title: Existential loneliness and end-of-life care: a systematic review.
abstract: 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.
authors.affiliation: Department of Metamedica, Section Philosophy and Medical Ethics, Vrije Universiteit Medical Centre Amsterdam, Amsterdam, The Netherlands. EJ.Ettema@vumc.nl
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Ettema
authors.forename: Louise D
authors.initials: LD
authors.lastname: Derksen
authors.forename: Evert
authors.initials: E
authors.lastname: van Leeuwen
mesh_terms: D000223:Adaptation, Psychological; D001291:Attitude of Health Personnel; D001293:Attitude to Death; D003142:Communication; D003210:Concept Formation; D004644:Emotions; D006801:Humans; D008132:Loneliness; D010166:Palliative Care; D011788:Quality of Life; D012934:Social Isolation; D029181:Spirituality; D013727:Terminal Care; D013850:Thinking