Table 6.

Synthesized findings, categories, findings, and their level of evidence.

Synthesized findings	Categories	Findings
Being autonomous	Need to be treated as a person	Qualitative findings and illustrations
		Being recognized as a person (C)	“To become acquainted with one or two nurses.” 65
			“I really like it when they come to see me in the evening, after the news and ask me if everything is okay or if I need anything [. . .] And when they give me a backrub. It just takes a few minutes.” 65
		The need to maintain physical and spiritual integrity (C)	“Since we know little about death, most of us have a lot of questions. Health professionals’ support, which is demonstrated through patiently answering our questions, is invaluable.” 68
			“Please do not let me look ugly; I need to be good looking when I enter the afterlife.” 68
		Normal behavior (U)	“I have this disease, and I’m living my life, studying, and maybe ahead of apparently healthy people, scientifically and mentally. That’s why I don’t like them pity me; I detest pity. I like them to pray for me, and come and visit, but not because they pity me.” 56
		Concept of loss (C)	“Yes, I feel bad, but not that bad. Enough, My body is a waste, feel repulsive (repeated twice). A waste, for my children, for my parents, for people like you who serve others, a waste.” 59
		Loss of jobs & social prestige (C)	“I have debts of Rs 50,000 due to my daughter’s marriage. . . Before my death, she has to get married, so I arranged a marriage for her, and she got married. I borrowed money from a family, but they want their money back because their daughter will be getting married shortly.” 61
		Quantitative findings a
		To be treated the way I want	To keep my sense of humor
		To have a human touch	Be called by name
		To maintain my dignity	Take opinion seriously
		Respect for autonomy	To be treated as a person, not just another case
		To have a doctor who knows me as a whole person	Recognition as a person until the end of life
	Need to be in control	Qualitative findings and illustrations
		Maintain independence (U)	“I’m fairly independent, and I’ve sort of tried since I got the illness to keep things as normal as I could.” 57
			“I’m one of those people who would never interfere in someone else’s life and tell them what to do, and I really don’t like anyone doing it to me either.” 57
		Balancing independence and the need for assistance (U)	“I’m fiercely independent, and I’d rather crawl on my hands and knees to do something, rather than have people do it for me. But sometimes, you have to have a bit of care.. [A care aide]. Gives me all the confidence in the world.” 57
		Reliance on others and the change in relationships (U)	“You never think that you are going to get in a position where you um you can’t look after um everybody else.” 60
			“We’re not intimate at the moment (higher pitch voice) because I find it (. . .) we don’t even talk about it, we just sort of blank it out because I just don’t have the will or the energy.” 60
		It is mine to keep together (U)	“I want to be able to have control or say about my illness, whether I think I should take chemo [chemotherapy] or not. The doctors tried to talk me out of it [her decision to stop treatment], and it’s just like, it’s MY body.” 64
			“Me not taking chemo, that’s control.” 64
			“I got a hand in what is going on. I got to know what’s in the bottle; I got to know how long it’s going to take. I got to know what tests they are doing and why they are doing that test. Why are they doing this? What are they looking for?” 64
		God controls our lives (U)	“Actually, I don’t think you can have control. I think you are given an opportunity, because you can’t control something you can’t heal, and you can’t control something you can’t make. Only the good Lord can do that. But you do to other people, help other people.” 64
			“The Lord knew I had cancer even before I did. Already knew what I had before the storms [Hurricane Katrina]. And He wanted me to be in a place [Texas] where He knew I could be taken care of.” 64
		Having a choice and being in control (U)	“Well, that, if patients want it, they [nurses] would not just do it in a stereotyped way—but would ask you if you would like a bath with a washcloth, or take a shower, or a bath in the tub today.” 65
			“Well, I am not very demanding. But I pay attention and I need to see what they give to me. In the beginning, well, of course, they did not know me—they just poured it [medicine] into my mouth.” 65
