Existential loneliness and end-of-life care: A systematic review

• Published in: Theoretical medicine and bioethics Vol. 31; no. 2; pp. 141 - 169
• Main Authors: Ettema, Eric J, Derksen, Louise D, van Leeuwen, Evert
• Format: Journal Article
• Language: English
• Published: Dordrecht Dordrecht : Springer Netherlands 01.04.2010; Springer Netherlands; Springer Nature B.V
• Subjects: Adaptation, Psychological; Attitude of Health Personnel; Attitude to Death; Communication; Concept Formation; Education; Emotions; End-of-life care; Ethics; Existential loneliness; General Surgery; History of Medicine; Hospice care; Humans; Loneliness; Palliative Care; Philosophy; Philosophy of Medicine; Quality of Life; Review; Social Isolation; Spirituality; Terminal Care; Theory of Medicine/Bioethics; Thinking; Loneliness; Palliative care; Existential loneliness; End-of-life care; Review
• ISSN: 1386-7415; 1573-1200; 1573-0980
• DOI: 10.1007/s11017-010-9141-1

Patients with a life-threatening illness can be confronted with various types of loneliness, one of which is existential loneliness (EL). Since the experience of EL is extremely disruptive, the issue of EL is relevant for the practice of end-of-life care. Still, the literature on EL has generated little discussion and empirical substantiation and has never been systematically reviewed. In order to systematically review the literature, we (1) identified the existential loneliness literature; (2) established an organising framework for the review; (3) conducted a conceptual analysis of existential loneliness; and (4) discussed its relevance for end-of-life care. We found that the EL concept is profoundly unclear. Distinguishing between three dimensions of EL—as a condition, as an experience, and as a process of inner growth—leads to some conceptual clarification. Analysis of these dimensions on the basis of their respective key notions—everpresent, feeling, defence; death, awareness, difficult communication; and inner growth, giving meaning, authenticity—further clarifies the concept. Although none of the key notions are unambiguous, they may function as a starting point for the development of care strategies on EL at the end of life.