Abstract
Introduction
For people living with advanced cancer, the possibilities for experiences of joy are seriously influenced by the consequences of the illness. Due to the limited expected lifetime, the need to support such experiences that may entail joy and contribute to quality of life are of importance. Research shows that people with advanced cancer experience quality of life through occupations they are able to perform and enjoy. The aim of this study was to describe which occupations contribute to joy for people living with advanced cancer and explore how they reflect upon these occupations during an occupational therapy intervention.
Methods
In total, 111 people with advanced cancer from the intervention group in a randomised controlled trial participated in the present study. Thirty-six of these participants were interviewed, and for 10 participants, this was combined with participant observations. A directed and a conventional content analysis were applied.
Results
148 occupations contributing to joy were categorised into self-care, leisure and productivity. Most occupations were placed into leisure (89%). Participants had three distinct approaches to occupations contributing to joy: Finding solutions to maintain occupations contributing to joy; having an all or nothing approach; and hoping to resume occupations contributing to joy.
Conclusion
This study found a wide range of occupations contributing to joy and shows the importance of focusing on enabling leisure occupations for people living with advanced cancer. The wide range of occupations as well as participants’ approaches to occupations may be useful to inform future interventions to enable enjoyment for people living with advanced cancer.
Introduction
People living with advanced cancer often experience loss of bodily functions, inability to maintain social roles and engage in basic daily activities (Johnsen et al., 2009; Moghaddam et al., 2016). Such losses may lead to negative emotions, worries and depression (Thewes et al., 2012; Zachariae and Mehlsen, 2004). This may call upon support for experiences of joy, which may facilitate improvement of quality of life despite the serious circumstances of advanced cancer (Burkhardt et al., 2011; Cohn et al., 2009). Joy is related to a feeling of contentment (Izard, 1977) as well as an increased awareness and realisation of one’s resources (May, 1994). This definition is consistent with eudaimonic well-being, which occurs when doing occupations that are worth doing despite being challenged in skills and abilities (Hayward and Taylor, 2011).
Scholars highlight engagement in occupations as essential sources for experiencing meaning and joy (Lala and Kinsella, 2011; Lyons et al., 2002; Robinson et al., 2012). Occupation can be defined as “everything that people do to occupy themselves, including looking after themselves (self-care), enjoying life (leisure), and contributing to the social and economic fabric of their communities (productivity)” (Law et al., 2002).
Positive subjective experiences such as enjoyment through engagement in occupations may foster experiences of meaning which may lead to well-being (Csikszentmihalyi, 1993; Eakman et al., 2018). For people living with advanced cancer, engagement in valued occupations, such as occupations contributing to joy, seems to contribute to quality of life (Peoples et al., 2016, 2017). A qualitative study about people with cancer receiving palliative care showed that interactions with others as well as the ability to continue everyday life was identified as a source of joy (Svidén et al., 2010). Other studies about engagement in creative occupations for people with advanced cancer and other life-threatening illnesses found creative occupations as sources of joy (La Cour, 2008; La Cour et al., 2005; Svidén et al., 2010). Even for people with advanced cancer that cannot be cured, it is important to support their quality of life (Strang, 2002). One way to support quality of life may be to enable occupations contributing to joy for people living with advanced cancer.
Healthcare services such as rehabilitation, palliative care and occupational therapy may have a tendency to focus on the problems patients experience and how to solve these instead of having a more supportive focus (Skjødt et al., 2020; Wæhrens et al., 2020; Wessels et al., 2002; World Health Organization, 2018). Recent research and interventions for people with advanced cancer indicate the importance of also focusing on enriching aspects of life (La Cour et al., 2005) as well as providing an opportunity for enjoyment (La Cour and Lindahl-Jacobsen, 2018; Raunkiær and Gärtner, 2020). Hence, it may be necessary to gain knowledge about what contributes to joy in order to target such interventions.
Even though current research addresses joy, occupation and life-threatening illness (Lala and Kinsella, 2011; La Cour et al., 2005, 2009a; Lyons et al., 2002; Svidén et al., 2010; Robinson et al., 2012), no research has so far investigated which occupations people with advanced cancer highlight as contributing to joy at the end of life and how they reflect upon these occupations during an occupational therapy–based intervention.
The Activity, Cancer and Quality of Life at Home Project (the ACQ project) developed and evaluated an occupational therapy–based intervention which among other things focused on enabling occupations contributing to joy for people with advanced cancer living at home (La Cour et al., 2020; Pilegaard et al., 2017, 2018). The project generated a large amount of data regarding occupations contributing to joy and data about conversations between the participants and occupational therapists during the intervention concerning occupations contributing to joy. The present study is based upon these data.
