Aesthetic experiences of patients with advanced cancer in end-of-life care in China: A phenomenological study

Abstract

Background

For most patients with advanced cancer, an important prerequisite for quality of end-of-life care is understanding their preferences. Nurses reported the challenges in the care process, such as poor communication patterns of sensitive topics. Aesthetic experience values meaningful moments and is sensitive to the impact of different environments and situations. Aesthetic expression enables individuals to transform intuitive cognition into artistic behavior, ultimately expressing real needs through aesthetic cognition, enhanced sensibility, and reflection, thereby promoting improved care quality. However, there is still a lack of studies exploring aesthetic experiences in end-of-life care from the perspective of patients with advanced cancer.

Objective

To explore the aesthetic experiences in end-of-life care as perceived by patients with advanced cancer during hospitalization.

Methods

This study applied a hermeneutic phenomenological approach and was conducted in an oncology unit of a hospital in China. This hospital was the hospital promulgated by the local health department as a pilot hospice care program. The hospital mainly admitted patients with advanced cancer who have given up radiotherapy and chemotherapy after being treated in a higher-level hospital. Data collection spanned from August to December 2023. Ten participants were invited to engage in reflective experiences using the individual face-to-face interviews followed by the creative drawings. The data were analyzed and interpreted following van Manen’s approach.

Results

The findings revealed four themes: 1) Dynamic understanding; 2) Cherished relationships; 3) Prioritizing being presentable; 4) Creating a peaceful atmosphere. Patients with advanced cancer present different states at each stage of their disease progression, which requires dynamic understanding to provide more precise care. In addition, their demands for cherished relationships, a presentable style, and a peaceful atmosphere will also increase during this process. We need to pay attention to these moments that are meaningful to them for improving the quality of end-of-life care.

Conclusion

This study explored the aesthetic experiences from the unique experiences of patients with advanced cancer in end-of-life care, thereby using aesthetic elements to create and cultivate a unique end-of-life care ideal, which will stimulate the creativity and respond to the special challenges of end-of-life care.

Background

When the cancer care team determines that cancer can no longer be controlled, care activities are mainly focused on improving the quality of life for patients with advanced cancer in the next few weeks or months (National Cancer Institute, 2021). As care quality is becoming the main issue in the healthcare setting, competent oncology nurses described a strong desire to provide high-quality care, and they emphasized the importance of maintaining hopes of patients with advanced cancer within the death-denying cultural context (Dong et al., 2016).

An essential prerequisite for maintaining hopes and improving the quality of patient-centered end-of-life care is to understand patients’ preferences (von Blanckenburg et al., 2022). In the process, the main challenge in implementing end-of-life care programs is excluding patients with advanced cancer from sharing sensitive topics (Rabben et al., 2024). As a result, medical staff and surrogates make care trade-offs without understanding the preferences of patients with advanced cancer. This situation results in end-of-life care failing to meet the needs of patients with advanced cancer who still have unresolved issues at the end of their lives (Wang et al., 2018).

In fact, sensitive topics about death or the end of life have historically been regarded as taboo in most types of cultures, and individuals often tend to avoid discussing them as much as possible—a cultural influence that persists to the present day, including in China (Tu et al., 2022). A study revealed a close relationship between aesthetic experiences and the meaning of the end of life and death (Shahmohammadi et al., 2024), and certain psychological states (reactions, attitudes, emotions) are considered to be related to aesthetic experiences (Asare-Aboagye et al., 2023). Furthermore, aesthetic philosophy recognizes the use of aesthetic expressions in artworks to delineate substantive and abstract aesthetic experiences, thereby making sensitive topics that are not conducive to end-of-life care transparent (Chang & Chen, 2012; Scruton & Thomas, 2024).