		Quantitative findings a
		Being dependent on others	Experiencing loss of control over one’s body
		Loss of control over one’s life	Experiencing loss of control over one’s life
		Not being connected to machines	To be treated as a person, not just another case
		Experiencing difficulties in asking for help	To be treated the way I want
		Reluctance giving tasks out of hands
	Need to continue life as usual	Qualitative findings and illustrations
		The extent of physical and psychosocial needs (C)	“I’m breathless, always breathless.” 60
		Impact of the disease on social activities (U)	“I can’t go anywhere [. . .] . . . I don’t [really] have a life I’m sitting indoors everyday . . . I used to be meet friends and have coffee and it [would] give you a bit of life back.” 60
		Plans for the future/sense of normality (U)	“I just wanted to get on with getting it sorted out, not worrying other people too much, and to get back to work and normality.” 67
		Living day by day (U)	“This is my life now, nothing I can do….Now that I am sick, nothing is important.” 99
		Quantitative findings a
		Coping with frustration of not being able to do things you used to	Difficulties in continuing usual activities/social activities
		Changes in usual routine and lifestyle	Difficulties in employment or following study
		Frustrations because inability to do as much as before	Difficulties in doing heavy/personal transportation/shopping/preparing meals or cooking/rising, walking, climbing stairs/doing light housework/body care, washing, dressing, or toilet
	Need to deal with financial concerns	Qualitative findings and illustrations
		Socio-economical clarification (C)	“And then you get to sit there afterwards and think ‘God, yes, I do actually feel awful and there are all these things I can’t do’. The option of staying on sickness benefit [with a flex job in this case] rather than receiving disability pension is really good.” 54
		Financial problems (Uns)
		Social needs (C)	“My father is a farmer. He can’t manage all the money for my treatment. I have three sisters, two older and one younger. . . I used to earn a lot of money, used to take care of my home. . . I won’t live, what will happen to my father, my mother [crying]?” 62
		Quantitative findings a
		Finances in order	Extra expenditure because of the disease
		To have my financial affairs in order	Reduced income because of the disease
		Difficulties filling out forms	Difficulties in making arrangements
		Dealing with concerns about financial situation	Difficulties in making life companion acquainted with financial and administrative issues
		Paying the non-medical costs of your illness	Coping with organizing financial situation
	Need to be informed about medical condition	Qualitative findings and illustrations
		Information needs (Uns)
		Understanding of disease (diagnosis, severity, and prognosis) (U)	“I mean, I had not smoked for 20 some years. It didn’t make any sense to me.” 58
			‘What can I expect?” 58
		The fear of knowing more (U)	“If I were to know about my illness I would feel tensed.” 61
		Need for information (Uns)
		Quantitative findings a
		To be fully informed about your medical test result as soon as possible	Making ethical decisions about care
		Receiving accurate medical judgments from the medical staff	Lack of information in written
		Being able to have an open discussion with your doctors	Difficulties in remembering what was told
		Getting adequate information from medical staff about side effects and prognosis	To trust my doctor
		Decision-making participation	Need for truth
	Need to be informed about future	Qualitative findings and illustrations
		Concerns about the future (U)	“I’ve got a grandson that wants to become an NBA star. And I told him I’ll live to see him play one game.” 58
		Quantitative findings a
		Dealing with fears about what is going to happen to you	Difficulties in coping with unpredictability of the future
		Fears about the future
Being connected	Need to maintain relations	Qualitative findings and illustrations
		Love and belonging (U)	“I don’t meet people. The only people I see now is my carers. Otherwise I don’t see a soul. I don’t see anybody. . . Oh very very lonely. Very very lonely.” 55
