SAMPLE THESIS TITLE WITH A CONCISE AND ACCURATE DESCRIPTION


i 

 

EXPLORING THE LIVED EXPERIENCE OF THE HUMAN-COMPANION ANIMAL 

RELATIONSHIP FOR PEOPLE WITH CANCER 

by 

 

Nandini Maharaj 

 

B.A., The University of British Columbia, 2009 

M.A., The University of British Columbia, 2013 

 

A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF 

THE REQUIREMENTS FOR THE DEGREE OF 

 

DOCTOR OF PHILOSOPHY 

in 

THE FACULTY OF GRADUATE AND POSTDOCTORAL STUDIES 

(Interdisciplinary Studies) 

 

THE UNIVERSITY OF BRITISH COLUMBIA 

(Vancouver) 

 

October 2019 

 

© Nandini Maharaj, 2019 



ii 

 

 

The following individuals certify that they have read, and recommend to the Faculty of Graduate 

and Postdoctoral Studies for acceptance, the dissertation entitled: 

 

Exploring the lived experience of the human-companion animal relationship for people with 

cancer 

 

submitted by Nandini Maharaj in partial fulfillment of the requirements for 

the degree of Doctor of Philosophy 

In Interdisciplinary Studies 
 

Examining Committee: 

Arminee Kazanjian 

Co-supervisor 

Bill Borgen 

Co-supervisor  

Rosemin Kassam 

Supervisory Committee Member 

Ken Bassett 

University Examiner 

Marla Buchanan 

University Examiner 

 



iii 

 

 

Abstract 

More than half of Canadians share their homes with a pet (i.e. companion animal). 

Outside of the home, researchers and practitioners have increasingly embraced pets for their 

health-enhancing potential. Still our understanding of the relationship between cancer patients 

and their pets remains inadequate and incomplete. The purpose of this phenomenological study 

was to explore the lived experience of the human-companion animal relationship for people with 

cancer. I sought to examine how people engage in meaning-making through their intimate 

relationships with their pets. I recruited participants from cancer centres and community-based 

organizations that provide psychosocial support to cancer patients and their families. Using the 

method of photo-elicitation, I conducted in-depth interviews with nine women and five men. The 

participants varied with respect to age, the stage and type of cancer, and the type of pet in their 

care (e.g. dog, cat, and fish).  

After transcribing the interviews verbatim, I analyzed the transcripts using an iterative 

process of reading, reflecting upon, and writing out my interpretations. One such method 

involved seeking the assistance of researchers and health care professionals to analyze data 

extracts from the 14 original interviews. From the eight phenomenological themes that I 

generated, I identified three higher-level themes, known as super-ordinate themes, which 

correspond to the following meaning-making strategies: disengagement/acceptance, distraction, 

and support seeking. These super-ordinate themes are presented using anecdotes and quotations 

from participants, as well as, my own interpretive commentaries. I discuss the findings in light of 

theoretical constructs and empirical research. Highlighted in the discussion are implications of 

the study for research and practice in supportive cancer care, along with potential avenues for 

future investigation. 



iv 

 

 

Lay Summary 

The purpose of this study was to explore the meaning of pets for people with cancer. 

Phenomenology is a research method that can be used to draw out people’s experiences in order 

to understand what is unique to an individual, and what is common to human experience. I 

interviewed nine women and five men, and invited them to bring in photos of their pets for 

discussion. After transcribing the interviews, I read the transcripts repeatedly, wrote out my 

interpretations, and discussed the findings with researchers and health care professionals. I 

identified eight themes, which I then organized into three overarching themes. Themes refer to 

patterns of meaning that repeat themselves in a set of interviews. Some themes confirm findings 

from previous studies while others offer new insights into the meaning and importance of the 

human-pet relationship. I conclude with health system implications of the study and directions 

for future research.   



v 

 

 

Preface 

This dissertation, including the research design, data collection, interview transcription, 

data analysis, and manuscript writing, is my original work. I sought feedback from my 

supervisory committee in designing and implementing the study protocol, including the 

participant recruitment strategy and interview guide. After completing a first round of analysis 

on the 14 interviews, I sought the assistance of two human-animal bond researchers and three 

cancer care specialists with analyzing data extracts from the interviews.  

I received approval to conduct this study from the Behavioural Research Ethics Board of 

the University of British Columbia. The UBC Ethics Certificate number is H16-01471.  

 

 

 

 



vi 

 

 

Table of Contents 

Abstract ................................................................................................................................... iii 

Lay Summary ........................................................................................................................... iv 

Preface ....................................................................................................................................... v 

Table of Contents ..................................................................................................................... vi 

List of Tables ............................................................................................................................ xi 

List of Figures..........................................................................................................................xii 

Acknowledgements ................................................................................................................ xiii 

Dedication ................................................................................................................................ xv 

Prologue ..................................................................................................................................... 1 

Chapter 1: Introduction ............................................................................................................ 3 

1.1 Background of the Study..............................................................................................3 

1.2 Relevance of the Study ................................................................................................5 

1.3 Defining Key Concepts ................................................................................................7 

1.3.1 The Psychosocial Impact of Cancer..........................................................................7 

1.3.2 The Human-Animal Bond ...................................................................................... 10 

1.3.3 Meaning-Making and Spirituality........................................................................... 14 

1.4 Theoretical Framework .............................................................................................. 19 

1.4.1 Attunement and Relationship Science .................................................................... 20 

1.4.2 Carver’s Model of Resilience and Thriving ............................................................ 22 

1.5 Phenomenological Approach to the Study .................................................................. 24 

Chapter 2: Literature Review ................................................................................................. 28 

2.1 Pets and Human Health .............................................................................................. 29 



vii 

 

 

2.1.1 Salutary Effects of Pets .......................................................................................... 29 

2.1.2 Therapeutic Effects of Pets .................................................................................... 31 

2.1.3 Companion Animals and Cancer ............................................................................ 36 

2.2 Human Health and Spirituality ................................................................................... 39 

2.2.1 Cancer and Spiritual Coping .................................................................................. 39 

2.2.2 Cancer and Meaning-Focused Coping .................................................................... 44 

2.2.3 Cancer and Meaning-Making ................................................................................. 49 

2.3 Spirituality and Pets ................................................................................................... 51 

2.3.1 Spiritual Significance of the Human-Animal Bond ................................................. 51 

2.3.2 Sacred Consumption and the Human-Animal Bond................................................ 53 

2.3.3 Meaning-Making and Companion Animals ............................................................ 55 

2.4 Conclusion................................................................................................................. 58 

Chapter 3: Methodology ......................................................................................................... 60 

3.1 Phenomenological Approach to Inquiry ..................................................................... 60 

3.1.1 Philosophical Underpinnings of Phenomenology ................................................... 60 

3.1.2 Situating Max van Manen’s Phenomenology ......................................................... 63 

3.1.2.1 Phenomenology as attitude ............................................................................. 65 

3.1.2.2 Phenomenology as method ............................................................................. 67 

3.1.2.3 Phenomenology as writing and reflecting ....................................................... 68 

3.2 Research Design ........................................................................................................ 69 

3.2.1 Methods for Collecting Lived-Experience Descriptions ......................................... 70 

3.2.1.1 The experiential data-gathering interview ....................................................... 70 

3.2.1.2 Photo elicitation ............................................................................................. 71 



viii 

 

 

3.2.2 Study Procedures ................................................................................................... 71 

3.2.2.1 Participant selection ....................................................................................... 71 

3.2.2.2 Recruitment and research context ................................................................... 72 

3.2.2.3 Interviews ...................................................................................................... 74 

3.3 Data Analysis ............................................................................................................ 77 

3.3.1 Reflective Methods for Exploratory Noting and Theme Development .................... 79 

3.3.1.1 Making initial and exploratory notes .............................................................. 79 

3.3.1.2 Developing emergent themes ......................................................................... 80 

3.3.1.3 Isolating phenomenological themes ................................................................ 81 

3.3.2 Reflective Methods for Writing and Rewriting a Phenomenological Text............... 84 

3.3.2.1 The experiential anecdote ............................................................................... 84 

3.3.2.2 The vocative method ...................................................................................... 85 

3.3.2.3 The data-interpreting interview ...................................................................... 86 

3.3.3 Trustworthiness Criteria for Qualitative Research .................................................. 87 

3.3.3.1 Conditions for data collection ......................................................................... 87 

3.3.3.2 Conditions for data analysis ........................................................................... 88 

Chapter 4: Results ................................................................................................................... 92 

4.1 Demographic Characteristics ..................................................................................... 92 

4.2 Findings ..................................................................................................................... 97 

4.2.1 Super-ordinate Theme: (Dis)connecting with the Journey ...................................... 97 

4.2.1.1 It’s hard to erase those words ......................................................................... 99 

4.2.1.2 It’s amazing how in evolution ...................................................................... 106 

4.2.1.3 It flickers by so quickly ................................................................................ 114 



ix 

 

 

4.2.2 Super-ordinate Theme: Pulling you out of yourself .............................................. 121 

4.2.2.1 It’s sort of silly, but ...................................................................................... 122 

4.2.2.2 It’s a sense of responsibility ......................................................................... 130 

4.2.3 Super-ordinate Theme: Speaking Volumes with their Actions .............................. 137 

4.2.3.1 It’s a silent kind of love ................................................................................ 139 

4.2.3.2 It mattered that they were there .................................................................... 146 

4.2.3.3 It’s like each living thing has meaning .......................................................... 152 

4.3 Reflections on the Use of Photo-elicitation .............................................................. 160 

Chapter 5: Discussion ........................................................................................................... 164 

5.1 Overview of the Study ............................................................................................. 164 

5.2 Theoretical Framework Revisited ............................................................................ 165 

5.3 Key Findings from the Eight Phenomenological Themes ......................................... 171 

5.3.1 Kindred Play ........................................................................................................ 171 

5.3.2 Mattering Presence .............................................................................................. 176 

5.3.3 Impetus to Hope ................................................................................................... 180 

5.3.4 Animal-Human Divide ......................................................................................... 186 

5.3.5 Transcendent Relationships .................................................................................. 191 

5.4 Implications ............................................................................................................. 197 

5.4.1 Play and Social Connection .................................................................................. 197 

5.4.2 Enrichment and Engagement ................................................................................ 199 

5.4.3 Empathy and Imaginal Coping ............................................................................. 202 

5.5 Limitations .............................................................................................................. 204 

5.6 Future Directions ..................................................................................................... 206 



x 

 

 

5.7 Conclusion............................................................................................................... 209 

References.............................................................................................................................. 213 

Appendices ............................................................................................................................ 247 

Appendix A Literature Review Search Strategy ................................................................... 247 

Appendix B Recruitment Poster .......................................................................................... 248 

Appendix C Consent Form .................................................................................................. 249 

Appendix D Interview Guide ............................................................................................... 254 

Appendix E Demographic Questionnaire ............................................................................. 256 

Appendix F Example of Exploratory Noting and Isolating Themes ..................................... 258 

 



xi 

 

 

List of Tables 

Table 1 Participant socio-demographic and cancer information ................................................. 94 

Table 2 Pet information ............................................................................................................. 96 

 



xii 

 

 

List of Figures 

Figure 1 Intersections identified in the literature ........................................................................ 28 

Figure 2 The eight phenomenological themes organized into super-ordinate themes .................. 97 

Figure 3 Title and abstract screening to identify primary and secondary literature ................... 247 

 



xiii 

 

 

Acknowledgements 

I gratefully acknowledge the 14 women and men who took part in this study. I was 

deeply touched by the vulnerability and fearlessness you showed while sharing your stories with 

me. I wish you and your beloved animals a long and happy life together.  

I thank my supervisory committee, Arminée Kazanjian, Bill Borgen, and Rosemin 

Kassam for their continued support and encouragement. Your guidance has been invaluable to 

the development and success of this project.   

I acknowledge funding support from the Social Sciences and Humanities Research 

Council and UBC Affiliated Fellowships. Thank you to Steven Taubeneck and Enid Ho.  

I offer my gratitude to the following organizations for promoting the study: Callanish 

Society, BC Cancer Agency, Vancouver ecoVillage, and Simply Natural Raw Pet Food.  Thank 

you to Lyn Rae, Colleen Haney, and Barbara Weber.  

A very special thank you to Dr. Richard Calland for the care and attention you have 

shown Dally over the years.  

It is no surprise that the first poem I ever wrote was about dogs: To Peppy, Lassie, 

Peppy’s son, and Laddie. And to all the brindle brothers and great southern writers. 

To Rusty, thank you for breathing life into me. I’ve never needed someone so much. You 

test my patience everyday but I love you dearly…so until tomorrow…  

To Frankie, thank you for your warmth, penetrating stare, unabashed jealousy, and total 

disregard for personal space. With you, under the moonlight, I never feel left behind.  

To Ma, thank you for bringing light to our home. You are an exceptional mother. Thank 

you for your care and devotion and all the warm meals and handmade clothes.  



xiv 

 

 

To Daddy, I hope I’ve made you as proud as when I said “pearl white.” Thank you for 

keeping me up late to watch Psycho, Jaws, and every Bruce Lee movie (and Cinderella too). I 

share with you a love of dogs, talent for art, and unmatched loyalty. Please take care of Dally.  

To mum, with love. You are the first and best teacher I have ever had. I have been 

listening and learning from you even before we ever laid eyes on each other. You taught me 

letters and circles and everything in between. I love you more today than yesterday. Thank you 

for showing me how to be a good mom to Dally—the best mom. And remember all we have 

learned together: slide on the ice, give ‘em hell army, if you give away one you’ll only have two, 

it’s nice to be the nice, and doctors can’t change rule number one. You are the Dorothy to my 

Sophia (alright I’m Rose), and the Harry to my Barbara (alright I’m Carol).  