Meanwhile, Reñosa (2016) explored the connection between life experience and aesthetic expression, using an interpretive phenomenological approach to create drawings of aesthetic expression that most authentically reflect a person’s meaningful phenomenal moments (Bianchi, 2020). On the other hand, meaningful moments of the person-centered care process also reflected the impact of the behavior of artful nursing and its positive outcome (Siles-Gonzalez & Solano-Ruiz, 2016). As part of the aesthetics and art of nursing, the nursing aesthetic experience is an essential element of professional nursing, emphasizing the meaningful moments of the caring process (Vega & Hayes, 2019). End-of-life care based on aesthetic experience includes creativity, curiosity, flexibility, compassion, valuing the dying patient, empathy, integration of nursing features, and the ability to use aesthetic gifts to plan end-of-life care (Shahmohammadi et al., 2024), which lets nurses transform intuitive cognition into artistic behavior, and ultimately improved the quality of EOL care by aesthetic cognition, enhanced sensibility, and reflection (Chang & Chen, 2012). Therefore, it is crucial to understand the aesthetic experiences of care recipients in end-of-life care (Radmehr et al., 2015). During the process of nursing practice, if there is no aesthetic meaning, it is difficult to show the characteristics of exquisite service in the technical operation of nursing work (Yang, 2013).

Aesthetic experience during care has a positive impact on patients with advanced cancer (Proietti et al., 2021). A previous study demonstrated that incorporating aesthetic experiences into EOL care training programs can effectively address the needs and expectations of patients with advanced cancer (Shahmohammadi et al., 2024). In addition, aesthetic experiences can relieve existential suffering (Maes, 2022). The practice of aesthetic experience is employed as a valuable tool in end-of-life care to address diverse forms of suffering associated with serious illness, especially in the context of existential suffering and feelings of meaninglessness (Miller, 2020). Hence, if we take seriously the existential experiences of patients with advanced cancer in the end-of-life care process and the concept of person-centered care, nurses are more likely to understand and incorporate the aesthetic experiences of care recipients into their nursing practice, which will improve the quality of end-of-life care (Shahmohammadi et al., 2024). However, we would argue that aesthetic experiences of patients with advanced cancer have been undervalued and underplayed (Miller, 2020).

Aesthetic considerations in nursing practice from the perspective of nurses have been explored in numerous studies across various countries, including Indonesia (Betriana et al., 2022), Nepal (Dahal & Kongsuwan, 2022), China (Li et al., 2025), Iran (Radmehr et al., 2015; Shahmohammadi et al., 2024), U.K (Szubielska & Imbir, 2021). There is a lack of studies exploring aesthetic experiences in end-of-life care from the perspective of patients with advanced cancer. This study aims to explore the aesthetic experiences in end-of-life care as perceived by patients with advanced cancer. The insights garnered from this study stand poised to enrich the discourse surrounding aesthetics in end-of-life care. Nurses can appreciate and utilize this knowledge to design whole-person care at the end of life that is congruent with the patient’s needs, wishes, and cultural beliefs.

Methods

Study Design

This qualitative study employed a hermeneutic phenomenological approach based on Gadamerian philosophy, which posits hermeneutics as a means to reveal the conditions that foster understanding, perception, experience, and knowledge (Gadamer, 1976). Furthermore, Gadamer emphasized the importance of aesthetic experience and revealed that art constitutes an experiential domain, with artworks, such as drawings, serving as genuine reflections of individuals’ experiences (Gadamer, 1976). Moreover, the truth of human experience becomes deeper when it is transformed into an aesthetic expression (Betriana et al., 2022). Therefore, in this study, the experiences of patients with advanced cancer were explored to gain a clearer understanding of how aesthetic expressions are utilized in drawings within the context of end-of-life care. This study strictly complied with the Consolidated Criteria for Reporting Qualitative Research (COREQ) standards (Tong et al., 2007).

Setting

The study was conducted in the hospice ward of the oncology department at a hospital in southwest China. This hospital specializes in providing care for patients with advanced cancer who have discontinued radiotherapy and chemotherapy after treatment at a tertiary-level facility. The oncology unit comprises 43 patient beds.