		Social support (U)	“My family supports me both physically and mentally, and keeps me spirited. Even though they want to remove my ovary and uterus, everyone reacts as though it’s not a problem. [They say] at most you can’t have a baby, your own health is more important. They support me in every way.” 56
			“I expect my friends to visit me, and have a heart‑to‑heart. My relative came to visit and made me very happy. That’s the spirit. They could have not cared and not come. Whenever they saw me, they wished me God’s blessing. Well that keeps my spirit high.” 56
		Being connected to family (U)	“. . .on Sundays, around half past 11 [. . .] when the phone is ringing, I know it is [name of niece]. [. . .] That really makes me happy, that’s lovely. [. . .] And I really can rely on it, oh yes, yes.” 65
			“If I need them, they’ll be here right away. I’ll never get lost in misery. That’s worth a lot.” 65
		The need to experience more reciprocal human love (U)	“I recite the Buddha’s name to help me forgive my Daddy since he tortured me and didn’t allow me to receive elementary education because I am a girl. It might have made mistakes and owed him a debt from my last life.” 66
		Being connected with the world outside (U)	“Being connected to other people. Being connected to people outside and to people here in the nursing home, being in some kind of relationship.” 65
		Need for connection/loneliness/depression (C)	“Post operation I was down as I couldn’t think what the correct words were and struggled explaining test phrases.” 67
		Social needs (C)	“. . . to see my brother, never told you that I have a brother, did I? I regret not staying in contact with him during all these years. But I do hear from my son now. It made me happy and moved me. But is it too late now?” 69
		Feeling closer to d Go (U)	“I have only some emotional problems but I can’t express it. If you are affected by an illness will you get closer to God? You don’t pray when you are safe but I am able to understand God.” 61
		Being spiritually connected (C)	“I have confidence that there will be a good end and that every step to the end will bring a good result. Well, God, who guides you into it, will help you to pass and lead you out.” 65
		Social isolation (U)	“You don’t have a social life.” 58
			“I find myself apologizing a lot. I am sorry I cannot do this or that.” 58
		Strengthening spiritual belief (C)	“When you sincerely want something from God, he gives it. When you go to a shrine with clear conscience, you get results, otherwise you won’t.” 56
		Loss of social networks (U)	“And I think what it is, ‘We hear that he’s really sick’ and ‘If he gets all horrible and wasted’. Where they’re a bit fearful. When they visit, what they’ll be presented with.” 57
			“Sometimes I get a bit lonely. The worst time is six o’clock at night, when you come in, shut the door and lock it, and put the lights on.” 55
		Solitude (U)	“Just needed to accept this on my own.” 67
		Need for companionship linked to struggle with embarrassment and vulnerability (U)	“Although I feel lonely and scared because of my declining health (during the evening and night in particular), I was embarrassed to ask for my children’s comfort and companionship because I used to be their leader and protector.” 68
		Marital intimacy (U)	“[It was] better than previously because previously, all the while I was working [long] hours. Sometimes I came back at 10 o’clock. . .they had already slept.” 99
		Connectedness with friends (U)	“When they come, I am very happy. We talk and I never feel that I am sick….Then about for a month, they never come. They called….sometimes they are scared to come because [I am] sick, so they are scared to disturb me.” 99
		Quantitative findings a
		Being forsaken by others	To have a nurse I feel comfortable with
		Problems in the contact with (one of) the children	Presence of family
		Problems in contact with family, friends, neighbors, or colleagues	To have my family with me
		Family and friends to be allowed with you in hospital whenever you want	Your relationship with God
		Dealing with maintaining relationships with family members	Becoming closer to a spiritual community
		Being at one with God	Fear of being alone
		Praying	Loneliness
		Continuity of social support	Problems in relationship with life companion
		At peace with God	Difficulties keeping confidence in God or religion
		To have close friends near	A connection with a higher power
		To perform religious or spiritual rituals	Life beyond the individual
