To explore patients’ existential challenges when living with chronic pain or multiple sclerosis, 23 semistructured patient interviews were conducted together with an interpretative, phenomenological analysis inspired by Søren Kierkegaard. Patients experienced their illness as a “stroke of fate” resulting in despair and a profound struggle to find out, who they were, and how they could relate to themselves in their new life-situation. Becoming oneself was experienced as a long-term existential process realized by synthesizing the existential poles of necessities and possibilities through “the other,” such as relationships, nature, spirituality, or God. The different ways to respond to the existential challenges were identified as subjective choices of aesthetic, ethic, and religious life-spheres. The Kierkegaardian relational self and the life-spheres as diverse possibilities are valuable for understanding patients’ existential challenges and the complicated process of finding a new way to relate to oneself when life is fundamentally transformed by illness. To resolve the existential struggles, it seems essential to take a subjective stand in life and have a relationship to something bigger than oneself. The findings can inform clinical practice and inspire health care professionals to identify patients who would welcome a dialogue about illness-related existential struggles for the benefit of their health.

This article aims to understand why religion has proven difficult to address in secular healthcare, although existential communication is important for patients’ health and wellbeing. Two qualitative data samples exploring existential communication in secular healthcare were analyzed following Interpretative Phenomenological Analysis, leading to the development of the analytical constructs of ‘the secular’ and ‘the non-secular’. The differentiation of the secular and the non-secular as different spheres for the individual to be situated in offers a nuanced understanding of the physician–patient meeting, with implications for existential communication. We conceptualize the post-secular negotiation as the attempt to address the non-secular through secular activities in healthcare. Employment of the post-secular negotiation enables an approach to existential communication where the non-secular, including religion, can be addressed as part of the patients’ life without compromising the professional grounding in secular healthcare. The post-secular negotiation presents potential for further research, clinical practice, and for the benefit of patients.

Objective: Research suggests that existential, spiritual, and religious issues are important for patient’s psychological adjustment when living with chronic pain and multiple sclerosis. However, there is a paucity of studies investigating how physicians experience and approach these patients’ needs. Design: Physicians’ experiences with and approaches to existential, spiritual, and religious needs when treating chronic pain or multiple sclerosis were studied in eight semi-structured interviews and analysed using interpretative phenomenological analysis (IPA). Results: Physicians found that only few patients had spiritual and religious needs; however, they experienced that every patient were struggling with existential challenges related to the illness and rooted in a changed identity and approaching death. How the physicians approached these needs appeared to be influenced by six conditions: Their medical culture, training, role, experiences of time pressure, their personal interests, and interpersonal approach. Conclusion: Physicians’ training seems better suited to meet biomedical objectives and their patients’ concrete needs than patients’ wish for a relational meeting focused on their subjective lifeworld. This challenge is discussed in relation to modern patient-centeredness, doctor-patient relationship, culturally constructed experiences of privacy, and future clinical practice and research needs.

Research documents that many chronic non-malignant pain patients experience existential, spiritual and religious needs; however, research knowledge is missing on if and how physicians approach these needs. We conducted a systematic review to explore the extent to which physicians address these needs in their communication with chronic non-malignant pain patients and to explore the facilitators and challenges of this communication. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searching Embase, Medline, Scopus and PsycINFO. The quality of the included articles was assessed based on design-specific screening tools. We included four of 2337 screened articles and found the quality to be good. Physicians’ communication about existential, spiritual and religious needs was given low priority and depended on the patients’ own initiative, except when clinicians were interested in holistic care. Patient dissatisfaction with the physician’s attention to these needs was related to higher pain and depression. Physicians’ challenges for addressing these needs were their tendency to prioritize physiological aspects and close further elaboration of existential needs when addressed by the patients. The main facilitator was the individual physician’s willingness to listen with openness and empathy to the patients’ existential concerns. A tentative conclusion is that physicians rarely meet the existential, spiritual and religious needs of their chronic non-malignant pain patients. This might be due to higher priority of physical aspects, lack of time and a lack of knowledge about the importance of and training in the ability to address these needs. Further research is needed on physicians’ communication about existential, spiritual and religious needs and on their training in here.

In a post-secular society, the secular and non-secular co-exist and a negotiation can therefore be needed to secure the secular grounding of professional approaches and the respect for the diversity of subjective lifeworlds of individuals. Post-secular negotiation is a theoretical concept and methodological approach enabling the meeting between the secular and the non-secular in a post-secular society at three levels: (a) the societal, (b) the inter-/disciplinary, and (c) the local level in the meeting between professionals and help-seekers. Post-secular negotiation is theoretically grounded in an understanding of societies as social constructions, on existential theory, and on the phenomenological concept of the Ontological Epoché. Post-secular negotiation can be applied in qualitative research and clinical practice in existential communication as an approach to the diversity of the subjective lifeworld of the individual that does not compromise the secular grounding of the professional. For professionals in research and clinical practice to conduct a post-secular negotiation, a double-loop self-reflective practice is significant, and keeping a logbook is presented as a tool supporting this. The article presents post-secular negotiation as an approach to existential communication in research and daily clinical practice and discusses it as an ethical demand and potential for resonance.