 

‘Night sweet Prince 



xv 

 

 

Dedication 

 

I dedicate this work to my dearest Dally. You are a truly inspiring creature. You were not the dog 

I imagined but instead the son I never knew I wanted. Your miraculous capacity to heal yourself 

never ceased to amaze me. You somehow woke up even handsomer every day.  

Said the owl to the dove, you’re someone I can’t live without but have to let go.  

Our sun bathing • bench sitting • deep conversations on our walks • evening walks with Gayatri • 

chaise lounging • bath time singing • never-ending back scratches and then you pawing at me or 

biting me to continue scratching • finding a good use for my years of learning TV theme songs • 

cuddling on your couch at my insistence • the first time you initiated a snug after 8 years • snugs 

and nuzzles at 12:14 • cleaning your wrinkles every morning • brushing your teeth while you bit 

my fingers • wrangling you into the bath tub, though you did try to make a get-away each time • 

tensely clipping your nails • watching you sleep with that grimace on your face • hearing you 

snore overnight and then worrying when I didn’t hear you snoring • kissing you on your shiny 

black lip, though you pulled away most times • licking my feet and legs after a shower • bum 

scratches in the bathroom • sitting at the top of the stairs when it was the first day of school • 

watching you see a horse for the first time • watching you in the snow on your first birthday • 

baking you treats • watching you enjoy your treats • our home run on the baseball diamond • 

taking you to see Santa • chipping my tooth our first Halloween • sneaking your pills into your 

food • watching you sneakily eat everything and leave the pill behind • pulling me into traffic to 

get away from someone you didn’t want to pet you • hiding under the coffee table when you 

didn’t want to go for a walk • our many vet visits and recovery periods • making a bed of 

anything on the floor  

 

 

 



1 

 

Prologue 

In accordance with van Manen’s (1997, 2014) treatment of the reduction, it was 

necessary to make my assumptions about the human-companion animal relationship explicit. I 

discussed my beliefs with others, formally and informally. I engaged in reflective journaling, 

keeping an audit trail of my questions and insights. I wrote about my profound curiosity and 

affection towards animals, both the ones I’ve shared my life with and those whom I’ve admired 

from afar. One such curious animal is the English bulldog or simply the bulldog. Due to 

unethical breeding practices, this former bastion of athleticism is now ranked among the 

unhealthiest breeds with significant and enduring health problems. These are the same charges 

levied against me as the guardian of Dally, a bulldog with characteristic health problems and 

uncharacteristic strength and resilience, the kind usually reserved for his genetic forerunners.  

Dally is not my first dog, my fifth in fact, and we share an unspoken bond that always 

seems otherworldly to me. While waking from sleep, we open our eyes together in synchronous 

fashion. And even while loving this extraordinary creature whom I consider my son and twin 

soul, I’m aware that people think that he is just a novelty, a popular dog breed, or worse, a 

pitiable relic and tragedy of genetics and poor breeding. Dally is not a dog to be underestimated. 

He walks with great agility and elegance without the distinctive waddle typical of some bulldogs. 

He eats with fervor, every time looking up as if to say “what’s next?” He sleeps deeply, snoring 

at times until he wakes himself and turns around to stretch out in another direction. He chews 

only one side of each new toy. He turns his head away from me as I approach him with a camera. 

He appears disdainful when I try to kiss him. He always wants me to initiate a cuddle (except for 

exactly three times). This genetic catastrophe is the love of my life. 



2 

 

 

I often wonder why I relate to him so much and what his story shares with the stories that 

ground this dissertation. People look at Dally and make up their minds about him. They look at 

me and my skin colour or see my first and last name. They wonder where I was born and what 

my first language is or in one memorable instance if I’m Dally’s dog walker. These are the same 

thoughts I kept returning to while reflecting on the experiences of these 14 individuals. I 

wondered how they could take of their pets while going through such a difficult time. I wondered 

if I myself would have the strength to care for Dally if I were in their shoes. I wondered what 

they thought of me pursuing a PhD about pets, of all things. When they spoke of the inevitability 

of losing their pet, my eyes welled up too, thinking about Dally. When we shared a laugh, I 

thought of Dally and his strange quirks. In hearing a participant’s story about euthanasia, I 

wondered if I would ever have to make such a difficult decision and would it be to end Dally’s 

suffering or mine. I wondered all these things as I listened deeply to their stories.  

As I say later in this work, and paraphrase here, I sat with these once healthy human 

companions now suffering from the effects of the disease and its treatment. And then I thought 

of Dally and how people discount him and underestimate him at every turn. I know better 

because of him and from the experiences of these women and men. As in the reduction, I pushed 

through my beliefs and concepts about what it means to be a cancer patient, attempting to 

appreciate the person before me. And still, it was not enough to see them as a person but to 

appreciate them as loving guardians who mattered to their pets. The themes and essences I 

uncovered are universal as I see them and write about them. But it wouldn’t be entirely true to 

say that these stories are altogether mine. These are the words and experiences of 14 individuals, 

filtered through my assumptions and preconceptions. And if I’m truly honest with myself, if you 

want to know Dally’s story, keep reading…



3 

 

 

Chapter 1: Introduction 

In this chapter, I introduce the reader to the phenomenon of interest—the human-

companion animal relationship for people with cancer. I discuss the relevance of the study in the 

context of social science and health science research, as well as, contemporary approaches to 

studying the human-companion animal relationship. After discussing the concepts and theories 

underlying this research, I invite the reader to look beyond these concepts and theories in order 

to adopt the kind of “wondering pathos” that exemplifies phenomenological inquiry. 

Phenomenology begins with wonder and curiosity, meaning we approach our inquiry with an 

openness and attentiveness to how people describe their lived experience. The chapter concludes 

with the research question. 

1.1 Background of the Study 

Many people experience a deep sense of affiliation and kinship with companion animals. 

Companion animals are valued for their affection, companionship, loyalty, and authenticity. 

Their inimitable qualities strike at the core of who we are as human beings allowing us to find 

meaning and purpose in the ordinary and mundane aspects of our lives. They remind us of the 

fragile nature of life and the interconnectedness of all living beings (Skeen, 2011), which has 

been called the foundation of compassion (Faver, 2009). This sense of interconnectedness along 

with a need to find meaning may take on particular significance when confronting a life 

threatening illness such as cancer (Jim, Richardson, Golden-Kreutz, & Andersen, 2006; J. A. 

Smith, Flowers, & Larkin, 2009). Receiving a cancer diagnosis can profoundly impact people’s 

beliefs about themselves and their relationships (Girardin, 2000; Vachon, 2008). Some authors 

refer to this as a “crisis of meaning” or “spiritual crisis,” leading to a search for meaning 

(Carroll, 2001; van der Spek et al., 2013).  



4 

 

 

People often look to various sources to find meaning, including their interpersonal 

relationships (e.g. family, friends, community), creative pursuits (e.g. art, music, literature), and 

spiritual practices (e.g. meditation, prayer, yoga) (Molzahn et al., 2012; Pargament & Mahoney, 

2002; Streng, 1976). The outcomes of this search for meaning often have implications for a 

person’s well-being and adjustment to cancer (Molzahn et al., 2012). While some patients fare 

poorly in particular domains of psychological functioning such as anxiety and depression 

(Johnson, Meadows, Haubner, & Sevedge, 2008; Mehnert et al., 2012; Molzahn et al., 2012), a 

number of them demonstrate personal growth and resilience (Costanzo, Ryff, & Singer, 2009). 

Understanding the psychosocial factors that promote resilience in some patients and distress in 

others provides an important topic for investigation (Carver, 1998; van der Spek et al., 2013).  

During times of stress and illness, some people seek out animals for companionship and 

spiritual guidance (Anderson & Anderson, 2003; Faver, 2009; Goodall, 1999; Hanrahan, 2011; 

Holak, 2008; Holt, 2001; Manes, 1997; McElroy, 1998). Borrowed from the words of renowned 

primatologist Jane Goodall (1999), this affinity toward other living beings can be described as a 

“sense of wonder, of awe, that can lead to spiritual awareness” (p. 3). Likewise, Temple 

Grandin’s work as an educator and animal activist demonstrates that animals have much to teach 

us about our own spiritual development (Grandin & Johnson, 2009). By adopting a stance of 

openness and curiosity, we can enter into mutually beneficial relationships with animals that 

transcend notions of human superiority over nonhuman animals (Faver, 2009; Skeen, 2011). 

Long recognized among indigenous groups, ancient cultures, and non-Western teachings (Coren, 

2008; Skeen, 2011), this spiritual kinship or bond between people and animals has garnered 

increased attention in academic disciplines as diverse as anthropology, philosophy, psychology, 

literature, and veterinary medicine (B. P. Smith & Litchfield, 2009). However, to my knowledge, 



5 

 

 

this convergence of having a relationship with a companion animal, making meaning, and using 

spiritual coping has yet to be investigated within the context of cancer. The purpose of this 

phenomenological study is to develop an essential understanding of the nature and meaning of 

the human-companion animal relationship for people with cancer (van Manen, 1997).  

1.2 Relevance of the Study 

Research indicates that, aside from physiological benefits associated with having a pet, 

many people cherish their pets’ companionship and its impact on their quality of life 

(Podberscek, Paul, & Serpell, 2000; Ryan & Ziebland, 2015; Staats, Sears, & Pierfelice, 2006). 

Nevertheless, the health-promoting and therapeutic benefits of pets have attracted the most 

attention in peer-reviewed publications, media releases, and popular works (Becker & Morton, 

2002; Sakson, 2009; Thomas, 2015). The emergence of animal-assisted interventions (e.g. visits 

with therapy animals) is buttressed by research linking interactions with therapy animals to 

physiological processes that are critical for maintaining one’s overall health (Marcus, 2012b). 

However, even as hospitals, nursing homes, and cancer care facilities continue to embrace 

therapy animals in their complementary and alternative programs, our understanding of the close 

bonds that develop between people with cancer and their companion animals remains inadequate 

and incomplete (Franklin, Emmison, Haraway, & Travers, 2007; Ryan & Ziebland, 2015).  

A study from the University of Oxford suggests that the tendency to discount the role of 

pets in qualitative health research is not uncommon (Ryan & Ziebland, 2015). Ryan and 

Ziebland conducted a secondary analysis of 61 in-depth interviews with people suffering from 

long-term conditions and the carers of these patients. The researchers found that the interviewers 

seldom initiated discussions about pets, even when pets were present, and often chose not to 

follow-up when participants talked about their pets. Interactions between participants and their 



6 

 

 

pets were described as “interruptions” in verbatim transcripts of the interviews. Such findings are 

concerning when we consider that companion animals are involved in some of the most intimate 

areas of a person’s life (Cohen, 2002; E. Power, 2008). These cherished companions can provide 

researchers with valuable insights into relational dynamics that are important for a person’s 

health and well-being (Balcombe, 2009; Fraser, 2009; Girardin, 2000; Würbel, 2009b).  

Historically, research on the human-animal bond has been conducted using positivist 

methods such as laboratory experiments (Fraser, 2009; Shen-Miller, 2011). Such methods 

continue to play an integral role in strengthening the scientific credibility of approaches to 

studying the human-animal bond (Würbel, 2009a). For example, in animal welfare research, the 

use of behavioural and physiological measures has done much to advance our understanding of 

animal behaviour and cognition (Fraser, 2009; Grandin, 2005; Shen-Miller, 2011; Würbel, 

2009a). National funding agencies have directed their efforts towards studying the health-related 

effects of pet ownership and pet therapy using robust scientific measures (Cherniack & 

Cherniack, 2015; Fraser, 2009). Although these findings are instructive, they fall short of 

providing an empirical understanding of the meaning or essence of the human-companion animal 

relationship for people with cancer (Ryan & Ziebland, 2015; Shen-Miller, 2011).  

Many facets of the human-animal bond are not amenable to quantification or 

experimental manipulation. Qualitative methods can provide the necessary empirical grounding 

from which to develop clinically meaningful applications and interventions (McPhedran, 2011). 

A considerable advantage of conducting qualitative interviews is the ability to probe further and 

elicit details about topics that are pertinent to the very people we wish to know more about in our 

work (K. T. Ashing-Giwa et al., 2004; Krueger & Casey, 2009; Ryan & Ziebland, 2015). 

Qualitative methods aim to reveal the complexity of a particular phenomenon within its natural 



7 

 

 

context (Fraser, 2009; Guba & Lincoln, 1994). Accordingly, researchers have the flexibility to 

move between inductive (i.e. driven by the data) and deductive (i.e. driven by hypotheses) 

reasoning to understand the meaning that people attribute to their experiences (Morrow, 2007; 

Shen-Miller, 2011). Consistent with a social constructivist epistemology (Carter & Little, 2007), 

this study draws upon qualitative methods that allow researchers and participants to co-construct 

rich narratives that are grounded in the experiences of the participants (Shen-Miller, 2011).  

In a previous study on the meaning of having a companion dog (Maharaj, Kazanjian, & 

Haney, 2016), participants described their relationship with their dogs as having a spiritual 

quality. Some participants reported that their dogs provided a connection to a loved one who had 

passed away. Others described finding greater peace and enjoyment of being out in nature when 

accompanied by their dogs. Extending this work, the purpose of this study is to understand the 

nature and meaning of the human-companion animal relationship during periods of serious 

illness and recovery. Studying the experiences of people with cancer provides a rich context for 

exploring the deeply embodied meanings of the human-companion animal relationship.   

1.3 Defining Key Concepts 

1.3.1 The Psychosocial Impact of Cancer  

The burden of cancer is considerable, with nearly one in two Canadians expected to be 

diagnosed with cancer during their lifetime, and one in four projected to die from cancer in 2017 

(Canadian Cancer Statistics Advisory Committee, 2018). Many cancer patients describe 

experiencing pain, functional impairments, chronic fatigue, existential concerns, and family 

burden (Mehnert et al., 2012; van der Spek et al., 2013). Cultural understandings of cancer as 

being synonymous with suffering and death remain, in spite of progress in cancer care (Bultz & 

Carlson, 2006; Waldrop, O’Connor, & Trabold, 2011a). Lung, breast, colorectal, and prostate 



8 

 

 

cancer make up roughly half of new cancer cases and cancer deaths in Canada (Canadian Cancer 

Statistics Advisory Committee, 2018). Slightly more men than women develop cancer. 