		Religious rituals such as chant, prayer, lighting candles
	Need to care for loved ones or be taken care of by loved ones	Qualitative findings and illustrations
		Family support (U)	“I needed my family with me.” 67
		The perception of being a burden (U)	“All these days, I’ve lived an active, independent life. I could earn my livelihood. Now, I’m totally incapacitated; I have to depend on others for everything.” 61
		Relationships (U)	“I don’t want to interfere with my children’s lives. I don’t want to do this to them.” 70
		Psychological and spiritual needs (C)	“I don’t feel like discussing [my feelings. . .] because then they [family] will be upset. . . if they listen to these things of mine they might get upset. . .” 62
		Children are participant’s life (C)	“I can feel they are shattered inside because [I am] the mother….So I say my children are brave. So, I’m taking their bravery and I say. ‘I have to face it.’” 99
		Quantitative findings a
		Capacity to help others	Solace someone
		Worries you have about your family	Concerns about the worries of those close to you
		Dealing with concerns about your family’s fears and worries	Concerns about the ability of those close to you to cope with caring for you
		Not being a burden to my family	Finding it difficult to talk about the disease because of not wanting to burden others
		To have my family prepared for my death	Experiencing little support by others
		To be able to help others	To prevent arguments by making sure my family knows what I want
		Experiencing too little support by others
	Need to communicate with others	Qualitative findings and illustrations
		Need to talk (U)	“I needed to cry and be allowed to talk about my fears of not seeing my grandchildren ever, of not seeing my sons ever married or settled down. My fear relating to my son who has depression and what might happen to him. My sadness at leaving my husband after 32 years of marriage. I felt I was being hushed when I tried to say these things and that made me more upset. I needed to cry and say them.” 67
		Communication barriers in families (C)	“I sometimes feel that they might be feeling frustrated because of my condition. They haven’t shown anything openly so far – they are bearing everything patiently – maybe also because of the way I have treated them all these years.” 61
		Communicate with God (C)	“One has more faith in this period. I did have faith before, but I feel closer to God now.” 56
		Prayer (U)	“Besides treatments, the only cure is prayer. The doctor may diagnose, but with prayer his diagnosis may change easily. Perhaps my prayer is above his diagnosis, and surely that’s so.” 56
			“Prayer calmed me, and I felt closer to God; I forget my illness. It gave me more will. I felt calmer, the more I prayed, and forgot my illness.” 56
		Spiritual needs (C)	“Sometimes it helps just to talk to someone. . . . to get out of your own mind and just to talk.” 63
			“I am 77 so I can see the age is the cliff coming up. And wonder what on the other side. …. I’d rather solve it (the question) myself, find my own answers.” 63
			“My spiritual needs at this stage in my life [are] to be in as strong and as spiritual a setting as I can be in surrounded by my Christian brothers and sisters and doctors too and that’s being provided at the VA.” 63
		Talking to God (C)	“Yes, this is all God’s will. He is the one who gave me the illness. He is the one who can heal me. That is all I hope for.” 99
		Quantitative findings a
		Talking to other people about cancer	Conversation with cleric about the meaning of death
		Sharing your thoughts and feelings with people close to you	To be able to talk about what death means
		Dealing with the reactions by your family and/or friends to your illness	To be able to talk about what scares me
		Being able to express feelings with friends and/or family	Difficulties in talking about the disease with the life companion
		To have someone who will listen to me	Difficulties in finding someone to talk to (confidant)
		Need for religious expression
	Need to get in touch with others	Qualitative findings and illustrations
		None.
		Quantitative findings a
		Visits from a hospital chaplain	Visits from clergy of own faith community
		To meet with clergy or chaplain	Getting in touch with other patients with similar disease
		Difficulties being available to others	Visits from fellow members of your faith community