Recruitment of Participants

This study used purposive sampling with specific inclusion criteria to recruit participants. It had previously been recommended that qualitative studies require a sample size of 0-12 to reach data saturation (Braun & Clarke, 2021; Guest et al., 2020; Hennink & Kaiser, 2022). However, saturation, according to qualitative research, was reached when no new themes or concepts emerged in the subsequent interviews (Rahimi, 2024).

The selection criteria included: 1) patients who are Chinese diagnosed with advanced cancer; 2) aged over 18 years; 3) Patients who are clearly conscious (good cognition and no depression) and can express themselves; 4) who are willing to participate in this study. A total of ten patients with advanced cancer were ultimately recruited. No participants withdrew or refused during the study.

Data Collection

Data collection spanned from August to December 2023. The first researcher maintained professional neutrality throughout the research process to ensure impartiality. Researchers did not have a prior relationship with the participants. The rapport with the participants was established before the interviews through informal conversations.

Afterward, a face-to-face individual interview was conducted, and participants who were willing to draw were provided with 2–3 sheets of A4 paper, 12 colored crayons, pencils, and erasers. Ample time was allotted for participants to create a visual representation depicting the aesthetic experiences they experienced in end-of-life care. In cases where participants required additional time and were unable to complete their drawing immediately, they were permitted to submit their drawings to the investigator after they finished on a specific date and time, as agreed upon by the participants. And then the first researcher returned for one visit to discuss the meaning of the drawings and gain more precise insights. Throughout the process, she maintained the preservation of participant privacy and comfort.

Guiding questions in individual interviews included prompts such as ‘Tell me or draw stories about your aesthetic/comfortable/pleasant experiences in nurses’ end-of-life care; Please elaborate on the significance of the picture you have drawn; Could you share your feelings and thoughts regarding the end-of-life care you have received from the nurses?’ The investigator is intentionally silent while encouraging participants to express themselves freely. Probing questions were devised to delve deeper into emerging themes during the interviews. The interviews were reviewed by three experts on end-of-life care for these questions. Each interview session lasted 45-60 minutes, with audio recordings used to capture the conversations. The interviews were transcribed verbatim by the first researcher to facilitate subsequent data analysis.

Data Analysis

To maintain the integrity of the data, the first researcher listened to the recordings and transcribed them into Chinese. Then, the key extracts were translated into English and cross-validated.

For the data analysis, researchers followed the steps of hermeneutic phenomenological analysis (van Manen, 1990, 2016). These steps are as follows: 1) The three researchers read the interview notes repeatedly and reviewed the qualitative content of each picture in conjunction with the visual materials; (2) The first researcher identified and selected important excerpts to be highlighted and coded, which were reviewed and confirmed by the other two researchers; (3) The first researcher reviewed the drawings and corresponding transcripts, and then the three researchers worked together to identify the visual elements present in the drawings; (4) Three researchers reviewed and reached consensus on the themes, and the first researcher completed the text description and supplemented the verbatim examples; (5) The three researchers thoroughly examined the description of the phenomenon, seeking to ensure that the entire article accurately reflected the experiences of patients with advanced cancer during the end-of-life care process, and then discussed and confirmed until three researchers were confident that the essence had been effectively captured.

The research team members are all women, including the first, a PhD candidate and a nurse with 14 years of experience in end-of-life care, who has received training in qualitative research courses. The second and third are PhD who are experts in qualitative research, palliative care, and aesthetic care.

Trustworthiness

The trustworthiness of this study was determined based on four criteria proposed by Lincoln and Guba: credibility, confirmability, transferability, and dependability (Lincoln & Guba, 1985). Assessing credibility through triangulation and detailed transcription. The triangulation approach adopted two different data sources, including interviews and drawings, and the researchers then synthesized the interview results and interpreted. Confirmability of the qualitative data was ensured through ongoing verification and validation procedures implemented throughout the data collection and analysis process. Transferability was achieved by providing a comprehensive description of the study site, demographic data of participants, and methods used to collect data. Dependability was established through rigorously documented data collection techniques, procedures, and analysis.

