title: Living in the presence of death: an integrative literature review of relatives' important existential concerns when caring for a severely ill family member.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Mid Sweden University, Department of Health Sciences, Östersund, Sweden.
authors.forename: Christina
authors.initials: C
authors.lastname: Melin-Johansson
authors.forename: Ingela
authors.initials: I
authors.lastname: Henoch
authors.forename: Susann
authors.initials: S
authors.lastname: Strang
authors.forename: Maria
authors.initials: M
authors.lastname: Browall