		Turn to a higher presence
Finding and having meaning	Need to accept and find meaning in situation and/or illness	Qualitative findings and illustrations
		Acceptance of one’s situation (C)	“I had faith in God. I am not worried as I leave everything to Him.” 59
			“Karma is what I am experiencing now, Yes, I may have sinned. I do believe in karma. I feel very bad that such a thing has happened to me.” 59
		Accepting reality (U)	“I think of the disease as part of my body and I have gotten so used to it. It fights me and me, too.” 56
			“Why should have God wished me this disaster, well what God gives can’t be disaster, but why me. I feel he always chooses the best, and that calms me.” 56
		Religious needs (U)	“Whole thing has awakened in me stirred in me religious beliefs. Whole reappraisal of life.” 67
		Seeking meaning (U)	“When I think about my disease, the question arises, why me? And the answer comes to me. I feel I got ill because I was better in some things than others, or else God wants to test me, to see how thankful we are in every circumstance, he wants to see if we are up to it or not.” 56
		Spirituality (U)	“I’ve started to ponder. Ask myself if I’m religious. I’ve never thought about those things before, but I do now.” 69
		Changing meaning of life (U)	“Sometimes I talk with my disease. You have come, but rest assured I’ll beat you; I won’t let you win. I fight you twice as hard as you fight me. I really feel there is a tenant living in my body that should soon leave.” 56
		Passive acceptance of their situation (U)	“I had faith in God. I am not worried as I leave everything to Him.” 59
			“Karma is what I am experiencing now, Yes, I may have sinned. I do believe in karma. I feel very bad that such a thing has happened to me.” 59
		Quantitative findings a
		Meaning and purpose	Difficulties accepting the disease
		Finding meaning in experience	Confusion about why this has happened to you
		Coping with suffering	Finding meaning
		Finding meaning in illness and/or suffering	Make sense of why this happened to you
	Need to have had a meaningful life	Qualitative findings and illustrations
		Thoughts about meaning of life (U)	“I felt guilty that I had not done enough in my life to prepare for this.” 67
		Dying without regret (U)	“I ask myself, ‘What things can I leave behind that will be remembered by others?’ The more positive the answers, the more peace and the less regret I have.” 68
		The need to fulfill the meanings of life and preserve one’s dignity (U)	“Sometimes I want to die; but, I owed others a lot of money. I should return the money then die innocently since I don’t want to rebirth in the world again.” 66
		Ascertaining a sustained being in the world (U)	“I asked my oldest son to demonstrate his filial piety by compliance with my unfulfilled duties, such as taking over my role of caring for his siblings and deal with family issues.” 68
		Meaning and purpose (U)	“I feel that my usefulness on earth is finished now. I’m neither use nor ornament now really.” 55
		Searching for belonging in the future world by attaining a firm sense of religious affiliation (U)	“Living is a daily battle for an old dying person; I simply can’t stay independent like I used to be. Religious support has been like cool drink of water and a crutch to help me on my daily walk through the desert.” 68
		Having a prosperous end (C)	“I wish it all ends well when I pray. I’m not afraid of people. All I want is not to burden myself on my kids, not to suffer, not to need their help, so they don’t tire. I don’t want to be a bother for anyone.” 56
		Quantitative findings a
		To perform religious or spiritual rituals	Affirmation of one’s past life
		Plunge into beauty of nature	Not experiencing pleasure anymore
		Divine	Feel life was meaningful
		Appreciating beauty	To feel that my life is complete
		Feelings of futility	Find a meaning for existence
		The meaning and purpose of human life	Someone bring you spiritual texts
		To remember personal accomplishments
	Need for forgiveness	Qualitative findings and illustrations
		Begging forgiveness (U)	“I always say, you gave me the disease, and I don’t know when I may go, but I want to go forgiven.” 56
		Quantitative findings a
		Freedom from blame and guilt, and forgiving others	Reconciliation and forgiveness
		Finding forgiveness	Wanted to forgive yourself or others
	Need for completion	Qualitative findings and illustrations
		None.