The aim of this study was to (1) describe which occupations contribute to joy for people living with advanced cancer and (2) explore how people living with advanced cancer reflect upon occupations contributing to joy during an occupational therapy intervention with a supportive focus.
Methods
Design
The present study is based on data extracted from a randomised controlled trial (RCT) within the ACQ project investigating the efficacy of the Cancer Home-Life Intervention compared to usual care (ClinicalTrials.gov NCT02356627). The intervention was an occupational therapy–based programme consisting of a mandatory component aiming at identifying peoples’ prioritised occupations and five tailored, adaptive components. More details about the intervention and the RCT can be found elsewhere (La Cour et al., 2020; Lindahl-Jacobsen et al., 2020; Pilegaard et al., 2017).
A total of 242 people with advanced cancer participated in the RCT of which 121 were allocated to the intervention group and 121 to the control group (Pilegaard et al., 2017). Out of the 121 participants allocated to the intervention group, 113 received the intervention (Pilegaard et al., 2017).
Participants
111 participants from the intervention group were included in the study. Two of the 113 intervention participants were excluded due to missing data on occupations contributing to joy. In order to address the first part of the aim and to provide a manageable overview of participants’ reported occupations contributing to joy, a subsample of one-third (n = 36) of the participants was randomly selected from the intervention group (n = 111). In addition, 10 participants from the intervention group (n = 111) were selected as part of an evaluation of the intervention (La Cour et al., 2020). These 10 participants were also included in the present study in order to address the second part of the aim. Figure 1 illustrates the selection process. Participant selection.
Participants were recruited from oncology units at Odense University Hospital, Denmark and Aarhus University Hospital (AUH), Denmark, from February 2015 to October 2016. Included participants were home-living adults (≥ 18 years), diagnosed with advanced cancer who had a World Health Organization Performance Status 1-2 and lived at home or in sheltered living on the Island of Funen or within a maximum radius of 60 km from AUH (Pilegaard et al., 2017).
Data collection
Data were collected in two ways by using a variation of free listing (Weller and Romney, 1988) and through participant observations. Firstly, free listing was used at baseline, prior to randomisation, where the participants were asked to list maximum five occupations of their choice that they perceived as contributing to joy (Pilegaard et al., 2017).
These lists of occupations contributing to joy were collected in order to ascertain the participants’ own perceptions and to inform a supportive focus in the intervention. Secondly, participant observations were conducted during the intervention delivered in the homes of 10 participants as part of an evaluation of the intervention (La Cour et al., 2020). The participant observations were conducted by an anthropologist in order to provide descriptions on the interactions between the occupational therapist and the participant in the context in which they occur and thereby help understand the daily lives of the participants (Savage, 2000). Field notes were written from all ten participant observations.
Data analysis
Content analysis was applied as this approach is suitable when the purpose is to obtain descriptions of a phenomenon, in this case, occupations contributing to joy for people living with advanced cancer (Kyngäs and Vanhanen, 1999). More specifically, two forms of content analysis were applied: 1) directed content analysis for the listed occupations and 2) conventional content analysis for the participant observations. While directed content analysis is informed by previous knowledge, conventional content analysis is without influence of preconceived categories or theoretical perspectives (Hsieh and Shannon, 2005; Kyngäs and Vanhanen, 1999). This latter form of analysis is relevant when knowledge about a certain phenomenon is limited (Lauri and Kyngäs, 2005).
Directed content analysis
Directed content analysis was applied to the listed occupations contributing to joy by use of predetermined categorisations of occupations as suggested by Law et al., being self-care, leisure and productivity (Law et al., 2002). Firstly, the two first authors individually divided the occupations into the three different categories. Secondly, this subdivision was compared and through consensus, the final categorisation was reached. Consensus was gained through continuously revisiting the definition of self-care, leisure and productivity to ensure the most suitable categorisation of each reported occupation.
Conventional content analysis
Conventional content analysis was used to describe and explore occupations contributing to joy. An initial reading of all 10 sets of field notes was conducted to get acquainted with the material. During the second reading, notes were taken whenever the theme of joy or other positive emotions in relation to an occupation occurred. These notes were verbatim extracts and served as codes. The codes were then organised into categories emerging from analysis of the different reflections on occupations contributing to joy.