Ethical Considerations

This study was a part of a large study, “Development of Aesthetic Nursing Practice Model for Quality of Peaceful End-of-Life Care in Oncology Unit: Action Research” and received approval from the University’s Ethics Committee of the Center for Social and Behavioral Sciences (approval no: 2023-St-Nur-017) and the permission of the hospital. The first researcher shared the research goals and objectives with the participants and explained that they had the right to decline participation in the research. Their information was kept confidential. The researchers ensured that participants were protected from harm or discomfort. Their names were not published in this study; instead, codes and participant numbers (P1…) were used to identify the data. All data were stored in a secure location accessible only to researchers. The data of participants will be destroyed after finishing data analysis within 2 years. During the research process, the researchers met the patients’ wishes and requirements while adhering to relevant regulations and systems. The application of nursing aesthetics created a relaxing, nostalgic, and comfortable atmosphere, and their drawings have been authorized for publication.

Results

A total of ten patients diagnosed with advanced cancer were included in this study, coded from Participant 1 to Participant 10. The average age of participants was 51.6 years, with ages ranging from 28 to 72 years. Among them, four were male patients and six were female patients, with nine participants being married and one unmarried. Their educational backgrounds varied, with four participants holding bachelor’s degrees, two holding master’s degrees, and one holding a doctoral degree, while the remaining participants had graduated from a technical secondary school. In terms of religious affiliation, one participant identified as Catholic, three identified as Buddhist, and the rest reported having no religious affiliation (see Table 1 for the details).

Table 1.

Characteristics of patient participants with advanced cancer (N = 10)

Participant number	Age (year)	Gender	Marital status	Religion background	Education	Experienced the death of relatives or close friends	Type of cancer
1	41	Male	Yes	Yes	Master	Yes	Lung cancer
2	32	Male	Yes	No	Bachelor	No	Rectal cancer
3	28	Male	No	No	Master	No	Liver cancer
4	47	Male	Yes	Yes	Doctoral	Yes	Prostate cancer
5	63	Female	Yes	No	Bachelor	Yes	Colon cancer
6	55	Female	Yes	No	Bachelor	No	Breast cancer
7	72	Female	Yes	No	Bachelor	Yes	Stomach cancer
8	55	Female	Yes	No	Below bachelor	Yes	Colon cancer
9	52	Female	Yes	Yes	Below bachelor	Yes	Liver cancer
10	71	Female	Yes	Yes	Below bachelor	Yes	Pancreatic cancer

Human activity is always directed and goal-oriented behavior. For people with illnesses or syndromes, this experience cannot be separated from the context: they perceive, feel, dream, and judge experiences in relation to their own world, and aesthetic expression can reveal and describe the deeper experience of the individual (van Manen, 1990). The phenomenological research perspective emphasizes human experience, specifically the lifeworld revealed through the communication of personal experiences. This is the foundation of the humanities and guides us to understand the essential structure of human life (Eriksen et al., 2022). Therefore, in order to describe and construct the complexity of the lifeworld, philosopher Max van Manen proposed four basic existential themes based on the perspectives of phenomenology, which can be used to view the lifeworld: 1) Lived time covers the experience of perceiving time, describing the different cognitions and feelings people present in the three time dimensions of past, present and future; 2) Lived human relation to others; 3) Lived body describes the state of people living in the world with their bodies; 4) Lived space is described as ‘feeling space’ (van Manen, 1990).

The results of this study revealed four thematic categories that illuminate the aesthetic experiences of patients with advanced cancer in end-of-life care structured within Van Manen’s four lifeworld’s frameworks: 1) Lived time: dynamic understanding; 2) Lived human relations: cherished relationships; 3) Lived body: prioritizing being presentable; 4) Lived space: creating a peaceful atmosphere.

