“I would describe myself as a deformed troll”: Using Interpretative Phenomenological Analysis to explore body image struggles among palliative care patients.

Abstract
Background. Illness adjustment is a widely studied area in the palliative care context. However, research focusing on how altered body image can affect men and women in palliative care is limited and unclear.
Aim. To explore the links between palliative care patients’ affected sense of self, altered body image and terminal illness adjustment.
Design. Semi-structured interviews were conducted, and the Interpretative Phenomenological Analysis approach was used to analyse patients’ experiences.
Setting/Participants. English-speaking, adult palliative care outpatients were interviewed at a local community hospice in the United Kingdom. The mean age was 55 years (ranging from 35 – 65).
Results. Analysis of accounts indicated three superordinate themes: (I) ‘Not being me’: self-discrepancy, (II) Existing in the landscape of loss, (III) Living and thriving in the landscape of loss. The most disturbing issues, such as appearance-focused struggles and low body-confidence were stemming from participants’ frustration over their lack of control and their attachment to their former self-image.
Conclusions. The patients’ insights demonstrated that body image distress was prevalent amongst all respondents regardless of gender or diagnosis. A spiral model is described showing how discrepancy-based processing (i.e. ‘not being me’) and rigid attachment to former self, can have harmful consequences on palliative patients’ abilities to cope. In order to facilitate adjustment to a self-identity crisis resulting from a terminal diagnosis, it is necessary for professionals to recognise and address body image changes among palliative care outpatients.