Based on these categories, the authors read across the field notes in order to find patterns of these reflections. This resulted in three main categories representing the participants’ three distinct approaches to occupations contributing to joy.
The first and second readings were conducted independently by the two first authors. The rest of the analysis was done jointly by the two first authors while continuously consulting and validating with two senior researchers (second and last author).
Ethical considerations
Data were collected according to ethical procedures, described in the study protocol of the ACQ project (Brandt et al., 2014). The Danish Data Protection Agency has given permission to use data (J.nr. 2018-41-5324). Data were kept and handled on a secure laptop provided by The University of Southern Denmark. Participants were given fictional names to ensure anonymity.
Results
Characteristics of the participants (N = 111).
IQR: interquartile range.
Listed occupations contributing to joy
Categorisation of occupations contributing to joy.
A majority of the occupations (89%) were categorised as leisure. Examples of occupations within this category were ‘Being together with my grandchildren’, ‘Going for a walk’ or ‘Doing crosswords’. Self-care was the second largest category (7%) with occupations such as ‘Being in good health’, ‘Personal hygiene’ and ‘Helping my spouse making dinner’. Productivity was the smallest category (4%). Examples of such occupations were ‘Being a part of the working force and doing the job’, ‘Doing charity work’ and ‘Greet people in the second hand shop’.
Approaches to occupations contributing to joy
The analysis revealed that the participants had three distinct approaches to occupations creating joy: 1) finding solutions to maintain occupations contributing to joy; 2) having an ‘all or nothing’ approach to occupations contributing to joy and 3) hoping to resume occupations contributing to joy. Participants mostly talked about more or less indirect ways of dealing with loss of occupations contributing to joy or risk of loss of these occupations.
The three approaches are further unfolded below through paradigmatic extracts and quotations from the conversations between the occupational therapist and the participants. Extracts from the field notes without direct quotes are presented with single quotation marks and direct quotes are presented with double quotation marks. Larger extracts or quotes are indented.
Finding solutions to maintain occupations contributing to joy
Finding solutions to maintain occupations contributing to joy was a dominant approach as it was brought forward by most of the participants, although in different ways. Finding solutions to maintain occupations was seen in different ways: changing the physical environment; maintaining occupations through assistive technology; being explicit about the illness; and prioritising occupations.
One way of finding solutions was changing the physical environment. One participant, Paul, lived with his wife. He was especially fond of woodturning and when the occupational therapist arrived, his wife did the welcoming since Paul was busy in the workshop. In order to understand what his hobby meant to him and to experience his surroundings and his practice of woodturning, the occupational therapist went to the workshop to meet him there. Several large machines were placed along the walls and Paul showed the visitors around. He explained how his occupation was affected by his illness. The anthropologist noted: (...) it’s his problems with motor skills that torment him the most and that he takes one day at a time. (...) He explains how it can end in disaster if he loses his grip or loses touch with what he’s handling, so he’s made some safety measures in order to operate his machines (field note, Paul).
To Paul, woodturning seemed to create joy and by making up his own safety measures on the machines, he was able to maintain this occupation without getting injured.
Taking the approach to find solutions led to Paul and other participants accepting the use of assistive technology.
Paul had difficulties picking up ‘eyes’ for the mice he made from woodturning and the occupational therapist therefore introduced him to tweezers: ‘“Yes that one is good for mouse eyes!” Paul bursts out’ (field note, Paul). Paul’s outburst could be seen as an outburst of excitement, most likely because the tweezers created the potential to maintain occupations contributing to joy.
Another participant, Peter, lived on a farm with his wife. Peter went for walks three times daily, prioritising to keep up with social contacts. The occupational therapist asked Peter about the daily walks and whether they were exhausting for him. Peter had already been provided a rollator but said that he would like not to be depending on it though it enabled him to maintain his daily walks, visiting family and meeting neighbours and friends. The anthropologist notes: (...) it [the rollator] just works really well for him; especially to sit on and take a break or if he meets someone and stops to talk to them along the way (field note, Peter).
Peter referred to these walks and social interactions countless times during the intervention, and it seemed very crucial and enjoyable to him to be able to continue socialising in this way. Peter verbalised how important it was to him that people did not avoid him despite his illness.
Rita would only use her rollator to go for walks in the countryside and never use it when going to town to meet other people. These examples show that the use of assistive technology is dependent on the context and that the solutions that work for the participants differ according to what matters most to them.