Canadians over the age of 50 account for the majority (89%) of cancer cases (Canadian Cancer 

Society’s Advisory Committee on Cancer Statistics, 2015). For most types of cancer, advances in 

prevention, screening, and treatment have contributed to improved survival rates (Kazanjian, 

Smillie, Howard, Ward, & Doll, 2012).  

The term cancer survivorship is used to describe a “distinct phase in the cancer trajectory 

that occurs between the end of primary treatment and recurrence or end of life” (Doll, Kazanjian, 

Smillie, Ward, & Chasen, 2012). While 80,800 Canadians are expected to die of cancer in 2017, 

it is estimated that as of January 2009, over 800,000 Canadians are living with and beyond 

cancer (Canadian Cancer Statistics Advisory Committee, 2018). This growing population of 

people living with cancer (i.e. cancer survivors, current and former cancer patients) has unique 

psychosocial needs (Costanzo et al., 2009; Doll et al., 2012; van der Spek et al., 2013). 

Psychosocial oncology is a specialty within cancer care that is concerned with understanding and 

addressing the psychological, social, emotional, spiritual, functional, and quality of life aspects 

of cancer (Murph, 2010). A whole-person approach is used to provide optimal care for patients 

through the cancer journey, from prevention to bereavement (Bultz & Carlson, 2006; Murph, 

2010). Although research on psychosocial oncology is relatively common in scientific journals 

and conferences, it is useful to unpack these terms before delving into the literature. The root, 

“psycho,” refers to aspects relating to the mind, mental states, or mental processes while “social” 

refers to people’s relationships with others (Murph, 2010). “Oncology” is the branch of medicine 

that is concerned with the prevention, diagnosis, and treatment of cancer.  



9 

 

 

A related concept is supportive care, a key element of cancer survivorship that 

encompasses a broad range of services and interventions including the following: self-help and 

informational resources, support groups, spiritual care, and patient and family counselling 

(Canadian Cancer Society’s Advisory Committee on Cancer Statistics, 2015; Tighe, Molassiotis, 

Morris, & Richardson, 2011). Supportive care is not limited to a particular area of practice within 

cancer care, nor is it dependent upon the phase or type of cancer. Instead, supportive care is an 

obligation of all cancer care professionals in demonstrating respect for a person’s inherent 

dignity (Richardson, 2004). At the center of supportive care are the patients, as well as, the carers 

and family members of those affected by cancer, hence the continued growth of psychosocial 

interventions.  

The psychosocial oncology literature attests to the importance of social support as a 

buffer against the effects of stress, and the essential role of the mind and spirit in healing and 

recovering from cancer (Bultz & Carlson, 2006; Dunkel-Schetter, Folkman, & Lazarus, 1987). 

Treatment for cancer is often accompanied by tremendous upheaval and uncertainty. Yet, 

somewhat paradoxically, maintaining a treatment regimen also provides a level of consistency 

and certainty (Canadian Cancer Society’s Advisory Committee on Cancer Statistics, 2015). 

During the survivorship phase, people often resume regular activities as they reflect upon their 

cancer experience. Although ongoing support is available for some people, others may feel alone 

in their cancer experience (van der Spek et al., 2013; Yalom & Josselson, 2011). For others, 

social support may decline as people have less contact with their health care team, and also 

perhaps, family members and friends. One constant that endures for many people in this journey 

is the companionship of a beloved pet. Few people can match the level of dedication and 



10 

 

 

unmitigated loyalty of pets toward their human caretakers. Central to this extraordinary 

relationship is the experience of connection and validation (Blazina, 2011).  

For people, being able to explore as well as express the meaning of their relationship with 

companion animals may bring new understandings of their cancer experience and survivorship 

experience; for health care providers, the agency to better address the needs of patients; and for 

researchers, improved interpretive power to understand the lived experience of people with 

cancer (Blazina, 2011). Different theories have been proposed to help account for why some 

people’s relationships with companion animals are so important for their health and well-being. 

Before discussing the theoretical framework for the study, I describe key concepts surrounding 

the human-animal bond, noting definitions that are commonly found in the literature and 

clarifying my use of these concepts. Next, I draw the reader’s attention to the concept of 

meaning-making and its pertinence to the cancer experience.  

1.3.2 The Human-Animal Bond 

The relationship between humans and animals has been in existence long before the term, 

human-animal bond (HAB), came into popular use (Fine, 2011; Hines, 2003). Attributed to the 

ground-breaking work of Konrad Lorenz and Boris Levinson, the HAB gained formal 

recognition in the 1970s and 1980s in academic reports and the mainstream media, soon working 

its way into the public consciousness (Hines, 2003). An entire field of research known as 

anthrozoology is dedicated to the study of the HAB (Podberscek et al., 2000). Interdisciplinary in 

its scope, anthrozoology encompasses a broad array of perspectives from business, the 

humanities, as well as, the natural, social, and applied sciences (Hanrahan, 2011; Vitztum, 2013). 

Among the manifestations of the HAB is the phenomenon of pet ownership, meaning the 

keeping of animals for pleasure and companionship (Walsh, 2009a). Pets may be acquired 



11 

 

 

through purchase or adoption, and often reside within or near their caretaker’s home. Although 

service animals may cohabit with people, these animals are not considered pets from a legal 

standpoint (Walsh, 2009a). Service animals are working animals and receive extensive training 

in order to provide assistance to people with disabilities, combat veterans, and law-enforcement 

personnel (Pachana, Massavelli, & Robleda-Gomez, 2011).  

Although the terms pet and pet owner are widely used and understood by researchers and 

the general public, these seemingly benign terms belie the controversy surrounding their use 

(Grier, 2006; Walsh, 2009a). Some authors are critical of the term pet, arguing that its use signals 

a failure to recognize the animal’s inherent dignity and self-worth (Sandoe, Corr, & Palmer, 

2015). Likewise, the term owner is considered to imply human mastery over non-human animals 

(Skeen, 2011). Views of animals as “less developed forms of life” once prevailed among 

behaviourists in the mid to late 20th century (Skeen, 2011). Even today, some purists would 

argue that objective assessment of animal behaviour is the only suitable subject matter for 

research (Skeen, 2011). Proponents of an alternate view prefer the terms companion animals and 

guardians or caretakers to refer to animals and people, respectively (McNicholas et al., 2005; 

Pachana et al., 2011). These terms are intended to highlight the emotional connection that some 

people share with animals, as well as, ethical concern for the welfare of animals (Walsh, 2009a). 

What is clear from the above discussion is that the terms used by researchers to describe 

animals are not inconsequential. While I agree that pet and companion animal are not equivalent, 

my use of the term pets is not intended to be demeaning or demoralizing. The very premise of 

this work is based upon my view of pets and people as being mutual partners in an authentic 

relationship (E. Power, 2008; Walsh, 2009a). My interest in the potential well-being effect of 

pets for cancer patients should not be taken to imply that this is the only or most important part 



12 

 

 

of the relationship. Not all pets are considered companion animals, and not all companion 

animals are considered pets. Firstly, people may care for and live in close proximity with pets 

and yet, may not experience the kind of emotional connection that exemplifies the human-

companion animal relationship (Walsh, 2009a). Secondly, people who are entrusted to care for 

animals may develop strong emotional bonds with them (e.g. wildlife, zoo animals), yet these 

animals would hardly be considered pets. Horses are one such example for whom this distinction 

is not entirely clear, as horses can serve as companion animals, working animals, or both 

(Keaveney, 2008; Sandoe et al., 2015). 

In this study, the term pet is used in a broad manner to refer to animals that cohabit with 

and are cared for by people. The term companion animal is used when I wish to emphasize the 

emotional connection between pets and people. Consistent with Sandoe et al.’s (2015) 

conceptual framework, companion animals can be thought of as a “subset” of pets with whom 

people share a “special interactive bond.” The psychological and reciprocal nature of this bond is 

considered to be the key and defining feature of the human-companion animal relationship 

(Sandoe et al., 2015). Accordingly, I have chosen to focus upon cats and dogs, the most common 

household pets in North America (Sandoe et al., 2015). Moreover, considering that the focus of 

this study is on pet ownership among cancer patients, it would be a significant omission to 

overlook the role of pets in a therapeutic context (e.g. animal-assisted therapy, pets as detectors 

of disease), as much of the research with cancer patients has been conducted in this area 

(Fleishman et al., 2015; Marcus, 2012b). Some pets, given their temperament and disposition, 

are trained and certified to provide comfort to people in various settings (Pachana et al., 2011; 

Walsh, 2009a). What follows is a brief explanation of the terminology used in research on 

animal-assisted interventions (AAI).  



13 

 

 

In the literature on AAI, substantial variability exists in the terminology used by 

researchers and clinicians (Fine, 2011; Vitztum, 2013; Walsh, 2009a). Different terms have been 

identified including animal-facilitated therapy, human-animal interaction, animal-assisted visits, 

pet mediated therapy, and pet visits (Vitztum, 2013). The two most widely used terms are 

animal-assisted activity (AAA) and animal-assisted therapy (AAT), both of which are subsumed 

under the broad heading of animal-assisted interventions (Fine, 2011). AAA refers to 

interventions such as pet visits in which teams of therapy animals and their handlers visit patients 

in health care settings (Bibbo, 2013). AAA varies in length and time, can be delivered 

individually or in a group, and often has no specific goals or objectives (Wells, 2009a). In 

contrast, AAT is characterized as having explicit therapeutic goals and is designed specifically 

for a particular client or patient group to address social, emotional, and physical issues (Urbanski 

& Lazenby, 2012; Walsh, 2009a; Wells, 2009a). Where possible, I have maintained this 

distinction to be consistent with other reports.  

As with other psychosocial interventions, current metrics for evaluating the success of 

AAIs rely upon measurable changes in psychological and behavioural variables before and after 

the intervention, in line with a positivist orientation (Fleishman et al., 2015; Johnson et al., 

2008). The psychosocial oncology literature is replete with examples of this kind of approach, 

citing the need for larger sample sizes, improved standardization of interventions, and longer 

follow-up of participants (Henry et al., 2010; Johnson et al., 2008; S. K. Smith et al., 2011). Such 

aims are appropriate when seeking objective answers, but misplaced when attempting to 

understand aspects of human experience (e.g. relationships, meaning) that are largely subjective 

in nature. Moreover, implicit in traditional models of cancer care is an assumption that the 

person is the agent of change and has the ability to exercise control over his/her environment and 



14 

 

 

behaviour (Giddens, 1991; Pargament & Mahoney, 2002). Undeniably, there are many things 

that are beyond people’s control that can leave them feeling powerless and ineffective. The 

question becomes: How do people contend with the inherent tension arising from their attempts 

to exercise personal agency and the knowledge that there are limits to their control?  

In the work of Giddens (1991), a person’s capacity to act independently (i.e. agency) is 

both constrained and facilitated by the rules and resources (i.e. structure) that make up the social 

system, in this case, the cancer care system. Since structure and agency are thought to influence 

each other continually (Giddens, 1991), it is conceivable that people going through cancer are 

not just passively accepting the rules surrounding them, but instead, are actively engaged in 

making-meaning through their everyday social practices. Accordingly, people with a companion 

animal can produce new meanings or rules about their relationship with their companion animal 

(Blazina, 2011), as well as, their cancer experience (e.g. spending time with my companion 

animal helps me heal). In the next section, I bring together perspectives on spirituality to help 

frame my discussion of meaning-making. Meaning-making provides a unique lens through 

which the human-companion animal relationship can be explored in all of its richness and 

complexity. Although meaning-making and spirituality are conceptually related, spirituality is 

more commonly used and accepted in psychosocial oncology and anthrozoology.   

1.3.3 Meaning-Making and Spirituality 

In a socio-cultural context where images of death and suffering continue to pervade the 

minds of those impacted by cancer (Bultz & Carlson, 2006), the poignancy of the bond between 

a person and his/her companion animal is all the more striking. The experience of cancer may 

bring about a heightened awareness of a person’s priorities through his/her attempts to find 

meaning and connectedness with others, referred to by some authors as evidence of spiritual 



15 

 

 

coping (Baldacchino, Borg, Muscat, & Sturgeon, 2012). Though spirituality and its dynamic 

counterpart, spiritual coping, are burgeoning topics within the health fields (Migdal & 

MacDonald, 2013), the human-companion animal relationship has all but been ignored as a 

potential source of meaning and connectedness. Seeking the companionship of an animal may 

itself be a form of spiritual coping (Faver, 2009; Skeen, 2011). Despite its growing use and 

assessment in health care (Frey, Daaleman, & Peyton, 2005), spirituality is a term that conjures 

up mixed reactions. Some researchers regard spirituality as being too personal or private, and 

believe that the psychosocial aspects of illness are more suitable for empirical research 

(Baldacchino et al., 2012). Others remain doubtful of attempts to quantify spirituality, 

considering it misleading to describe spirituality as dichotomous or linear (i.e. one person is 

more spiritual than another) in nature (Senreich, 2013).  

Given these somewhat conflicting perspectives, spirituality has been conceptualized as a 

multidimensional and highly individualized phenomenon (Carroll, 2001; Migdal & MacDonald, 

2013; Molzahn et al., 2012; Senreich, 2013). One common approach to defining spirituality is to 

note its similarities and differences with religion. As with religion, spiritual practices can be 

undertaken individually or as part of a group. These phenomena are not mutually exclusive. 

People can see themselves as both religious and spiritual (Pargament & Mahoney, 2002). 

Highlighting a customary distinction, Pargament and Mahoney (2002) define religion as “a broad 

individual and institutional domain that serves a variety of purposes secular as well as sacred,” 

and spirituality as “the key and unique function of religion” (p. 647). Furthermore, while some 

spiritual belief systems rest on the notion of the “unknowability of existence,” others presume 

that the nature of existence is in fact known (Senreich, 2013; Yalom, 1980).  



