title: Meanings of being old, living on one's own and suffering from incurable cancer in rural Norway.
abstract: OBJECTIVE
  The aim of this study was to explore and understand the lived experience of older people living alone and suffering from incurable cancer in rural Norway.
  
  
  METHODS
  Narrative interviews were conducted with five older people with incurable cancer (three women and two men, aged 71-79), receiving outpatient and life-prolonging chemotherapy and living alone in their homes in rural areas. A phenomenological hermeneutical approach was used to interpret the meaning of the lived experience.
  
  
  RESULTS
  Four main themes were found: enduring by keeping hope alive, becoming aware that you are on your own, living up to expectations of being a good patient and being at risk of losing one's identity and value. Enduring this situation means struggling with terminal illness and facing death in a brave manner, and replacing former ways of living. The process of providing treatment may threaten dignity and cause additional distress.
  
  
  CONCLUSIONS
  These results show a complex and comprehensive situation where physical symptoms and emotions are interwoven. Further the results describe how the ways of suffering caused by the manner in which care is delivered, suffering related to the cancer disease and existential suffering, may increase each other's impact. The social and rural context calls for special attention as the patients may lack recourses to gain sufficient care. Their comfort depends to a large extent on the health professionals' sensitivity.
authors.affiliation: Centre for Care Research Mid-Norway, Steinkjer, Norway; Department of Health Sciences, Mid-Sweden University, Sundsvall, Sweden. Electronic address: siri.a.devik@hint.no.
authors.forename: Siri Andreassen
authors.initials: SA
authors.lastname: Devik
authors.forename: Ingela
authors.initials: I
authors.lastname: Enmarker
authors.forename: Guri Bitnes
authors.initials: GB
authors.lastname: Wiik
authors.forename: Ove
authors.initials: O
authors.lastname: Hellzèn
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D007407:Interviews as Topic; D008132:Loneliness / Q000523:psychology*; D008297:Male; D033262:Narration; D009369:Neoplasms / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D009664:Norway; D010166:Palliative Care / Q000379:methods / Q000523:psychology*; D011788:Quality of Life; D018570:Risk Assessment; D019035:Rural Health Services / Q000592:standards / Q000639:trends; D012424:Rural Population / Q000706:statistics & numerical data*; D012934:Social Isolation; D012959:Socioeconomic Factors; D019452:Terminally Ill
keywords: Dignity; Incurable cancer; Older people; Phenomenological hermeneutics; Rural palliative care; Suffering