Lived time: dynamic understanding

Within the context of end-of-life care, the interaction between nurses and care recipients requires an understanding of living and growing in a caring manner. Some individuals, upon reaching the advanced stages of cancer, undergo significant behavioral changes as their condition worsens. Unlike in the past, this time they exhibit irritability and occasionally irrational behavior, and may even refuse treatment, so they hope that nurses can understand their expressions at different time. In this case, the nurse should perceive these changes dynamically, intentionally remain patient, and try to understand their fears and possibly loss of hope while accepting them as they are growing slowly in caring for self so that they may lead to becoming more peaceful, as one participant said:

When I noticed that my condition was getting worse. I had to show them my most vulnerable side, but the nurses weren’t angry. They regarded me as her child, allowing me to lose my temper and smash things at will. They smile and understand my state. I gradually feel warm and calm like this. P5

At the same time, another participant shared a narrative through a drawing (Figure 1): the green road depicted in the painting signifies that long-term understanding has eliminated many obstacles, making communication between nurses and patients as smooth as a green channel.

Figure 1.

Dynamic understanding between the nurse and the patient (illustrated by Participant 4)

The artwork of a male participant who expressed through drawing: “As we gain a deeper understanding, the nurse understands my mood changes at every stage. Now there are fewer barriers to communication between us.”

Sometimes when I found that I was ignored by the nurses, I tend to exaggerate my pain level to get doctors and nurses to pay more attention to me, but the nurses are gentle enough to accept my mistakes at this time, and correct my pain scores with another question, then she smiled and immediately knew that I am exaggerating, this process made me feel very interesting and cute, which reminded me of the happy times when I was a kid. P4

Meanwhile, the shortage of nursing personnel often increases nurses’ workloads at certain times. However, dynamic understanding between nurses and beneficiaries can often avoid this problem. As one participant said:

The nurses would also reflect different states at different times. Sometimes, nurses are too tired to talk, and they are always moved by my understanding of them, which makes me also feel warm and kind in my heart. P1

Lived human relations: cherished relationships

Cherished relationships include love, shared needs, companionship, and compassion. For patients with advanced cancer, it is very important to be with loved ones such as family and friends during end-of-life care. Cherished relationships help patients and their loved ones adjust the care process according to their specific needs and conditions. Patients with advanced cancer always want to make up for their loved ones, but are also afraid of being abandoned by them. As a result, they desire more robust companionship and care from their loved ones. In this context, if the nurse can provide a bridge for them, they would be very relieved and happy (Figure 2). As one patient drew and described:

Figure 2.

Cherished relationships (illustrated by Participant 8)

The artwork of a 55-year-old female diagnosed with Colon cancer. This participant’s narrative accompanies the drawing: “The nurse is always thinking of me, feeling my heart with her heart, and making me feel the warmth of being with my loved ones.”

Nurses connected my heart with my loved ones. We like to play mahjong (A board game originating from China, the game is usually played by four people) when we are together. They think I am in good shape. Hence, my nurse always acquiesces and gives us as much time as possible to play mahjong. She is very nice. P8

On the other hand, patients with advanced cancer are worried that their current illness or future death will bring trauma to their closest person. When nurses act as “family members,” patients with advanced cancer feel extremely grateful. As one described in Figure 3:

Figure 3.

Cherished relationships (illustrated by Participant 9)

The artwork of a 52-year-old female diagnosed with Liver cancer. Because she got married and had children very late, she is very worried that no one will take care of her children at her age of 52. Her drawing described that “The nurse not only took good care of me, but also took good care of my child, just like our protective ‘tree umbrella’.”

I can’t take care of my child due to illness. When they always take good care of my child, help him with his homework, and find a place to eat with him, I’m very grateful to them. P 9

Lived body: prioritizing being presentable

To be presentable means to be acceptable, decent, neatly or cleanly dressed, and fit to be seen. In Chinese funeral culture, people prefer to die decently. Therefore, cleansing and dressing are the priorities for the deceased, as well as keeping a presentable and comfortable state during the dying period, which is their responsibility for their death. Nurses play an essential role in this process. One participant’s drawing (Figure 4) showed that nurses use their caring umbrellas to protect patients with advanced cancer from ‘wind’ and ‘rain’ to keep them clean.

