged, revealing that relationships formed the foundation of patients' identity and meaningful living. These themes encompassed recognizing life as sustained through others' generosity, finding emotional grounding in relationships, striving to remain contributive, recognizing mortality through relational responses, reciprocating kindness, preserving authenticity, balancing closeness and distance, and relying on healthcare professionals as partners. The themes were organized into a relational model comprising four concentric contexts (Self, Family and Fundamental Bonds, Active Reciprocal Relationships, and Mortality and Meaning-Making Context) and two dialectical dimensions (Sustained by Others ↔ Being Oneself; Receiving ↔ Contributing).

CONCLUSION: Patients actively construct meaning through relationships across multiple contexts while navigating dialectical tensions between dependence and selfhood. This relational model may guide nurses in assessing relational needs and supporting meaningful living at EOL. Limitations include the single-site design in Japan and the cross-sectional nature of data collection.