16 

 

 

The intent in this chapter is not to stake claim to a singular and exhaustive definition of 

spirituality, nor to utilize spirituality as a thinly veiled guise for religion. Spirituality is not 

always tied to religion. Atheists and agnostics can have spiritual needs of their own (Carroll, 

2001). Rather, the intent is to situate the present study in the context of research on psychosocial 

oncology, making clear my own assumptions and drawing upon concepts (e.g. meaning-making, 

spiritual coping) that have been formalized in research. In keeping with the spirit of 

phenomenology (i.e. bracketing my assumptions), my view of spirituality is similar to 

nontheistic approaches that emphasize humanistic, existential, and secular aspects of human 

experience (Senreich, 2013). Two themes that predominate in these approaches are meaning and 

connectedness (Girardin, 2000; Meezenbroek et al., 2010). For example, Girardin (2000) 

describes spirituality as a “stabilizing force” that helps people stay connected to what is 

meaningful to them. Connectedness is understood to refer to relationships with oneself, others, 

nature, and/or the transcendent (i.e. a higher power) (Senreich, 2013).  

From these perspectives on spirituality, it is not hard to see the connection between the 

human-companion animal relationship and the humanistic theories (Gestalt psychology, 

phenomenology, and existentialism), each of which has grappled with the question of what it 

means to be human (Yalom & Josselson, 2011; Yontef & Jacobs, 2011). These theories place 

emphasis upon genuineness, authenticity, empathy, unconditional positive regard, and active 

engagement in the here and now (Yalom & Josselson, 2011; Yontef & Jacobs, 2011), the very 

qualities that are often attributed to companion animals (Walsh, 2009a). Within humanistic 

theories, meaning is considered to be a fundamental concern of human life, and people are 

construed as meaning-making beings (Frankl, 2006; Yalom, 1980). It appears that meaning-

making even has a biological basis, such that people are naturally inclined to find a pattern or 



17 

 

 

explanation when confronted with seemingly random stimuli (Yontef & Jacobs, 2011). In his 

memoir, Frankl (2006) wrote that “the will to meaning” or “this striving to find a meaning in 

one’s life is the primary motivational force” of human beings (p. 99). While it may appear that 

meaning is just out there in the world waiting to be discovered, such a view, according to Frankl, 

masks the reality that life is without intrinsic meaning; people make meaning.  

Likewise, Yalom counts meaning as one of the inescapable concerns of the human 

condition, the others being freedom, isolation, and death (Yalom & Josselson, 2011). Although 

loneliness is ubiquitous to human experience, existential isolation is understood more 

distinctively as a sense of “despair at living an unobserved life” (Yalom & Josselson, 2011, p. 

312). For people, having others witness what they experience in life, helps to alleviate existential 

isolation (Yalom & Josselson, 2011). It is through these intimate connections with others that 

people may find solace in the face of stressful life events. However, intimate connections are not 

limited to those between people. Many people describe experiencing a profound level of 

intimacy in their relationship with their companion animals (Blazina, 2011; Gavriele-Gold, 

2011). Moreover, a paradox exists in that, although people can derive meaning from having 

intimate relationships with others, they may feel isolated at the same time (Yalom & Josselson, 

2011). Commonly observed among people coping with cancer (van der Spek et al., 2013), this 

seeming paradox speaks to the relational dimension of meaning-making (Blazina, 2011).  

People attribute meaning to their experiences and may seek out others to validate these 

meanings (Neimeyer, Burke, Mackay, & van Dyke Stringer, 2010). In the case of companion 

animals, this kind of validation transcends words and language, and is believed to fulfill a need 

for attunement (Bowlby, 1982). Introduced here and elaborated upon in the next section 

(Theoretical Background), “attunement” refers to the experience of being in sync with how 



18 

 

 

someone else is feeling and thinking, and reciprocating through verbal or nonverbal 

communication (Blazina, 2011; Lasher, 1998). Although not a panacea for loneliness, the 

human-companion animal relationship embodies the experience of an “attuned relationship” 

(Blazina, 2011; Faver, 2009). Interacting with a companion animal enables a person, however 

briefly, to be fully engaged in the here and now. These kinds of here and now experiences have 

been called mindful moments and kindred relaxation in the literature (Faver, 2009). The notion 

that being more mindful can promote better health (Nagasawa et al., 2015), perhaps an 

oversimplification, does not seem so far-fetched. The aim of finding physiological evidence to 

substantiate this notion falls within the scope of those working from a positivist lens. In contrast, 

my intent is to examine the meaning that constitutes lived experience, more precisely, the 

meaning of these here and now experiences as people live through them (van Manen, 1997; 

Yontef & Jacobs, 2011).  

Favouring authentic experience over contrived explanations, humanists are cognizant of 

the impact of using theories that can dehumanize the very people whose experiences and 

behaviours they are attempting to explain (Yontef & Jacobs, 2011). With this in mind, I extend 

my discussion of attunement in the next section. Although not considered a theory itself, 

attunement is a foundational concept in attachment theory (Bowlby, 1982; Winnicott, 1971) and 

in a sub-discipline of social science known as relationship science (Hazan & Shaver, 1987). 

Attachment theory is commonly applied to the human-companion animal relationship (Beck & 

Madresh, 2008; Kurdek, 2008), emphasizing the primacy and universality of the attachment 

bond between infant and caregiver (Bowlby, 1982). Attunement is believed to operate at an even 

more fundamental level, providing the basis for developing strong affectional bonds with others 

throughout a person’s life (Blazina, 2011).  



19 

 

 

It seems that if attunement assists us in understanding the meaning of the human-

companion animal relationship, in other words, the piece about meaning-making and 

connectedness, then a theoretical framework would be useful for exploring how people 

experience this relationship during periods of serious illness and recovery. Originally proposed 

by O’Leary and Ickovics (1995), and subsequently expanded by Carver (1998), one model posits 

that there are four potential consequences that can occur in response to adversity (i.e. physical or 

psychological stress): succumbing (continued decline), survival with impairment (diminished in 

some way), resilience (homeostatic return to previous level of functioning), and thriving (exceed 

previous level of functioning). Carver’s model helps us to situate meaning-making and the 

human-companion animal relationship within the context of cancer. This is not to say that 

succumbing and survival with impairment are not possible outcomes. My intent is to move 

beyond the traditional emphasis upon the negative sequelae of a cancer diagnosis (Carver, 1998; 

Costanzo et al., 2009; Laranjeira, Ponce Leão, & Leal, 2013). 

1.4 Theoretical Framework 

In this section, I discuss the following theoretical constructs: attunement, resilience, and 

thriving. I say theoretical constructs with two thoughts in mind. Firstly, these constructs are 

distinguished from the phenomenon of interest—the meaning of the human-companion animal 

relationship for people with cancer. Secondly, these constructs are not formal theories in the 

sense of social theories that can offer “a significant level of predictive power” and can “stand 

apart from empirical analyses as coherent explanations of social life” (Pascale, 2011, p. 27). The 

task of the researcher is to develop a framework for identifying relevant phenomena. Not only do 

researchers bring their theories and assumptions to their research, but these theories and 

assumptions are also embedded within the research process (Pascale, 2011). To illustrate, 



20 

 

 

Carver’s (1998) model, with its emphasis on resilience and thriving, represents a departure from 

a traditional focus on impaired functioning and distress in people with cancer (Costanzo et al., 

2009). Underlying my use of this model is a belief that some kind of gain or growth can follow 

from adversity. However, growth does not simply happen. People engage in meaning-making 

and this occurs within a relational context (Berscheid & Regan, 2016).  

1.4.1 Attunement and Relationship Science 

Acclaimed acting teacher, Stella Adler, whose vision of acting called for authenticity, 

once said: “It is against the nature of human life to withdraw” (Riley, 2015). Just as we are 

inclined to find meaning, we are biologically predisposed to develop strong affectional bonds 

with others (Bowlby, 1982; Hazan & Shaver, 1987). People define themselves in relation to 

others (Yontef & Jacobs, 2011). Relationship science tells us that close, satisfying relationships 

are essential to a person’s well-being (Berscheid & Regan, 2016), with some evidence of an 

association between the human-companion animal relationship and lower morbidity and 

mortality (Campo & Uchino, 2013; Pachana et al., 2011). A relationship is satisfying to the 

extent that it meets a person’s needs among which attunement is regarded as a primary 

psychological need (Bowlby, 1982; Hazan & Shaver, 1987; Winnicott, 1971).  

Being attuned or “in sync” with how someone else is thinking or feeling requires 

empathy (Blazina, 2011; Mensch, 2003). Mensch (2003) describes empathy as experiencing “in 

the other’s body” or sharing the other’s embodiment. One of the predominant goals in the 

humanistic therapies is to help people develop greater empathy, curiosity, and concern for others 

(Yontef & Jacobs, 2011). The experience of being in sync with a comforting and responsive 

relationship partner is as much an element of the human-companion animal relationship as it is 

of interpersonal relationships (Blazina, 2011; S.-E. Brown, 2011). Companion animals witness 



21 

 

 

and participate in people’s lives, providing a psychological sense of accompaniment (Blazina, 

2011; Winnicott, 1971).  

The dynamic of attunement permits meaningful interactions between people and 

companion animals (Blazina, 2011). These interactions provide the foundation for the kinds of 

attachment bonds that are characteristic of the infant-caregiver relationship (Blazina, 2011). 

Companion animals, particularly dogs, have been described as attachment figures with whom 

people form strong emotional and psychological bonds (Beck & Madresh, 2008; Kurdek, 2008). 

On some measures of attachment security, companion animals are rated more highly than 

romantic partners (Beck & Madresh, 2008). Some researchers regard proximity seeking and 

maintenance as a form of attachment behaviour (Bowlby, 1982). People often wish to be in close 

contact with companion animals, petting, grooming, and cuddling with them. Companion 

animals provide a secure base from which a person can derive comfort when distressed (Kurdek, 

2008). A sense of purpose, of being needed, and of having a daily routine are all presumed to be 

influential in the development of attachment bonds with companion animals (Beck & Madresh, 

2008; Siegel, 2011). However, the extent to which the human-companion animal relationship 

qualifies as an attachment bond continues to be debated, with some authors suggesting that 

attachment is only one type of affectional bond among others (i.e. friendship), and is less 

pertinent to adult relationships (Kobak, 2009). 

Accordingly, some theorists continue to draw upon attunement for its broader scope with 

respect to lifespan development and to the establishment of different types of affectional bonds, 

from intimate relationships to formal relationships between people and health care providers 

(Blazina, 2011; Davis, 2011; Lasher, 1998). Our understanding of attunement is such that we 

recognize its importance for developing and maintaining satisfying relationships throughout a 



22 

 

 

person’s life, yet we have little empirical understanding of its role in strengthening the human-

companion animal relationship (Blazina, 2011). The dynamic of attunement is manifest in 

people’s tendency to develop shared meanings, in other words, core beliefs about themselves and 

others that evolve through mutual engagement in daily practices and routines (Neimeyer et al., 

2010). These shared meanings may be disturbed or threatened in the experience of cancer (van 

der Spek et al., 2013). However, losses and negative events do not necessarily invalidate the 

meanings people attribute to their experiences (Laranjeira et al., 2013). Such a view is consistent 

with Carver’s (1998) model of resilience and thriving. Although Carver himself does not address 

how resilience and thriving might generalize to the human-companion animal relationship, his 

model helps us to understand the importance of having supportive relationships in the face of 

adversity. Relationships can impact a person’s subjective experience without changing the 

objective situation; people may feel alone in their experience of cancer but not feel lonely.  

1.4.2 Carver’s Model of Resilience and Thriving 

Central to the construct of thriving is the idea that some kind of benefit or gain can be 

derived from an experience which may carry forward to future experiences (Carver, 1998; 

O’Leary & Ickovics, 1995). As with meaning-making, thriving may be elicited by a particular 

event or prolonged trauma but such an event or trauma is not required for thriving to occur 

(Carver, 1998). Thriving represents a kind of growth experience, and can be physical or 

psychological in nature. It is important to note that there are limits to both physical and 

psychological thriving (Carver, 1998). In the case of physical thriving, for example, people who 

are in good health prior to an illness may eat better and exercise more, yet still not be as healthy 

as their pre-illness state. Carver describes three kinds of psychological thriving: skill and 

knowledge development, confidence, and strengthened personal relationships. Knowing more 



23 

 

 

about a problem or stressor can help a person to manage his/her own emotions or deal with 

others more effectively. After going through a difficult experience, a person may come away 

with a renewed sense of confidence in being able to approach similar experiences in the future. 

Having confidence makes it more likely that an individual will persevere when he/she encounters 

difficulties (Carver, 1998). With regards to personal relationships, social bonds are strengthened 

when a person feels that he/she can turn to others for support when faced with an adverse event. 

These kinds of relationships are characterized by trust, security, and dependability (Carver, 

1998).  

Possible outcomes of thriving include reduced reactivity (i.e. desensitization) to 

subsequent stressors or faster recovery (i.e. enhanced recovery potential) from stressors (Carver, 

1998). A third potential outcome of thriving is that a person is able to function at a level that is 

consistently higher than that prior to the event (Carver, 1998). While such an outcome may be 

untenable, many researchers would agree that this is a subjective change, and is dependent upon 

one’s personal qualities (e.g. personality traits, coping responses) and unique life circumstances 

(e.g. availability of social support). Thriving may be manifested as a change in one’s orientation 

to life or a move toward greater acceptance of oneself or others (Carver, 1998). Studies 

employing comprehensive psychosocial measures provide evidence that supports the construct of 

resilience, rather than thriving (Costanzo et al., 2009). Following cancer, some people experience 

a shift in their priorities and greater appreciation of being present and in the moment (Molzahn et 

al., 2012; van der Spek et al., 2013). For many, this meaning is tied to their intimate relationships 

(van der Spek et al., 2013). Whether these examples count as resilience or thriving remains to be 

seen. Carver (1998) suggests that if we encourage people to view a particular situation as an 



24 

 

 

opportunity for growth, growth is more likely to occur. And if we learn more about why people 

thrive, we can teach it to others and ultimately benefit the overall health care system. 