Figure 4.

Prioritizing being presentable (illustrated by Participant 10)

The artwork of a 71-year-old female diagnosed with pancreatic cancer. The narrative with painting: “The nurse used her loving, caring umbrella to protect me from the rain, preventing me from getting wet and keeping my whole body clean and comfortable.

I would often vomit everywhere, but every time, the nurse cleaned the sheets and helped me wipe the vomit off my body. I felt very refreshed and less embarrassed. P10

At the same time, another participant also expressed her experience:

I had a lot of yellow pus on the skin. So, I was worried that the secretions would have an odor, that my relatives and friends who came to see me would dislike it, and that my fellow patients would talk about me. However, t he nurse always helps me clean up these secretions in time and use s aromatherapy, which makes me feel presentable in front of my loved ones and friends. P 6

Lived space: creating a peaceful atmosphere

The nature of the ward’s space atmosphere determines the psychological state of patients with advanced cancer, directly affects care efficacy, and disease outcomes (Zadeh et al., 2018). Nurses are responsible for adjusting the atmosphere to maintain a peaceful, safe, relaxed, and no worries around patients with advanced cancer. A participant described it this way:

I have shortness of breath, and my legs feel weak. The nurse always supports me in maintaining a comfortable but not long - term position, which eases my worries. P1

In such an atmosphere, everyone cared for each other’s love. Moreover, patients with advanced cancer indeed expressed their true feelings in a very relaxed atmosphere. One participant shared (Figure 5):

Figure 5.

Creating a peaceful atmosphere (illustrated by Participant 2)

The artwork of a 32-year-old male diagnosed with Rectal cancer. The narrative for drawing is: “The nurse’s considerate, peaceful way made the beautiful things I imagined come into my dreams. It was a very sweet dream.” This artwork effectively illustrates the themes of dedicated and peaceful care provided by nurses.

Sometimes I stare out the window in a daze, longing for the outside air, sunshine, butterflies, and bees, which are beyond my reach. Thus, my nurse bought me a lot of picture albums of natural scenery. She said with a smile, “ Sleep with the picture albums in your arms and let the sunshine, butterflies, and bees enter the fragrance of your dreams. ” Then we laughed together, how wonderful ! It makes me feel inner peace. P2

Similarly, patients with advanced cancer are more susceptible to micro-expressions of everyone around them, and they believe that these micro-expressions can bring them peace (Abdulghafor et al., 2022). Hence, they often enjoy the peaceful moments created by the warm micro-expressions of each nurse (Arantzamendi et al., 2020). As the participants said:

When I see the sweet smiles of nurses and hear the greetings from the sunshine, I feel very happy, and the sufferings are lessened, which helps me forget some of the discomfort and maintain a peaceful mind. P7

The nurse’s warm and peaceful demeanor also made the patient feel at ease. A young participant said:

Every time I felt pain, my responsible nurse was always by my side, touching my forehead, as warm as a mother touching her child, to keep me calm. P 3

Discussion

This study revealed aesthetic experiences in end-of-life care from the participants with advanced cancer. These experiences were related to dynamic understanding, cherished relationships, prioritizing being presentable, and creating a peaceful atmosphere. The main results were reflected within the four lifeworld existential categories, based on van Manen’s existentialist framework: lived time, lived human relations, lived body, and lived space (van Manen, 1990).

Lived time means that each individual experiences changes in the self related to the three dimensions of past, present and future (van Manen, 1990). To fully understand the entire process presented by the three dimensions of lived time, it is necessary to recognize it dynamically, which more deeply reflects the individual’s own life experience (Engebretsen & Bjorbækmo, 2020). As a previous study has shown, dynamic understanding is a process that changes over time and with experience. This process helps individuals gain a clear understanding of behavioral patterns, enhance communication, and foster healthier relationships. At the same time, another study also emphasized that a dynamic understanding of epistemology is a comprehensible aesthetic experience and contributes to the application of aesthetic nursing (Herholdt Lomholdt, 2019). Therefore, the experience of lived time can promote and manage positive and significant experiences of the end-of-life care journey for patients with advanced cancer through a dynamic understanding.