Another way of finding solutions was to be explicit about the illness in order to maintain occupations and social relations. Rita lived with her husband in a neat home dominated by art, Danish design and literature. Rita enjoyed visiting museums and inviting friends over for dinner but was not able to do it to the same extent as before she got ill. The occupational therapist asks Rita about occupations: It quickly turns into a talk about being open and honest about your illness and to what extent you should involve others: “You have to be open and honest about it, otherwise they will disappear. Don’t moan”. (...) Rita also finds it annoying that she can’t invite people for dinner because it’s too big a task. But then it can be sandwiches and pizzas that they order in. You just have to honestly say that you can’t keep up with as much as before (field note, Rita).
Being explicit was one of Rita’s ways to maintain occupations contributing to joy. In some ways, being explicit can also be said about Peter and his daily walks with his rollator. The rollator signalled it being legitimate to talk about his illness.
Ellen lived on her own in a flat in the city. She kept busy with painting, playing the violin and doing yoga. She also had a subscription to two different newspapers. Ellen described herself as a person of self-discipline, valuing daily routines and sticking to plans.
The approach of ‘finding solutions’ was apparent during conversations with Ellen. She found solutions by prioritising occupations she had sufficient energy to do: The occupational therapist starts asking about social occupations. The participant says that she still has some, but it’s decreased. And she picks out what makes sense spending time doing. The occupational therapist says: “I’m thinking that you prioritise…” The woman answers: “Yes, whatever drains me from energy, I stop doing” (field note, Ellen).
Prioritising social occupations, that did not drain Ellen from energy, would seem to make room for social occupations contributing to joy.
Having an ‘all or nothing’ approach to occupations contributing to joy
An ‘all or nothing’ approach was identified as either doing the occupation to the same extent as before or completely deselecting the occupation altogether. There was no middle way as opposed to the approach of finding solutions to maintain occupations. Carl lived in a house close to the forest with his wife who was ill and dependent on oxygen supply. Formerly, Carl would go for 1 hour walks with his dog, collect mushrooms in the forest and hunt. A decrease in functional ability was the reason why Carl deselected hunting and dinner parties: The wife says that she has suggested him going [hunting] and returning when he gets too tired. [Carl]: “But I’ve said no to that. It’s all or nothing. (...) It’s not fun sitting in the cabin, smiling as if all is fine when it’s not” (...) Prior [they] threw dinner parties with their friends, having fun and attended all sorts of things. But now it’s easier just staying at home. “We have declined everything”. “What holds you back?” the occupational therapist asks. Carl answers that he doesn’t want to just sit there, and the thing about not having any appetite. That’s not so festive (field note, Carl).
During the conversation with the occupational therapist, it would seem that because of physical decline, hunting and throwing dinner parties no longer seemed to create joy and so Carl chose to be without. The occupational therapist suggested that the Danish Cancer Society might have an offer for him – they have groups exclusively for men where he could meet other men in similar situations. Carl expressed no interest in this; the prospect of being social under these conditions did not seem to be a joyful option for Carl.
Ellen’s conversation with the occupational therapist revolved around prioritising occupations and energy. Ellen did not want to waste her time on pointless things with no prospects. She sold her allotment garden soon after she was diagnosed: She is very blunt and says that she doesn’t do things half-heartedly. It is all or nothing. For example, according to the allotment garden that she just knew she had to sell. But she misses it, and it has been a strange summer because she usually stays out there during summer, so she has felt a bit cooped up in the flat (field note, Ellen).
To Ellen it seemed important to do occupations wholeheartedly in order for them to create joy. She chose to do without her allotment garden despite the feeling of loss.
Hoping to resume occupations contributing to joy
Several participants expressed hope about being able to engage in occupations that they were no longer able to do. Peter hoped to return to his work at the farm: ‘He explains that he also takes a walk through the stables. “We still have livestock.” He hopes to be able to help out with the farming again’ (field note, Peter).
The occupational therapist asked Peter about potential hobbies and whether he was satisfied with his present involvement. Peter replied that if he recovered, he would like to help out at the local horse club. Walking through the stables everyday as well as wanting to be involved in volunteer work could indicate that Peter held on to the hope of resuming occupations creating joy.
William lived with his wife and was still employed at the time of the intervention. The couple lived in a house and William used to be in charge of its maintenance as well as the cooking. William showed the occupational therapist round the house as part of the intervention to get a more thorough understanding of William’s daily routines, his environment and how this was affected by his illness and treatment. It became clear how projects were waiting for his hopeful return to ‘normal’. In the hallway, William explained his plans for remodelling that had been postponed at the moment. In his large workshop, he showed his boats and explained how he normally did a lot around the house and with the boats. Using the word postponing indicated that William expected to resume the renovations as an occupation contributing to joy.
