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Open Nurs J. 2012;6:1-12. doi: 10.2174/1874434601206010001. Epub 2012 Feb 10.

Living in the presence of death: an integrative literature review of relatives' important existential concerns when caring for a severely ill family member.

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Mid Sweden University, Department of Health Sciences, Ă–stersund, Sweden.



The aim of this study was to explore relatives' existential concerns when caring for a seriously ill family member as well as to describe interventions that meet these concerns.


In this integrative literature review we assessed and classified 17 papers, 12 qualitative and 5 quantitative. Literature was sought in the databases Cinahl, PubMed, Psykinfo and Web of Science in September 2009 and in March 2010. Search terms used in different combinations were: family, family caregiver, next of kin, relatives, palliative, palliative care, end-of-life care, existential, spirit*. Data were redrawn from the papers results/findings, and synthesized into a new descriptive content.


The results were categorized from 13 papers exploring relatives' important existential concerns and 4 papers describing interventions aimed to support them in the existential area. A majority of the reviewed papers had been written in Sweden and concerned relatives of patients with cancer. One overarching theme, living in the presence of death, and three categories: responses to life close to death; support when death is near; and beyond the presence of death were created.


There is an urgent demand for large-scale studies using accurate methodology, as well as a need to design qualified investigations regarding the effects of various interventions, and to determine which interventions are the most effective in supporting relatives who experience existential distress manifested physically and/or psychologically. There is also a considerable demand for educational interventions among professionals in various healthcare settings to increase their knowledge regarding existential concerns among relatives.


Cancer; end-of-life care; family; incurable illness; nursing; review.

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