This sentiment is admirable and would certainly appeal to anyone who works with people 

whose lives have been impacted by cancer. Encouraging resilience and supporting people in their 

efforts to thrive remain in the horizon of possibilities; so too does the possibility of making our 

experience richer. The latter possibility necessitates a shift in how we approach this kind of 

inquiry. Rather than finding answers or drawing firm conclusions, phenomenology opens up a 

way of engaging with questions to provide qualitative insights into the meaning of a particular 

phenomenon (van Manen, 2014). Phenomenology offers a method of questioning that van 

Manen (2014) describes as a “wondering pathos.” Experiences that evoke a sense of wonder can 

lead to phenomenological questions about the nature and meaning of these experiences. For 

example, we might ask “What is this experience like?” Phenomenology invites us to adopt a 

particular attitude and an “attentive awareness” to our experiences as we live them as opposed to 

how we conceptualize them (van Manen, 2014).  

1.5 Phenomenological Approach to the Study  

Perhaps, my aim in pursuing a phenomenological investigation of the human-companion 

animal relationship for people with cancer could be perceived as rather modest. Everyday 

experiences are taken for granted, deemed simple, and less worthy of research attention (van 

Manen, 2014). Phenomenology shows us that these everyday experiences, however ordinary they 

might appear, are in fact much less simple than we would think. Typically, our thinking stops at 

our words, concepts, and theories (e.g. relationships are important for our well-being, growth can 

follow from adversity), and less often do we consider how they shape our experiences as we live 

them (van Manen, 2014). Phenomenology helps us to go beyond the words, concepts, and 



25 

 

 

theories to get back to the living moments of our experience in all of their richness and 

complexity. We can widen them, explore their nuances, and make them more precise.  

When people talk about their companion animal, they “call into being a certain relational 

quality” of the human-companion animal relationship that is meaningful to them (van Manen, 

2014). To take this example further, we seem to know what a companion animal is. Yet, when 

pressed to define this concept more precisely, we are left with questions such as “Do companion 

animals have to live in your home to be a companion animal, Do they have to be furry or can 

they have feathers or scales, Can a robot be a companion animal, So, just what is a companion 

animal?” In an earlier section, I spent four pages attempting to clarify what I mean by the terms 

pet and companion animal, and I used the terms attunement, resilience, and thriving to help 

explain why some relationships are especially meaningful and rewarding in the experience of 

cancer. Still, these are the words and concepts, which we must continually push through to 

understand the meaning of lived experience. Again, phenomenology is less about the search for 

answers to these kinds of questions than it is about our openness and attentiveness (i.e. 

wondering pathos) in conducting our inquiry (van Manen, 2014).  

Most of us know someone who has been affected by cancer, directly or indirectly. As 

such, we may have certain assumptions about what it’s like to have cancer or to have lived 

through the experience of cancer. But where does this experience really begin and end? What 

would it be like, instead, to ask about the experience of being a pet owner or companion animal 

caretaker for someone living with and beyond cancer? In a practical sense, we can call people 

cancer patients, former cancer patients, cancer survivors, and people with cancer. We can specify 

the type of cancer a person has and his/her stage of cancer. Regardless of the words we use, 

certainly we can agree that having cancer carries some kind of lasting significance. The words in 



26 

 

 

a sense prevent us from engaging with the world as we experience it. However, it is through 

words that we can access these experiences (van Manen, 2014).  

This study is essentially a “wondering” exploration of relationships in the context of 

adversity. The human-companion animal relationship tends to be overlooked, in some cases, for 

the lack of a shared language (i.e. spoken or written) of the kind that occurs between members of 

the same species (Hirschman, 1994; Sanders, 1993). We don’t really know if our companion 

animals experience things the way that we do. Yet, we can experience such intimacy in our 

relationships with them, in the absence of words. Gavriele-Gold (2011) argues that we have this 

kind of intimacy with companion animals precisely because they do not speak to us the way that 

people do. They don’t say things to hurt our feelings. They don’t give unwanted advice. 

Companion animals “keep their silence, yet they bear witness” to our life (Gavriele-Gold, 2011, 

p. 105). Furthermore, companion animals are rendered meaningful to us through our bodily 

engagement and social interactions with them. Van Manen (2014) refers to this experience as the 

kind of embodied knowledge that helps us navigate daily life. We experience this knowledge as 

if it simply resides in our body and, thus, it is difficult to put into words. For example, we know 

how much pressure to apply when turning a doorknob, and we know how to shift our body to 

stay balanced as we are walking.  

For a phenomenological human science, the body is not simply a transmitter of the 

physical world but rather constitutes what is meaningful to us (Merleau-Ponty, 2012). Much of 

positivist science, by contrast, is built upon the idea that we know how things are in reality, and 

there tends to be a distrust of the body (i.e. our senses can lead us astray) (van Manen, 2014). 

The separation of the mind (i.e. subject) and the physical reality (i.e. object) is prominent in 

Cartesian dualism whereas phenomenology treats the body as a vehicle rather than a barrier to 



27 

 

 

acquiring knowledge. Phenomenology invites us to consider how our experience might change if 

we let go of our belief that we know how things are in reality. It is precisely this kind of knowing 

and not knowing and the “impossibility” of it all (van Manen, 2014) with which we have to 

grapple when inquiring into the following research question: What is the lived experience of the 

human-companion animal relationship for people with cancer? 



28 

 

 

Chapter 2: Literature Review 

This chapter outlines the results of a narrative review of literature on the meaning of 

companion animals for people living with and beyond cancer. The main emphasis in this review 

is on pet ownership that occurs through purchase or adoption, with some attention given to the 

therapeutic role of companion animals. Along with the primary and secondary literature, the 

review includes qualitative and quantitative research conducted in both clinical and non-clinical 

settings (Bratzke et al., 2015; Mays, Pope, & Popay, 2005; Schaepe & Bergjan, 2015). The 

literature search strategy is described in an appendix to this chapter (Appendix A).  

As displayed in Figure 1, most empirical research has tended to focus on the areas where 

each pair of circles intersects. However, the area in the center of the figure, where all three 

circles intersect, is still relatively new in psychosocial oncology. 

 

Figure 1 Intersections identified in the literature  

In the discussion that follows, I present the findings of this narrative review as I draw upon the 

works of key authors and additional sources identified through a search of reference lists. This 

review is divided into three main sections: 1) Pets and Human Health, 2) Human Health and 

Spirituality, and 3) Pets and Human Spirituality.  

Pets 
[Companion 

animals] 

Spirituality 
[Meaning-

making] 

Human 
health 
[Cancer] 



29 

 

 

2.1 Pets and Human Health 

2.1.1 Salutary Effects of Pets 

The evidence base on pets and human health is mixed with some reports indicating 

substantial benefits from owning a pet, others suggesting no difference in health between pet 

owners and non-owners and, still others finding poorer health outcomes among pet owners 

(Cherniack & Cherniack, 2015; Siegel, 2011; Virués-Ortega & Buela-Casal, 2006; Wright, 

Kritz-Silverstein, Morton, Wingard, & Barrett-Connor, 2007). Some investigations are affected 

by methodological limitations such as small sample sizes, confounding variables, and 

insufficient follow-up (Siegel, 2011; Wells, 2009b). Nevertheless, research on the human-pet 

relationship lends empirical support to a widely held belief that pets are good for us (Becker & 

Morton, 2002; Vitztum, 2013; Wells, 2009b). Benefits observed among pet owners include the 

prevention of illness and the promotion of mental and physical health (Cherniack & Cherniack, 

2015; Friedmann & Tsai, 2006; Knight & Edwards, 2008; Wells, 2009b). Health benefits appear 

to be more prevalent, although not exclusively, among dog owners, and are often attributed to 

greater physical activity and social engagement provided by dog-walking (Cherniack & 

Cherniack, 2015; Knight & Edwards, 2008; Siegel, 2011; Wells, 2009b).  

Much of the existing research is aimed at older adults and children, with the strongest 

evidence provided by studies examining the impact of pets on a patient’s likelihood of survival 

in the aftermath of a cardiac event (Friedmann, Katcher, Lynch, & Thomas, 1980; Friedmann, 

Thomas, Stein, & Kleiger, 2003; Friedmann & Thomas, 1995). In their 1980 study of patients 

(N=96) who survived a heart attack, Friedmann et al. found that pet owners experienced greater 

longevity compared to non-owners. One proposed reason for this difference is the performance 

of Activities of Daily Living (ADL) associated with pet care responsibilities (e.g. feeding, 



30 

 

 

walking their pet). Follow-up investigations (Friedmann & Thomas, 1995; Friedmann et al., 

2003) and subsequent analyses revealed that the greatest benefits were achieved by dog owners. 

These results, however, could not be attributed solely to an increase in physical activity 

associated with having a dog. The authors point to greater heart rate variability observed among 

pet owners as a possible explanation, citing the finding that lower heart rate variability is linked 

to cardiovascular disease and mortality (Friedmann et al., 2003).  

Other proposed physiological mechanisms include positive changes in neuroendocrine 

functioning (i.e. increase in oxytocin, decrease in cortisol) that occur when interacting with pets 

(Horowitz, 2008; Odendaal, 2000). In one study, researchers found that gazing behaviour from 

dogs was followed by an increase in the concentration of urinary oxytocin in the owners of the 

dogs (Nagasawa et al., 2015). The hormone oxytocin is involved in empathy, social bonding, and 

maternal behaviour (Horowitz, 2008). The release of oxytocin in the dog owners then stimulated 

affiliative responses (i.e. tactile interaction) from them toward their dogs. This, in turn, resulted 

in an increase in urinary oxytocin in the dogs who were being talked to and petted by their 

owners. The results provide evidence of an “interspecies oxytocin-mediated positive loop” which 

is facilitated by mutual gazing behaviour that developed through the coevolution of dogs and 

humans (Coren, 2008; Nagasawa et al., 2015). Such modes of communication appear to be 

deeply engrained in human-dog bonding, and are absent in interactions between humans and 

wolves, dogs’ closest genetic relatives (Coren, 2008; Nagasawa et al., 2015).   

Laboratory experiments are instructive, finding reduced physiological reactivity among 

pet owners compared to non-owners (Allen, Blascovich, & Mendes, 2002; Horowitz, 2008; 

Wells, 2009b). In a study of dog owners (N=162), participants were randomly assigned to one of 

three support conditions: companion dog present, close friend present, or alone (Campo & 



31 

 

 

Uchino, 2013). For each condition, participants’ cardiovascular reactivity was measured while 

completing a mental arithmetic or cold pressor task. The results indicated that the participants’ 

blood pressure and heart rate was lower in the companion dog condition than in the close friend 

condition. These findings held across the type of stressor and were observed during and after the 

task, suggesting that pets not only minimized the effects of stress but also facilitated recovery 

from stress. The authors speculated that evaluation apprehension (i.e. concern about being 

evaluated) could help to explain the finding of higher cardiovascular reactivity in the close friend 

condition, despite receiving positive ratings (Campo & Uchino, 2013). Somewhat surprisingly, 

the responses of participants performing the task alone did not differ substantially from those 

who were accompanied by their companion dog. It is conceivable that simply knowing that their 

dog was nearby, if not in the same room, helped to alleviate distress. There did not seem to be a 

relationship between participants’ appraisals of their relationship with their dog and their friend, 

thus, confirming previous findings that pets provide a unique source of support that adds to 

rather than replaces human companionship (Brooks et al., 2013; Walsh, 2009b).  

2.1.2 Therapeutic Effects of Pets  

The practice of integrating animals into therapeutic interventions for people, is certainly 

not new (Fine, 2011). Founded in the 18
th

 century, the York Retreat in England was one of the 

first psychiatric facilities to record the benefits of interacting with an animal for patients with a 

mental illness (Fine, 2011). The first documented report of cancer patients receiving pet therapy 

in the form of weekly visits from cats and dogs, was a study in a New York City hospice with 15 

participants (Muschel, 1984). Following the 10-week intervention, participants exhibited 

decreased anxiety and despair. In the 30+ years since this report, a growing number of hospitals 

and cancer clinics have implemented programs involving visits from therapy animals who are 



32 

 

 

trained and certified to provide comfort, stress relief, and companionship (Horowitz, 2008; 

Johnson et al., 2008; Wells, 2009b). As noted in Chapter 1, the term, animal-assisted therapy 

(AAT), is used to refer to structured sessions with a therapy animal that are designed to achieve 

specific therapeutic goals (e.g. reduce depression) (Urbanski & Lazenby, 2012; Wells, 2009b). 

However, AAT is used by some authors to describe unstructured visits with therapy animals in 

hospitals and health care settings (Baun & Mccabe, 2003). The terms animal-assisted activities 

(AAA) and animal-assisted visits (AAV) are also used to describe therapy animal visits, leading 

to confusion and a lack of agreement in the literature (Fine, 2011; Vitztum, 2013). To be 

consistent with the original reports, various abbreviations (e.g. AAT, AAA, AAV, etc.) are used 

in this section to refer to the therapeutic functions of animals. 

