Resilience and Coherence in Palliative Medicine

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The objective of this project (TP 6) is an analysis of the concept of resilience and the comparison with other much used concepts in the field of palliative medicine such as sense of coherence, dignity-centered therapy, biography work, quality of life, meaning in life or mindfulness.The analysis will use three stages. In the first stage a systematic literature research in medical and social data bases such as Pubmed, Embase, Psychinfo and Google Scholar will identify available literature on interventions (dignity-centered therapy, logotherapy, biography, mindfulness stress reduction) and concepts (resilience, sense of coherence, meaning in life), if related to the medical care of severely ill or dying patients. Evaluation will be performed as an analysis of discourse in the literature. This will be supplemented with expert interviews. Relevant stakeholders in hospice and palliaive care will be interviewed in six focus groups with at least five participants. International experts will be interviewed via telephone or skype. Another six focus groups will be held with staff members of palliative care services, providing the perspective of daily routine practice. In the second stage of the project interviews with palliative care patients and their caregivers will be used to validate the hypotheses that have been developed in the first stage. Narrative semistructured interviews will be performed with 30 patients and 30 caregivers in different palliative care settings. In the third phase the hypotheses will be used for the construction of a grounded theory on the relationship and correlations between the concepts and interventions under investigation. The hypotheses and the grounded theory are the results of the project (TP 6). In addition, a matrix with the mutual influences of the evaluated interventions, concepts and values will be described. This contributes to the systematic development of the potential for medical and spiritual assessment instruments. However, as a specific perspective of this project it will also discuss critically the bounderies of assessment, and which aspects of resilience may not be accessible to assessment instruments, no matter how optimal they are constructed. The project thus also contributes to the third objective of the research group by expanding and correcting the discussion on resilience with potential unmeasurable elements.