Discussion
The aim of this study was to describe which occupations people with advanced cancer report as contributing to joy and to explore how they reflect upon these occupations during an occupational therapy intervention with a supportive focus.
The findings revealed a wide range of occupations, such as ‘Working at my former workplace’, ‘Being together with the family’, ‘Singing in a choir’, ‘Walking the dog’ and ‘Cleaning’. The majority of occupations contributing to joy was within leisure (89%). Analysing how participants reflected upon the occupations resulted in three distinct approaches to occupations contributing to joy.
As referred to in the introduction, research emphasises the importance of creative occupations as a source of joy (La Cour et al., 2005, 2008; Svidén et al., 2010). Results from this study such as ‘Singing in a choir’, ‘Flower arranging’ and ‘Knitting’ confirm these results. These creative occupations are a part of the category concerning leisure occupations. A cross-sectional study about everyday activities for people with advanced cancer found that leisure took up the second largest amount of time on a daily basis (Wæhrens et al., 2020). When comparing with the results from the present study, this could indicate that people with advanced cancer spend a significant amount of their time engaging in leisure occupations that could contribute to experiences of joy.
Across the three occupational categories (self-care, leisure and productivity), it was noticeable that occupations entailing being with others took up a large part of the listed occupations. Examples of such occupations were ‘Being together with the family’, ‘Talking on the phone to old friends from work’ and ‘When a good friend invites for dinner’. This result resonates with prior research indicating that interactions with others contribute to experiences of joy (Lala and Kinsella, 2011; Peoples et al., 2017). A qualitative research synthesis found a high frequency of associations between enjoyment through occupation and the experience of being connected to or supported by others through occupation (Eakman et al., 2018; Law et al., 2002).
The results of occupations contributing to joy, such as cleaning, working, cooking, gardening and watching TV resonate with prior research showing that it is important for people with advanced cancer to maintain as normal a life as possible (Johansson et al., 2006; Svidén et al., 2010) and to continue life as before diagnosis, which contributes to pleasure and joy (La Cour et al., 2009b; Svidén et al., 2010). Attempting to maintain a normal life could also be seen in the approaches ‘finding solutions to maintain joyful occupations’ and in having an ‘all or nothing’ approach to joyful occupations. By finding solutions, participants maintained their usual occupations, and this could be a way to maintain a normal life. This result is in line with a qualitative study (Peoples et al., 2016) which found that people with advanced cancer used self-developed strategies to manage occupations. In the present study, the example with Paul and his safety measures in his workshop was a solution to maintain occupations contributing to joy and hereby, a normal life. Paul being able to perform his occupations in the workshop could be an expression of both the positive experience of enjoyment and mastery (Eakman et al., 2018) as well as the ability to deal successfully with the challenges of daily living (Christiansen and Townsend, 2004). The above-mentioned synthesis (Eakman et al., 2018) found evidence for associations between the experience of enjoyment and mastery through occupations.
Deselecting occupations as an ‘all or nothing’ approach could be a way of maintaining integrity and avoiding facing one’s limitations, thereby holding on to what is still normal. Research shows that some people do not accept using assistive technology due to fear of being stigmatised, for example, looking old or ill (Hedberg-Kristensson et al. 2007; La Cour et al., 2020; Porter et al., 2011). One could argue that to Peter maintaining his daily walks was more important than keeping integrity by not using the rollator. In light of this, the use or non-use of assistive technology could be seen as either finding solutions or an all or nothing approach to occupations contributing to joy.
Finding solutions or deselecting occupations could also be seen as a way of revaluing one’s occupations. Revaluing is to change the attitude towards capability, lowering expectations about which occupations are most important and about how well they are performed (Svidén et al., 2010). A qualitative study (Svidén et al., 2010) found that people with advanced cancer revalue occupations in order to continue their everyday lives due to ongoing deterioration.
Hoping to resume occupations contributing to joy can also be a way to maintain normality. Some research shows that having cancer and working with hope is closely related (Hansen and Tjørnhøj-Thomsen, 2014). Hope is seen as a practice and is used to regain a feeling of normality. The practice of hope takes place in the present and is linked to both the past and the future (Hansen and Tjørnhøj-Thomsen, 2014). In the same way, our results show that participants in the present express hope to once again be able to perform occupations that contributed to joy in the past.