Researchers in one investigation explored the benefits of animal-assisted activities 

(AAA) for patients undergoing chemotherapy at a cancer infusion center (Marcus, Blazek-

O’Neill, & Kopar, 2014). The dog-handler teams spent a total of 103 hours visiting with 56 

participants (33 at the cancer infusion center; 23 in other areas of the hospital). In response to a 

satisfaction survey (46.3 % response), participants reported improvements in various cancer-

related symptoms such as enhanced relaxation, mood, sleep, attitude, and appetite, and decreased 

anxiety, stress, pain, and isolation. Over 95% of participants reported a positive response to the 

dog visits with 82.1% expressing an interest in future dog visits, and 91.1% indicating that they 

would recommend AAA to someone else (Marcus, 2013a; Marcus et al., 2014). Most 

participants rated the dog visits as having much or great benefit as indicated by the selection of 4 

or 5 on a five-point scale. Twenty-eight of the participants reported currently having a dog of 

their own. There were no significant differences in the results pertaining to gender, location in 

the hospital where they received AAA, current pet ownership status, and identification with 



33 

 

 

being a dog person. Only a few participants (5.5%) receiving treatment at the cancer infusion 

center expressed concern about the potential for germs introduced by dogs.  

In a similar investigation, researchers tested the efficacy of animal-assisted visits (AAV) 

for patients (N=42) with head and neck cancer who were receiving combined chemotherapy and 

radiation therapy (Fleishman et al., 2015). The participants’ quality of life (QOL) was assessed at 

baseline, week 3, and week 7 using a reliable measure (FACT-G). Satisfaction with AAV was 

also measured. The results indicated that there was a statistically significant and clinically 

meaningful increase in emotional well-being (EWB) and social well-being (SWB), in spite of 

moderate to high symptom burden and declines in physical well-being (PWB) and functional 

well-being (FWB). Satisfaction with the intervention increased during treatment and remained 

high at the end of the intervention. According to the qualitative data, the dogs were instrumental 

in providing unconditional love and acceptance (Fleishman et al., 2015). Changes in participants’ 

outward appearance did not seem to matter to the dogs who were simply happy to see them.  

Dogs and handlers were perceived as being helpful and supportive (Bibbo, 2013; 

Fleishman et al., 2015). However, participants felt that visits with volunteers would have been 

awkward without the dog being present. A few participants reported maintaining contact with the 

dog-handler team after the study. Despite the use of a valid and reliable QOL measure, there 

were some methodological challenges. The participants were self-selected and, therefore, may 

have espoused favourable attitudes toward animals regardless of the effects of the intervention. It 

was not feasible to use random assignment due to practical considerations such as participants’ 

schedules and preferences for animal visits. In any case, these study-related limitations are 

unlikely to pose a challenge when implementing AAV in clinical settings where the uniformity 

of methods and procedures are less of a concern for clinicians (Fleishman et al., 2015).  



34 

 

 

 The results of a post-test study provide additional evidence of the efficacy of AAA for 

cancer patients (Johnson et al., 2008). Thirty adult patients receiving radiation therapy were 

randomly assigned to one of three conditions: 12 dog visits, 12 human visits, or 12 quiet reading 

sessions over a 4 week period. Participants were Caucasian, with the exception of two 

participants who were African American. There were ten participants in each condition. The 

following hypotheses were tested: participants in the dog visits group would experience less 

fatigue and improved mood, self-perceived health, and sense of coherence (1) following the 

intervention, and (2) in comparison with the other two conditions. Sense of coherence refers to a 

person’s capacity to manage stressful life events and retain a sense of meaning and 

understanding when encountering difficulties. Each condition consisted of 15 minute sessions 

(i.e. received a magazine or a visit from a dog or human alone) delivered three times a week for 

four weeks. Participants received the session before their radiation treatment. In contrast with the 

studies described above (Fleishman et al., 2015; Marcus et al., 2014), the handlers were 

instructed to avoid talking to participants apart from the initial session in which they were asked 

to introduce the dog and monitor his/her behaviour and how the session went.  

Participants receiving visits from therapy dogs reported improvements in their health 

over the four week period (Johnson et al., 2008). Dogs helped to relieve anxiety and distract 

participants from their illness. Those in the dog therapy group experienced an increase in 

anger/hostility, confusion, and depression scores, although these changes were non-significant. 

As well, there were no statistically significant differences between the groups with regards to 

age, gender, race, education, or cancer site. Given the small sample size, replication is warranted 

with a larger and more diverse sample, and a longer follow-up period. Another limitation of the 

study was the absence of information about disease progression or the side effects of radiation 



35 

 

 

therapy during the four-week period. It is possible that the participants’ condition worsened 

during treatment, thus, affecting the validity of the findings. Contamination was also a potential 

issue as participants could have discussed the intervention while talking to others in the waiting 

room. Future research could benefit from controlling the stage and type of cancer, as well as, 

having additional measures of mood such as neurochemical changes in response to AAA.  

Findings from systematic investigations provide evidence that AAA can be a valuable 

addition to supportive care interventions for cancer patients and their families. Some reports 

suggest that AAA confers similar benefits for health care providers who work with cancer 

patients (Marcus, 2012a). In one quasi-experimental study, researchers found that the staff 

(n=34) of an outpatient cancer center generally viewed AAA positively. The dog visits did not 

add extra stress or work for the staff who agreed that AAA should continue at this facility 

(Bibbo, 2013). Despite the potential benefits of AAA for health and well-being, research on 

cancer patients is still limited and some questions remain unanswered. More research is needed 

to determine the optimal timing and length of AAA sessions, as well as, understand the impact of 

disease severity on the effectiveness of AAA (Bibbo, 2013). Standardized terminology with clear 

definitions is needed to advance theoretical and applied research (Vitztum, 2013).  

All in all, the findings suggest that AAA through volunteer services represent a cost-

effective and therapeutically effective intervention that can complement medical care (Marcus et 

al., 2014). When properly trained, therapy animals are seen as friendly, approachable, calming, 

and nonjudgmental (Walsh, 2009b; Wells, 2009b). As social catalysts, therapy animals provide 

support, eliciting physical touch and sociability from people (Fine & Eisen, 2008). AAA can 

empower patients to retain a sense of control in managing their illness, treatment, and ensuing 

side effects (Johnson, Meadows, Haubner, & Sevedge, 2003). Although patients may wish to 



36 

 

 

visit with therapy animals and report benefits from interacting with them, obtaining valid and 

reliable measures of these outcomes remains a challenge (Bibbo, 2013; Franklin et al., 2007; 

Johnson et al., 2008). However, as Fine and Eisen (2008) warn, if we were to focus exclusively 

on documenting measurable outcomes, we would miss the “magic” or “brilliance of the process” 

that is found in the daily interactions between animals and people. 

2.1.3 Companion Animals and Cancer  

At the intersection of pets and human health (Figure 1), there is limited research on how 

pet ownership impacts health when it comes to cancer. Similarly, despite burgeoning research on 

the therapeutic effects of animals for people with cancer, there is a dearth of studies on the 

experiences of cancer patients and their companion animals (Johnson et al., 2008; Nitkin, 2014). 

A search of the literature revealed a relatively large volume of research reports on comparative 

oncology, veterinary oncology, and animal-assisted interventions. From the 44 articles retrieved, 

only 10 focused on the topic of companion animals and cancer. Of these, five were written by the 

same two research teams, and their primary objective was to evaluate the impact of animal-

assisted therapy rather than pet ownership. Only one published study (Larson et al., 2010) and an 

unpublished dissertation (Nitkin, 2014) were identified that specifically addressed the 

experiences of cancer patients  and their pets. The purpose of the 2010 study was to assess the 

need for community and financial resources among cancer patients with pets. Participants 

(N=309, median age=59) were asked whether they had concerns about being able to care for 

their pets, and if they needed more information on pet-related resources.  

Of the 309 participants (median age=59, 56% women) surveyed, 170 had at least one pet, 

with dogs and cats being the most common type of pet. Most of these participants (80%) 

reported having support from family members to care for their pet following their diagnosis. 



37 

 

 

Participants indicated a high level of attachment to their pets, and believed that having a pet 

provides health benefits. A small percentage (6%) of participants had concerns about being in 

contact with their pets while in treatment. Only one participant reported giving up a pet because 

of a cancer diagnosis, and two participants chose not to acquire another pet due to their illness. 

Participants reported having concerns about lifting their pets while recovering from treatment, 

caring for pets with health problems, and having to limit their exposure to farm animals due to 

the risk for infection. Aside from these concerns, participants tended to emphasize the benefits of 

having a pet. Pets were described as being able to intuit when participants were stressed or ill. 

Pets helped participants heal and manage stress.  

Overall, the findings suggest that cancer patients benefitted from their pet’s 

companionship and had few concerns regarding the care of their pet during cancer treatment 

(Larson et al., 2010). Although only a small number of participants were in need of information 

on pet-related community and financial resources, the results may not represent the experiences 

of patients who lack similar resources. In the 2010 study, participants were receiving treatment at 

a tertiary care center. It is possible that these patients already had social support and resources 

that enabled them to manage their pet’s care without additional intervention. Nevertheless, 

providing patients with information about pet shelters, legal resources, and veterinary care may 

go a long way to reducing anxiety from not being able to care for one’s pet while undergoing 

treatment (Larson et al., 2010). Simply inquiring about pets during routine assessments may help 

to improve patient-provider communication (Walsh, 2009c; Wisdom, Saedi, & Green, 2009). To 

illustrate, Dr. Edward Creagan, a professor of medical oncology at the Mayo Clinic, regularly 

records the names of his patients’ pets in their medical charts, and even “prescribes” pets as part 

of their treatment plan (Horowitz, 2008). 



38 

 

 

Other investigations that lie at the intersection of pets and human health have examined 

the potential role of companion animals as a diagnostic tool for cancer detection (Wells, 2012). 

Dogs, given their olfactory acuity, are able to identify compounds in breath, sweat, and urine that 

are indicative of illness (Marcus, 2012b; Wells, 2012). This research has been motivated in part 

by the limitations of traditional screening methods which tend to be invasive, painful, and 

expensive. In any case, further research is needed to establish the extent to which dogs can 

identify the presence of cancer as opposed to ill health in general (Wells, 2009b, 2012). The use 

of small sample sizes and variations in the way that odour compounds are collected make it 

difficult to draw conclusions about the specificity with which dogs can detect cancer (Wells, 

2012). A second area in which pets have been discussed in relation to cancer patients is the risk 

of interacting with pets among people who are immunocompromised (e.g. young children, 

pregnant women, older adults) (Larson et al., 2010). The authors of one review indicate that 

concerns regarding the spread of zoonotic infections (i.e. disease transmitted from animals to 

humans) are unwarranted (Stull, Brophy, & Weese, 2015). These infections are relatively 

uncommon among pet owners and are minimized considerably by the use of proper handwashing 

(Marcus et al., 2014; Stull et al., 2015). In some cases, pets, rather than people, may be at risk for 

becoming colonized with human pathogens (Marcus, 2013b).  

In summary, the management of cancer requires a comprehensive approach to address the 

needs of patients for physical, medical, informational, emotional, social, and spiritual support 

(Marcus, 2012a; McCorkle et al., 2011). Empirical research on animal-assisted interventions 

represents an important step in validating anecdotal claims among cancer patients regarding the 

benefits of interacting with therapy animals. However, research on the experiences of cancer 

patients and their own pets is currently lacking. Efforts to improve patient engagement require a 



39 

 

 

broader understanding of the daily activities in which people invest their time and energy 

(Raque-Bogdan et al., 2015). Examining social occupations such as caring for a pet can provide 

insights into how cancer patients integrate their illness and survivorship status into their identity 

(Brooks et al., 2013). Being a pet owner is one such identity that speaks to the experience of 

living meaningfully in the face of a life-threatening illness (Girardin, 2000; Wisdom et al., 2009).  

2.2 Human Health and Spirituality 

2.2.1 Cancer and Spiritual Coping 

Coping is defined as the thoughts and behaviours that people use to manage stress 

(Folkman & Lazarus, 1988). Problem-focused coping refers to a person’s attempts to change or 

confront a stressful situation (Bigatti, Steiner, & Miller, 2012; Folkman, Lazarus, Gruen, & 

DeLongis, 1986). Emotion-focused coping refers to a person’s attempts to regulate emotional 

distress through distraction or avoidance (Folkman et al., 1986; Waldrop et al., 2011a; 

Wenninger et al., 2013). Spiritual coping, a type of emotion-focused coping, involves attempting 

to change or redefine the subjective meaning of a situation, for example, by searching for a larger 

purpose or reason (Molzahn et al., 2012; Vachon, 2008; Waldrop et al., 2011a). Although it is 

generally accepted that particular coping strategies can contribute to an enhanced sense of inner 

peace and contentment (Girardin, 2000; Laranjeira et al., 2013; Pargament & Mahoney, 2002), 

there is little consensus about what to call these strategies. Both spiritual coping and meaning-

making are found in the literature, along with other terms such as existential coping 

(Baldacchino et al., 2012; Migdal & MacDonald, 2013). The link between spirituality and health 

is such that spiritual coping may lead to improved well-being and quality of life for some people, 

and greater distress in others (Molzahn et al., 2012; Vachon, 2008; Visser, Garssen, & 



40 

 

 

Vingerhoets, 2010). Moreover, while spiritual coping has particular relevance for some people in 

dealing with a serious illness, for others, spiritual coping is of little to no consequence. 

In the study of spiritual coping and cancer, considerable attention has been given to end-

of-life issues among palliative care patients, dealing with advanced disease and diminished 

quality of life (Trevino, Balboni, Zollfrank, Balboni, & Prigerson, 2014; J.-S. Tsai et al., 2012). 

However, existential distress is not unique to those in palliative care (Girardin, 2000). 

Accordingly, there has been greater movement towards studying the spiritual resources, 

meaning-making processes, and coping strategies used by people in other stages of cancer 

survivorship (Boehmer, Luszczynska, & Schwarzer, 2007; Carroll, 2001; Laranjeira et al., 2013). 

