Missed opportunities to promote flourishing in cancer care: a brief examination of multiple myeloma

Recent theoretical and empirical advancements in well-being science can have meaningful implications for medical care when considering existential issues faced by people with incurable or life-limiting cancer diagnoses. We propose the possibility that certain elements of flourishing, such as meaning and purpose, deep personal relationships, and virtue, can be uniquely realised if targeted appropriately when life is ending. Using exploratory data from a study focussed on identifying the unmet psychological needs of patients living with the blood cancer multiple myeloma, we thematically analysed interviews with patients and clinicians to explore the possibility of flourishing at the end of life. Smouldering myeloma and multiple myeloma patients (n = 25) reported personal growth following their diagnosis through acceptance, meaning-making, and connection, yet reported the loneliness of dying with cancer with a desire to have a discussion about death in addition to their clinician focusing on maintaining treatment. On the contrary, clinicians (n = 10) were hesitant to discuss death, balancing hope in treatments with preparation for dying. We argue that the hesitation to discuss death thwarts the opportunity to flourish, and that existing solutions such as dignity therapy, meaning-centred psychotherapy, early palliative care, and multidisciplinary support can close this gap without diminishing hope in treatments.