The practice of working with hope is a way to handle despair and fundamentally revolves around postponing death (Hansen and Tjørnhøj-Thomsen, 2014). The approach hoping to resume occupations contributing to joy could then be seen not only as holding on to normality but also holding on to life.
Evaluation of the Cancer Home-Life Intervention shows that the occupational therapists find occupations contributing to joy as a valuable focus compared to a more common problem-oriented approach (La Cour et al., 2020). This view is supported by results showing the importance of helping people living with cancer strive towards goals that add to an experience of happiness (Wnuk et al., 2012). In addition, as shown in the analysis in the present study, it can be of value to not only enable moments of joy but also what matters most to people, for example, integrity, self-image, etc. From this perspective, it might in some cases be relevant to focus on other interventions than occupations contributing to joy during the occupational therapy intervention.
Methodological considerations
One strength of this study is the presentation of the listed occupations contributing to joy. By only using participants’ own words, the credibility and confirmability of these findings are strengthened (Guba and Lincoln, 1982). Choosing to draw on the definition of occupation presented by Law et al. (2002) contributed to one version of how the occupations contributing to joy were presented. Choosing a different definition would accordingly have resulted in a different presentation.
The participant observations were conducted by an anthropologist who was an expert in this methodology and without any prior knowledge of the ACQ project. The data collection was therefore expectedly not influenced by a preconceived understanding of the project and its underlying mechanisms such as relations between occupations and experiences of joy. This could be seen as a strength.
The listed occupations consisted of a few words or short sentences which constitutes a risk of misinterpretation and thereby placing the occupations in categories not consistent with the participants’ experience of the occupation in question.
In order to enhance credibility of the results, the second and last authors who were not part of the analysis process, were constantly consulted in order to secure compliance. The credibility of this study could have been further strengthened if the participants had the opportunity to elaborate on the listed occupations or to confirm the content of the field notes (Guba and Lincoln, 1982).
Since joy was merely a sub-element within the total data set, the authors had to search for data relevant to the aim of the present study. This may be seen as a weakness and may have caused less thick descriptions of occupations contributing to joy and thereby weakened the transferability of the results (Guba and Lincoln, 1982).
Implications for occupational therapy practice and research
The knowledge of the wide range of occupations contributing to joy generated from this study may be useful to inform future interventions to enable enjoyment for people living with advanced cancer, which in turn may also enhance their quality of life. It also provides knowledge about how people may approach occupations contributing to joy. This may be used in order to guide how occupational therapists support people with advanced cancer to maintain or to deal with loss of occupations contributing to joy.
Recommendations for Danish occupational therapists working in palliative care highlight the importance to support self-care, transfers and household occupations (DMCG-PAL, 2016).
One could argue that there is a discrepancy between these recommendations and the findings from the present study showing a wider range of occupations contributing to joy prioritised by the participants. Hence, there could be a need for a re-evaluation of the content in the recommendations. International recommendations for occupational therapists working in palliative care could also serve as inspiration because it includes a wider scope on occupations and quality of life (New Zealand Association of Occupational Therapists 2013; The Canadian Association of Occupational Therapists 2017).
The present study explored occupations contributing to joy on a descriptive level, and there is a need for further, in-depth research on occupations contributing to joy for people living with advanced cancer (La Cour and Lindahl-Jacobsen, 2018; La Cour et al., 2020), to explore the different approaches to maintain or deselect occupations contributing to joy on a more in-depth level and, furthermore, how these approaches affect well-being and the experience of maintaining a normal life.
Conclusion
The results showed a wide range of occupations contributing joy with leisure occupations being the largest category. The results underpin the importance of focusing on enabling leisure occupations for people living with advanced cancer. The participants had three distinct approaches to occupations contributing to joy: Finding solutions to maintain occupations contributing to joy; Having an ‘all or nothing’ approach to occupations contributing to joy and Hoping to resume occupations contributing to joy. The approaches determined whether to maintain or deselect occupations contributing to joy.
Key findings
148 occupations contributing to joy were identified, with leisure being the largest category. In addition, the participants had three distinct approaches to occupations contributing to joy.
What the study has added
This is the first study that examines empirical data on occupations contributing to joy for people living with advanced cancer during an occupational therapy intervention.
Footnotes
Acknowledgements
The authors would like to thank the participants who shared their time and experiences in relation to this study.
Research ethics
The Danish Data Protection Agency has given permission to use data (J.nr. 2018-41-5324). Date: 2018.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship and/or publication of this article.