For example, investigators in one study examined the spiritual practices and spiritual well-being 

of women (n=85) with gynecologic cancer using quantitative measures (A. J. Lopez, McCaffrey, 

Quinn Griffin, & Fitzpatrick, 2009). Overall, the participants reported high levels of spiritual 

well-being, self-efficacy, and life scheme (i.e. meaningfulness). The most common practices 

endorsed by participants as having a spiritual quality were taking part in family activities, 

listening to or playing music, exercising, and helping others. Participants less often used 

meditation, yoga, or communal prayer to express their spirituality. These results lend support to 

the notion of spirituality as something that gives a person a sense of meaning and purpose in life, 

while also highlighting the challenges of determining how best to conceptualize spirituality (Frey 

et al., 2005; A. J. Lopez et al., 2009; Pargament & Mahoney, 2002).  

The extent to which research terminology used resonates with participants’ experiences is 

not only a concern of studies that employ quantitative methods. In a qualitative study by 

Molzahn et al. (2012), participants reported feeling uncomfortable using the word spirituality, 

believing that it was too closely aligned with religion. Instead, participants preferred using 



41 

 

 

metaphors and talking about their attempts to find meaning in their illness through their 

relationship with their children, partner, pets, music, and nature. The goal of the study was to 

examine the spiritual stories of people (n=32, 18 men and 14 women) living with serious illness 

(e.g. cancer, end stage renal disease, and HIV/AIDS). In-depth narrative interviews were 

conducted with participants ranging in age from 37 to 83. Three major themes were identified: 

reflecting on spiritual relationships and personal beliefs, crafting beliefs for one’s own life, and 

finding meaning and transcending beyond words. Examples of spiritual practices included 

visualization, gardening, and therapeutic touch. Participants reported experiencing a deepening 

of spirituality that evolved from a blend of religious and non-religious beliefs. The results 

indicated that, despite researchers’ efforts to distinguish between religion and spirituality (Frey et 

al., 2005), few people tended to make this distinction (Molzahn et al., 2012).  

Such findings alert researchers and practitioners to the importance of engaging with 

participants in their own terms (Molzahn et al., 2012). Labeling something “spiritual” or 

“religious” may actually inhibit participants from discussing their beliefs. Accordingly, non-

traditional research methods have been proposed, including arts-based approaches, photography, 

story-telling, and meditation (Harper, 2002; Molzahn et al., 2012; Tighe et al., 2011). Another 

issue raised by research on spiritual coping is the need for larger and more diverse samples (Jim 

et al., 2006; A. J. Lopez et al., 2009). Some studies rely upon convenience sampling, yielding 

self-selected and homogenous samples with characteristics that may not be applicable to other 

patient groups or the general population (Molzahn et al., 2012). In view of these limitations, the 

findings of cross-cultural research are instructive for understanding the needs and experiences of 

underrepresented cultural and ethnic groups (K. Ashing-Giwa & Ganz, 1997; Chang et al., 2014; 



42 

 

 

Molassiotis et al., 2006; J.-S. Tsai et al., 2012). In this brief sampling of studies, positive and 

negative aspects of spiritual coping are discussed.  

In an investigation of the psychosocial needs of African American women with breast 

cancer, researchers found that participants often drew strength from their spiritual faith (K. 

Ashing-Giwa & Ganz, 1997). A total of 43 participants were interviewed using key informant 

interviews, focus groups, and in-depth interviews. Key informants referred to patients as 

“uninvolved victims,” explaining that patients tended to be passive and had less control over 

their illness compared to people in “mainstream society.” Patients were inclined to accept 

medical treatment without questioning their doctors’ recommendations or requesting a second 

opinion. Patient interviews confirmed key informant views of patients as being less active in 

managing their illness. Patients reported experiencing psychological distress, employment 

challenges, and a lack of information and support during their diagnosis and treatment. 

Additional barriers included a lack of medical insurance and poor relationships with doctors.  

For these women, their primary source of support and coping was their spiritual beliefs 

(K. Ashing-Giwa & Ganz, 1997). Having a child also motivated them to get better. A number of 

women reported that their attendance at church increased following their cancer diagnosis. Some 

women were reluctant to seek medical help, instead relying upon prayer as an antidote to cancer. 

Similar findings were reported in a study of Chinese women for whom it was not uncommon to 

avoid seeking medical care with or without a confirmed cancer diagnosis (Chang et al., 2014). 

The researchers speculated that having a high level of spiritual support may have contributed to 

delays in cancer detection (Chang et al., 2014). Such findings highlight a potential risk of 

spiritual or religious coping among people who rely upon their faith to the detriment of receiving 

timely medical care (K. Ashing-Giwa & Ganz, 1997). Nevertheless, it should be noted that, in 



43 

 

 

both studies, having a deep spiritual faith motivated patients to heal and recover from their 

illness (K. Ashing-Giwa & Ganz, 1997; Chang et al., 2014).  

Another notable finding from the studies discussed above is the view of cancer as being a 

private matter, and, for some individuals, a “punishment” from God (K. Ashing-Giwa & Ganz, 

1997; Chang et al., 2014). Such beliefs, referred to as negative religious coping (NRC), may be 

accompanied by an experience of being in conflict with God or disconnected from one’s spiritual 

life and community (Trevino et al., 2014). NRC is associated with poorer quality of life and life 

satisfaction, as well as, greater depression and suicidal ideation (Trevino et al., 2014; Yeung, Lu, 

& Lin, 2014). Assessments of NRC may be helpful for identifying people who are vulnerable to 

spiritual distress and suicidal ideation (Trevino et al., 2014). Moreover, examining spiritual 

coping can help researchers understand how people make sense of traumatic or critical life 

events (K. Ashing-Giwa & Ganz, 1997; Yeung et al., 2014).  

In another investigation, researchers surveyed Latina women (n=330) with breast cancer 

about their use of spiritual coping (García-Jimenez et al., 2014). The researchers examined the 

role of spiritual well-being as a potential mediator in the relationship between cancer self-

efficacy (i.e. belief in one’s ability to deal with cancer) and self-rated health. Spiritual well-being 

was assessed using a measure that includes religious (i.e. faith) and non-religious (i.e. inner 

peace) aspects of spirituality. The results indicated that inner peace was independently associated 

with better self-rated health (OR= 2.44, 95% CI 1.30, 4.56). Once inner peace was accounted for, 

there was no longer a significant association between faith and self-rated health. The researchers 

concluded that inner peace (i.e. meaning or purpose in life) was an important contributor to the 

health and well-being of participants. However, with less than one-third of the sampling frame 

included in the study, the results may not be representative of other groups of cancer patients. 



44 

 

 

Still, the findings have implications for women who are at increased risk of psychosocial distress 

due to ethnic and language disparities (García-Jimenez et al., 2014). Routine distress screening 

and interventions that promote meaning and purpose, discussed next, may go a long way to 

improving cancer self-efficacy and overall health (García-Jimenez et al., 2014). By offering 

culturally competent care, health care providers can address the spiritual and existential needs of 

patients, as well as, instill hope for patients coping with institutional barriers and inadequate 

resources (K. Ashing-Giwa & Ganz, 1997; Chang et al., 2014). 

2.2.2 Cancer and Meaning-Focused Coping  

Meaning-focused coping refers to strategies that people use to help make sense of their 

experiences and promote meaning in life (MIL) (Boehmer et al., 2007; Jim et al., 2006). 

According to one conceptualization, MIL is comprised of three dimensions: 1) satisfaction with 

one’s relationships and contributions to the world, 2) beliefs and values pertaining to one’s life 

and how well these are integrated, and 3) beliefs about life as being part of a pattern beyond 

one’s individual life (Jim et al., 2006). Meaning-focused coping strategies that involve the use of 

avoidance, denial, or blame can undermine a person’s long-term adjustment to illness (Jim et al., 

2006; Yeung et al., 2014). Despite providing temporary relief, strategies such as ignoring one’s 

illness or avoiding one’s emotions are less conducive to deriving meaning from an experience 

such as cancer (Boehmer et al., 2007; Yeung et al., 2014). Conversely, meaning-focused 

strategies that support a person’s view of the world and him/herself can help to preserve MIL 

(Jim et al., 2006). Examples of these strategies are acceptance, positive reinterpretation, 

information and support seeking, and prayer (Boehmer et al., 2007; Costanzo et al., 2009). 

Accepting or reframing a situation in a more positive light can be beneficial in situations over 

which people have little control (Boehmer et al., 2007). Rather than attempting to change the 



45 

 

 

situation, people can manage their emotional response to the situation, leading to greater self-

efficacy and control (Costanzo et al., 2009). 

In a longitudinal study, researchers assessed the coping strategies of women diagnosed 

with breast cancer (N=167, M age=51) at the time of their diagnosis, and assessed MIL two 

years later (Jim et al., 2006). The Meaning in Life Scale (MiLS) was used to measure the impact 

of a cancer diagnosis on participants’ reported MIL. Hierarchical multiple regression analyses 

revealed that participants’ coping ability at diagnosis was a significant predictor of the variance 

(17%) in MIL at the 2 year follow-up assessment. These relationships remained significant after 

controlling for depressive symptoms and cancer-related stress at diagnosis. Coping variables 

accounted for 5 to 43% of the variance in MIL. The results confirmed the original hypothesis 

that coping strategies have a long-term effect on MIL. Participants who tended to reframe 

negative events in a more positive light were able to find greater meaning and purpose from 

these events. It was unclear from the results whether MIL should be thought of as a trait that is 

stable or variable in response to major life events. Sources of MIL and the types of coping 

strategies that people use often differ based upon their unique life circumstances and associated 

challenges (Boehmer et al., 2007; Dunkel-Schetter et al., 1987; Jim et al., 2006).  

To shed light on the effectiveness of different coping strategies, researchers in one study 

examined the perceived self-efficacy and coping ability of 175 cancer patients (gastrointestinal, 

colorectal, and lung cancer) at one and six months after surgery (Boehmer et al., 2007). Also 

assessed was the influence of social support, both actual (i.e. received) and perceived (i.e. 

expected), on participants’ adjustment to cancer (Boehmer et al., 2007). Greater perceived self-

efficacy was associated with lower stress and depression and greater use of meaning-focused 

coping strategies. Participants who used meaning-focused strategies tended to have a positive 



46 

 

 

outlook and saw themselves as capable of dealing with difficult situations (Boehmer et al., 

2007). In terms of actual support, receiving assistance with managing their disease and 

recovering from cancer treatments helped to alleviate depression and enhance participants’ 

emotional well-being. The results also showed a significant association between perceived 

support and emotional well-being. The findings should be interpreted with caution considering 

the heterogeneity of the sample (i.e. differences in diagnosis, site and stage of cancer) and the 

lack of information regarding the refusal rate. 

Interestingly, some researchers have described perceived support as a personality trait or 

feeling of attachment (Sarason, Pierce, & Sarason, 1990), meaning it can vary between 

individuals or within the same individual over time. It remains to be seen whether these 

constructs (e.g. meaning in life, perceived support, and coping ability) should be thought of as 

stable or variable in nature. The coping strategies that people ordinarily rely upon may not be as 

effective when dealing with the tasks of cancer treatment (Boehmer et al., 2007). In response, 

interventions have been developed and tested with cancer patients to help them learn coping 

strategies that can improve psychosocial adjustment to cancer (Boehmer et al., 2007; Henry et 

al., 2010; Reynolds & Perrin, 2004; S. K. Smith et al., 2011). To illustrate, meaning-focused 

interventions (i.e. the Meaning-Making intervention), designed specifically to address existential 

issues, have begun to fill an important gap in supportive cancer care research (Harper, 2002; Lee, 

Robin Cohen, Edgar, Laizner, & Gagnon, 2006). Followed is a brief discussion of these 

intervention studies.  

Using a prospective single-arm pilot study, researchers evaluated the Pathfinders program 

in a sample (n=44, M age=51.5) of women with advanced breast cancer (S. K. Smith et al., 

2011). Developed by social workers, the Pathfinders program is a strength-based model designed 



47 

 

 

to enhance participants’ coping skills and resilience. The program helps participants to identify 

their inner strengths and establish a self-care plan. Over a period of six months, the participants 

completed assessments to evaluate changes in various resources (e.g. coping, social support, 

spirituality, self-efficacy, and optimism) and outcomes (e.g. despair, distress, QOL, and fatigue). 

Multiple linear regression analyses indicated that participation in the Pathfinders program was 

associated with lower distress and improved quality of life, adjusting for demographic 

characteristics. Improvements in distress correlated significantly with enhanced coping, social 

support, spirituality, and self-efficacy. Despite finding positive outcomes in the areas targeted by 

the program, there were some limitations including the small sample size, lack of a control 

group, and reliance on correlational data.  

In one randomized controlled trial, researchers examined the efficacy of the Meaning-

Making intervention (MMi) for newly diagnosed breast and colorectal cancer patients (Lee et al., 

2006). The MMi is intended to address existential issues by facilitating the development of 

meaning-focused coping strategies. Consisting of one to four individualized sessions, the MMi 

involves the discussion of beliefs about faith, religion, and spirituality. Journaling and guided 

imagery are used to explore the meaning of emotional and cognitive responses to cancer, in the 

context of previous life events and future goals. In the study, participants were stratified by 

cancer site and randomly selected to receive usual care (n=39) or four sessions (n=35) of the 

MMi. Patients with a diagnosis of brain metastases or psychiatric history were excluded from the 

study. The participants were asked to complete measures of self-esteem, optimism, and self-

efficacy at 6 and 12 months. Controlling for baseline scores, the experimental group showed 

significantly higher levels of self-esteem, optimism, and self-efficacy compared to the control 

group (Lee et al., 2006). Baseline levels of self-efficacy were not significantly different from the 



48 

 

 

general population. Compared to participants, non-participants were older, less educated, and 

had lower incomes. Subgroup analyses comparing breast and colorectal cancer patients were not 

possible as the final sample consisted mostly of women with breast cancer.  