Patients with advanced cancer presented different physical symptoms at different times, such as fatigue and lack of sleep in the early stages (Norinder et al., 2021), followed by fear of losing loved ones (Harnischfeger et al., 2023). Furthermore, as time goes by, various drugs, compression from advanced cancer, hypoxia, and other factors aggravated “end-of-life confusion” and made it more difficult to control (Ijaopo et al., 2023). End-of-life confusion not only often triggers uncontrollable fear, helplessness, frustration, and anger in patients with advanced cancer, but also hospice nurses are physically and emotionally affected by stress and burnout, thus experiencing anger, depression, sadness, grief, and guilt (Clayton & Marczak, 2023; Zhang et al., 2022). Additional research revealed a similar finding to the current study, which described how a dynamic understanding between nurses and patients with advanced cancer can help them gain a realistic understanding of their clinical situation and personal experience (Aghaei et al., 2020).

Lived human relations are the essential meaning of a caring relationship, defined as creating a caring existence based on the patient’s world (Mathiesen et al., 2024). This study demonstrated that a cherished relationship is a positive aesthetic experience perceived by participants during end-of-life care, emphasizing the aesthetic capacity of love. A similar description comes from a previous study, it showed that cultivating cherished relationships is a rewarding and valuable process because a person’s existence and worth is tied to love, especially during times when they are losing control of their lives, this relationship is a sublime aesthetic experience that cannot be expressed in words (Jonas, 2017). Another study also explored the role of cherished relationships as a spiritual guide in end-of-life care and bereavement work, which is one of the foundations of person-centered end-of-life care (Nysaeter et al., 2024). Patients with advanced cancer often feel more comfortable in the presence of their loved ones, and integrating loved ones through cherished relationships also has unique implications for assessing each patient’s well-being, thereby better motivating meaningful interventions in end-of-life care (Beng et al., 2022). In the future, more policies and support, such as increasing end-of-life care companion holidays, should be developed for end-of-life care.

The ontology of the lived body implies that there is no separation between body and mind, which is both physical and mental (Berndtsson, 2018). As the theme “prioritizing being presentable” of this study showed: “the nurse cleaned sheets and helped me wipe the vomit off my body. I felt very refreshed. ” This phenomenon is the same as described in a previous study, where lived body is a unique place of feeling that can only be experienced by the relevant experiencer, allowing them to experience every meaningful moment of situational and practical perceptual life (Sheets-Johnstone, 2020). In parallel, aesthetic experiences are most likely to capture these meaningful moments (Pizzolante et al., 2024). Additionally, presentability is a need for both comfort and dignity in end-of-life care; two other studies have also classified it as an aesthetic experience (Cribb & Pullin, 2022; Kong & Oh, 2023).

Both ontological reflection and epistemology suggest that it is crucial to understand the level of aesthetic experience (Herholdt Lomholdt, 2019). Pols (2017) believes that aesthetic values are closely related to good care in nursing, which involves ongoing interaction between the nurse and the patient’s lived body to achieve the presentation of aesthetic experiences (Harrison et al., 2019; Kong & Oh, 2023). However, with the advent of electronic health records and the increasing availability of technology, opportunities for face-to-face assessment and detailed understanding of patients with advanced cancer may be reduced (Harrison et al., 2019). This phenomenon will affect the quality of interactions between nurses and patients with advanced cancer, thereby reducing the quality of end-of-life care for patients with advanced cancer.

In addition, as patients approach the end of their lives, they have higher requirements for the quality of their lived space (Zadeh et al., 2018). Existential lived space is a space that individuals can feel and experience, characterized by a specific atmosphere that can affect a person’s feelings, behaviors, and mannerisms (Alrasheeday et al., 2023; van Manen, 1990). The theme of this study is “creating a peaceful atmosphere,” which falls under the aesthetic mood (Menninghaus et al., 2019). The descriptions of previous studies (Agom et al., 2022; Charan et al., 2023; Hansen et al., 2020; Hermans et al., 2023; Zadeh et al., 2018) are consistent with the current research; these studies have demonstrated that a peaceful atmosphere is a key factor influencing the quality of end-of-life care.