		Quantitative findings a
		Setting new priorities in life	Fulfillment of last wish
		Making the most of your time	Resolve unfinished business
		Dissolve open aspects in life	To take care of unfinished business with family and friends
		Resolving old disputes
Having a positive outlook	Need for hope	Qualitative findings and illustrations
		Hope and coping (U)	“It’s a bit of a downer really, I haven’t seen this doctor before. . .I said well it makes you feel better (referring to doing gentle exercise). . .he said ‘well why do it, there’s nothing there to build on, you’ve got nothing at all’. I didn’t need that at the time you know. I needed somebody to build me back up.” 55
		Hopefulness (U)	“When you know in your heart and have hope in God, surely God will help, your spirit will be high and you can defend yourself.” 56
		Faith in God (U)	“With all the possibilities today, when one falls ill, one doesn’t think about dying. One thinks about the doctors and specialists. That’s God’s will. He gives the disease and the cure.” 56
		The need to foster hope for survival and obtain a peaceful mind-set (C)	“Truth-telling helps patients learn better about their cancer status and have a hope for survival. Then, they’ll be less frightened.” 66
		Reassurance (U)	“Needed reassurances – about survival, to deal with inner panic and disappointment and fears.” 67
		Hope (C)	“I don’t want people to think I’m sick, not moving, not doing anything, and yet I am bothering them with all my unnecessary complains when they are also busy with their own job…. I don’t think I like it [the situation]. . . I don’t want to overstay my worldly time.” 99
		Hopelessness (U)	“Sometimes lying down, I think to myself, ‘Having done so much, what did I get in return?’ Because of this, that’s why you see, I don’t really bother much about caring for the kids [grandchildren]. I just tell them to go and do what they want….I just give up hope.” 99
		Quantitative findings a
		Need for hope	Difficulties seeing positive aspects of the situation
		Hospital staff to convey sense of hope	Keeping a positive outlook
		Finding hope	Positive/gratitude/hope/peace
	Need for peace	Qualitative findings and illustrations
		Seeking inner peace (U)	“Sometimes I like to be on my own, but not for just thinking, it is good for prayers and reading the Quran. When I’m alone, I pray better and do my work better. Not that I sit down and ponder, but I like to be alone for communication with God.” 56
			“When I’m under immense pressure, I put on my tracksuit and go out. To satisfy myself and snap out, I read a book. That’s my fate.” 56
		Active behaviors (U)	“I have looked after my responsibilities toward my family well. I have not committed any mistake. Yes, one is selfish about ones husband and children.” 59
			“I do pooja to pay off the (karmic) debts of my previous birth. I have not missed doing pooja. It has been useful for me. The mind is satisfied and peaceful.” 59
		Meaning of prayers (U)	“After going to the prayer I am getting relief and also I get a good sleep. . .When I have pain I pray to God and after the prayer I don’t know where the pain is gone.” 61
		Quantitative findings a
		Personal meditation or prayer practices	Dwell at a place of quietness and peace
		Overcoming fears	Need for freedom and to be free
		Difficulties in relaxing	Relaxation or stress management
		Find peace of mind
Dealing with dying and death	Need to deal with dying and death	Qualitative findings and illustrations
		Planning for the end of life (C)	“I want to remain at home as long as possible but if I have serious symptoms I would have to go to hospital.” 57
			“I think that [hospice] would be a more peaceful place.” 57
		Dealing with death and dying (U)	“Well, you have to get along with it. At my age [100 years] I expect to die every day.” 65
		Faith, belief and existential issues (U)	“I’ve had more lives than a cat in the last 26 years. I should have been dead more times than a cat. I’ve had more than 9 lives.” 55
		Awareness that cancer and death are controlled by a higher power (U)	“The Lord knew I had cancer even before I did. Already knew what I had before the storms [Hurricane Katrina]. And He wanted me to be in a place [Texas] where He knew I could be taken care of. All the storms were putting me in another a place where He knew I could be taken care of. I don’t know when You [God] gonna decide to take me away from here. It may not be the cancer that takes me. That’s up to Your [God’s] hand.” 64
		Concern about the dying process and death (U)	“I know I’m dying. I just hope it doesn’t take too long.” 70
		Musings on death (U)	“I used to be afraid of death, now I am not feeling that. One of my superiors has said that death is not just the end of the road; it is just the bend of the road.” 59
		Individual death pathways (C)	“To be patient.” 99
		Quantitative findings a
		Fear of death	Bereavement support
		Feelings about death and dying	Death and resolution
		Difficulties concerning the meaning of death	Need for continuity and an afterlife
		Dying and death	To have my funeral arrangements made
		Dealing with spiritual issues of death and dying
	Need to die in a preferred way	Qualitative findings and illustrations
		To receive assistance in facing death peacefully (U)	“If there were reincarnations, what could I do to prevent me from becoming a pig in the rebirth?” 66
		The need for a final resting place for the body (U)	“If I don’t die at home in my own bed after I say goodbye to my family members and close friends, my soul might get lost.” 68
		Quantitative findings a
		To die at home	Being able to choose the place where you want to die
		Not dying alone

^aQuantitative findings reflect survey items. No further illustrations are given since the primary studies do not provide them.