Meanwhile, these previous studies also explored that creating a peaceful atmosphere requires many factors to be considered, such as culture, physical space, shortages of nursing staff, a lack of competitiveness, and insufficient information on disease progression (Agom et al., 2022; Charan et al., 2023; Hansen et al., 2020; Hermans et al., 2023; Zadeh et al., 2018). The environment atmosphere designed according to culture and religion can help patients with advanced cancer to have a peaceful mind (Glyn-Blanco et al., 2023). Simultaneously, adequate space supports visual access and patient proximity, which can help reduce patient loneliness and distress (Zadeh et al., 2018). In addition, nursing shortages and a lack of professional competition result in poor coordination of care, causing uncertainty and poor symptom relief, while patients and families receive inadequate information, leading to unpredictable and distressing disease trajectories (Hansen et al., 2020). Therefore, more financial support policies should be introduced to support and design more humanistic living spaces. At the same time, appropriate death education is needed. Because understanding the death process can reduce the fear of dying (Yang et al., 2024).

Strengths and Limitations

Given the sensitive nature of the topic discussed and the uniqueness of the participant population, aesthetic expression is believed as an excellent way to explore the inner worlds of patients with advanced cancer. Using both methods—drawings and interviews—increased the credibility of the findings. However, the limitations of this study include: 1) Due to the special circumstances of patients with advanced cancer, the number of recruited participants was limited, which may lead to potential bias in data interpretation; 2) This study was confined to the Chinese religious context, which limits its applicability to a wider context. Therefore, future research will focus on conducting larger-scale cross-cultural studies on aesthetic experiences in end-of-life care.

Implications of the Study

This study utilizes aesthetic expression to present the inner world of patients with advanced cancer, clarify the focus of end-of-life care, and guide nurses in providing aesthetically and compassionately sensitive care. Meanwhile, this study offered an effective data basis for the future development of the aesthetic nursing practice model. Likewise, as end-of-life care meets the demands of the times, the relevant knowledge system must be improved and updated, and the combination of aesthetic experiences will extend the diversity and humanity of end-of-life care and death education.

Conclusion

This study describes the aesthetic experiences of patients with advanced cancer through their lived experiences and aesthetic expression. Aesthetic experiences include dynamic understanding, cherished relationships, prioritizing being presentable, and creating a peaceful atmosphere. The findings of this study enrich the end-of-life care system, providing nurses and healthcare providers with data to improve the quality of life and death for patients with advanced cancer.

Funding Statement

Funding We acknowledge the grant from Thesis Financial Support of the Graduate School, Prince of Songkla University.

Declaration of Conflicting Interest

No conflict of interest to declare.

Authors’ Contributions

Xia Li: Conceptualization, Writing – original draft, Project administration, Formal analysis, Methodology, Data curation, Writing - review & editing. Waraporn Kongsuwan: Supervision, Project administration, Conceptualization, Formal analysis, Review & editing. Charlotte D. Barry: Supervision, Formal analysis, Writing – review & editing. All authors approved the final version of the manuscript.

Authors’ Biographies

Xia Li, PhD Candidate, RN, Doctor of Philosophy in Nursing Science (International Program), Faculty of Nursing, Prince of Songkla University, Hat-Yai, Songkhla, Thailand.

Waraporn Kongsuwan, PhD, RN, Associate Professor, Faculty of Nursing, Prince of Songkla University, Hat-Yai, Songkhla, Thailand.

Charlotte D. Barry, PhD, RN; NCSN, FAAN, Professor Emerita, Christine E. Lynn College of Nursing, Florida Atlantic University, USA.

Data Availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Declaration of Use of AI in Scientific Writing

There is nothing to declare.