Researchers in a subsequent investigation sought to evaluate the acceptability and 

usefulness of the MMi for newly diagnosed (stage III or IV) patients with ovarian cancer (Henry 

et al., 2010). In this pilot study, participants were randomized to the experimental (n=12) and 

control group (n=12). The experimental group received usual care plus the MMi, and the control 

group received usual care and were placed on the wait list for the MMi. The participants’ level of 

fatigue was an important determinant of the pace and frequency of the intervention which ranged 

from 30 to 90 minutes. Each session was intended to facilitate participants’ self-exploration 

regarding existential or spiritual dimensions of living with cancer. The primary outcome of 

interest was existential well-being. Additional measures included quality of life, distress, anxiety, 

depression, and self-efficacy.  

The results indicated short-term benefits of the MMi, including a significant 

improvement in meaning in life and a trend toward greater quality of life and existential well-

being (Henry et al., 2010). No significant effects were found for general self-efficacy or 

continuous measures of psychological distress. Based upon the findings, it is possible that the 

observed changes are the result of receiving the therapist’s time and attention as opposed to the 

intervention itself. The MMi is often used in conjunction with behavioural and educational 

interventions, making it more difficult to disentangle the effects of the MMi (Lee et al., 2006). 

One improvement to the study would be the inclusion of a larger sample size and a third 

comparison group to control for the effects of working with an attentive and supportive therapist 

(Henry et al., 2010). Improved standardization of the MMi and a longer follow up period would 



49 

 

 

also be useful for observing the impact of the MMi on psychological well-being. Nevertheless, 

these intervention studies lend empirical support to the notion that positive outcomes can follow 

from negative events, as some cancer patients even exceeded (i.e. thriving) their pre-diagnosis 

level of functioning (Carver, 1998; Lee et al., 2006). Meaning-focused coping may be one such 

mechanism that helps to account for these findings.  

2.2.3 Cancer and Meaning-Making 

At the intersection of human health and spirituality, the study of spiritual coping and 

meaning-focused coping provides some insight into how people adjust to cancer. Rather than 

attempting to distinguish between spiritual coping and meaning-focused coping, each of which 

has some overlapping components, I use the concept of meaning-making (introduced in Chapter 

1) to describe the ways in which people tend to derive meaning from their experiences. Meaning-

making complements traditional theories of coping that posit a transactional relationship between 

the person and his/her environment (Bigatti et al., 2012; Folkman & Lazarus, 1988; Waldrop et 

al., 2011a). Meaning-making takes into account that people have both capacities and limitations 

which affect their ability to exercise personal agency and control in managing a stressful 

situation (McCorkle et al., 2011; Pargament & Mahoney, 2002). Although spirituality has 

received increased attention in the psychosocial oncology literature (Carroll, 2001; Girardin, 

2000; Laranjeira et al., 2013; van der Spek et al., 2013), research on meaning-making is still 

relatively new, and few studies have considered how companion animals may be involved in this 

process (Nitkin, 2014).  

In the coping literature, support seeking is routinely reported among the strategies most 

often used by people to cope with cancer (Bigatti et al., 2012; Dunkel-Schetter, Feinstein, 

Taylor, & Falke, 1992; Hopman & Rijken, 2015). People make meaning from their experiences 



50 

 

 

and, in many cases, seek out relationships and connections to validate these meanings (Neimeyer 

et al., 2010). Accordingly, these relationships allow people to experience attunement, meaning 

the process of “tuning into the subjective experience of another being and responding to that 

experience” (Lasher, 1998, p. 131). Attunement is regarded as a fundamental need (Bowlby, 

1982; Winnicott, 1971) that, when fulfilled, provides a “psychological sense of accompaniment” 

(Blazina, 2011). Findings from recent studies suggest that some cancer patients do experience 

enhanced meaning, specifically, as it pertains to their intimate relationships (Molzahn et al., 

2012; van der Spek et al., 2013). Relationships can provide a buffer against the effects of stress, 

and yet, it is also apparent that adjustment to cancer continues well beyond the conclusion of 

treatment (Bultz & Carlson, 2006; Kazanjian et al., 2012; Waldrop et al., 2011a). 

For many people, cancer represents a critical life event with enduring psychosocial, 

existential, and physical consequences (Boehmer et al., 2007; Kazanjian et al., 2012; Vachon, 

2008). Research suggests that the stage of cancer can have a greater influence on how people 

cope with their illness than the specific type of cancer (Hopman & Rijken, 2015). When 

diagnosed at an advanced stage, a person is faced with the prospect of dying early. Existential 

issues refer to inexorable challenges of human life including loneliness, death, meaning, and 

freedom (Yalom, 1980). These issues may come into focus after a cancer diagnosis, prompting a 

person to reflect upon what is most meaningful in life (Girardin, 2000; A. J. Lopez et al., 2009; 

Yalom & Josselson, 2011). Research on spiritual and meaning-focused coping has all but 

overlooked the importance of companion animals. This is a substantial omission considering the 

potentially health-enhancing effects of human-animal bond practices such as kindred relaxation 

and mindful moments (Faver, 2009; Fine & Eisen, 2008). On the other side of the coin, for some 

people, the loss of a pet is both an inevitable and deeply impactful event (R. D. K. Brown, 2006; 



51 

 

 

Morley & Fook, 2005). Pet loss can be compounded by other losses that accompany cancer (e.g. 

decline in health, loss of a job), and are further complicated by issues surrounding the practice of 

euthanasia (R. D. K. Brown, 2006; Morley & Fook, 2005). Interventions designed to promote 

meaning-making and psychosocial adjustment to cancer must take into account both the benefits 

and risks of sharing one’s life with a companion animal.   

In summary, spirituality is increasingly recognized as being integral to the provision of 

holistic, patient-centered care (Carroll, 2001). Some authors question whether spirituality is too 

nebulous or ephemeral for empirical investigation, while others find the aim of formalizing 

spirituality into a treatment modality problematic (Girardin, 2000; Pargament & Mahoney, 

2002). Some oncology settings include tools to assess spirituality (e.g. FICA, HOPE) as part of 

their routine assessments (Girardin, 2000). Hospitals and health care facilities offer services to 

address patients’ spiritual needs including prayer, meditation, blessings, the reading of sacred 

texts, visits from spiritual leaders, and visits with therapy animals or patients’ own pets (Carroll, 

2001; Girardin, 2000). However, this last aspect of spiritual care remains understudied and 

underutilized in cancer care. Much of the scholarship on pets and human spirituality appears to 

be theoretical or conceptual in nature rather than empirical. Being in the presence of pets and 

attempting to relate to them is considered by some researchers as an “act of spiritual growth” 

(Skeen, 2011). With all that animals have to teach us about our spiritual development, perhaps it 

is no wonder that people continue to turn to animals in times of joy and suffering.  

2.3 Spirituality and Pets 

2.3.1 Spiritual Significance of the Human-Animal Bond 

The significance of animals for human spirituality has been documented throughout 

history in sacred texts, legends, customs, practices, and religious teachings (Brandes, 2010; R. D. 



52 

 

 

K. Brown, 2006; Coren, 2008; Hanrahan, 2011; Manes, 1997; B. P. Smith & Litchfield, 2009). 

Admired for their power and beauty, horses were worshipped as gods among ancient 

civilizations (Keaveney, 2008). In ancient Egypt, cats were associated with the goddess 

representing the sun, and were honoured accordingly (Walsh, 2009b). Mourning rituals were 

undertaken to mark the loss of a dog, including mummification and burial in one of Egypt’s 

animal necropolises (Coren, 2008; Walsh, 2009b). For their loyalty and companionship, dogs 

were revered as guides for their human caretakers in the afterlife (B. P. Smith & Litchfield, 

2009; Walsh, 2009b). In traditional Indigenous Australian spirituality, dogs were thought to be 

capable of detecting the presence of evil spirits (B. P. Smith & Litchfield, 2009). Moreover, 

people in other parts of the world have participated in similar burial practices over centuries, 

attesting to the intensity and endurance of the human-animal bond (Brandes, 2010; Morey, 

2006). Even today, some religious organizations offer animal blessings to acknowledge the 

significance of animals in people’s lives (R. D. K. Brown, 2006; Holak, 2008). Animal blessings 

can be traced back to St. Francis of Assisi, the patron saint of pets and animals in Catholicism 

(Skeen, 2011). Notably, these spiritual practices extend to ceremonies commemorating animals 

who have served in law enforcement and the military (Holak, 2008; Skeen, 2011).  

A common theme that emerges from research on spirituality is that of animals as 

“teachers” in relation to people (Grandin & Johnson, 2009; Keaveney, 2008; Maharaj & Haney, 

2015). Among the spiritual lessons gleaned from humans’ interactions with animals are an 

appreciation of diversity, and a recognition of the kinship and interdependence of all living 

beings (Faver, 2009; Hanrahan, 2011; Keaveney, 2008). These spiritual lessons confer particular 

obligations including the responsibility of humans to care for the environment and its inhabitants 

(Hanrahan, 2011; B. P. Smith & Litchfield, 2009). Humans’ very survival and well-being depend 



53 

 

 

on their efforts to preserve the well-being of animals, both domesticated and wild (Faver, 2009; 

Hanrahan, 2011). When referring to pets, some authors prefer the terms “parent companion” or 

“human caretaker” instead of pet owner to convey the moral and ethical duty of people to care 

for animals (Hanrahan, 2011; Walsh, 2009b). Accordingly, domesticated animals are seen as a 

mediator between nature and culture, allowing people to go beyond traditional understandings of 

family, friendship, and companionship (Hirschman, 1994; Mosteller, 2008; E. Power, 2008).  

2.3.2 Sacred Consumption and the Human-Animal Bond  

The human-animal bond provides experiences of a spiritual nature (Hill, Gaines, & 

Wilson, 2007; Holbrook, Stephens, Day, Holbrook, & Strazar, 2001; Keaveney, 2008). Pets are 

often kept inside the home and their physical proximity with people has particular meanings and 

implications (Mosteller, 2008). To illustrate, people and pets share a variety of consumption 

experiences (e.g. walking, eating, travelling, and watching TV) that transcend customary notions 

of possessors and possessions (Holbrook, 2008). These shared experiences have been referred to 

as “a sacred and spiritual consumption” (Holbrook et al., 2001). The consumer-pet relationship 

conveys a kind of intimacy that, according to some reports, is experienced as intrinsically 

rewarding rather than a means to an end (Holbrook et al., 2001; Podberscek et al., 2000). While 

pets may serve particular functions such as guarding the house or motivating people to engage in 

physical activity, these do not appear to be the primary reasons for having a pet (Hill et al., 2007; 

Holbrook, 2008). Pets may fulfill needs that exceed a person’s original expectations such as 

assisting in the accomplishment of important life projects or the resolution of existential 

concerns (Mosteller, 2008). To illustrate, people who see themselves as responsible pet owners 

may choose to take their dog for a walk everyday regardless of inclement weather. Such 

practices reinforce their self-concept and self-worth (Brooks et al., 2013; Mosteller, 2008).  



54 

 

 

Researchers have developed postmodern methodologies in an effort to better understand 

the consumer-pet experience (Hill et al., 2007; Mosteller, 2008). For example, in a 

phenomenological study, researchers conducted in-depth interviews with six participants 

regarding their professional work (e.g. breeding animals) in the pet care industry (Mosteller, 

2008). The participants reported caring for between 6 and 100 animals at some point during the 

course of their career. The results suggested that participants were deeply committed to ensuring 

the well-being of the animals in their care. From their early childhood experiences, participants 

had been socialized to think of pets as family members, leading them to develop strong 

emotional attachments to animals (Blazina, 2011; Mosteller, 2008; Walsh, 2009b). Two themes 

were identified: rescuer and caretaker (Mosteller, 2008). The rescuer theme reflected 

participants’ views of themselves as having compassion, empathy, and a sense of duty to help 

animals. The caretaker theme referred to participants’ dedication to animals including the 

personal and financial sacrifices they made. Participants reported that caring for a large number 

of animals had a negative impact upon their well-being. At times, participants felt isolated, and, 

at others, they felt that having animals led to more opportunities to socialize with people.  

Another example of the use of novel methodologies is provided by a study involving 

canine life histories which had been developed for the purpose of documenting the lifecycle of 

companion dogs (Hill et al., 2007). These canine life histories were produced by the principal 

investigators using in-depth essays and personal self-reflections. An analysis of these 

ethnographic reports revealed the essential role of pets in family gatherings and important life 

transitions (e.g. family member going to college). Within the family, pets appeared to have more 

than one capacity, enabling them to relate to family members in terms of each member’s unique 

developmental needs. What began as everyday pet care responsibilities soon evolved into 



55 

 

 

cherished routines that helped to solidify the bond between pets and family members (Hill et al., 

2007; Maharaj, 2013; E. Power, 2008). Quite simply, pets were seen as the embodiment of what 

gives meaning to daily life, permitting adults to become engrossed in the kind of delight and 

rapture that is often witnessed among children (Hill et al., 2007).  

2.3.3 Meaning-Making and Companion Animals  

In view of the foregoing discussion, it is worth noting that the desire and capacity to find 

meaning in life is not contingent upon experiencing a negative event (Carver, 1998). Meaning-

making can be thought of as a normative process that enables people to make sense of their 

experiences (Jim et al., 2006). For some people, the outcome of this process may be an enhanced 

sense of self-worth and self-efficacy in dealing with events, both good and bad (Boehmer et al., 

2007; Costanzo et al., 2009; Lee et al., 2006). One intriguing aspect of human experience is how 

people tend to make sense of their relationships with animals, particularly, pets and companion 

animals. Observed almost universally among pet owners (Serpell, 2003), anthropomorphism 

refers to the tendency of people to attribute human feelings and qualities onto non-human 

animals (Hirschman, 1994; Walsh, 2009b). Examples of anthropomorphism range from the 

mundane (e.g. characters in children’s books) to the extreme (e.g. models of human disease) 

(Pagani, 2011). With greater access to domestic spaces, pets have become increasingly 

anthropomorphized, cementing their place as family members (Dotson & Hyatt, 2008; Hoffer, 

2011). People talk to their pets, take photos of them, give them presents, celebrate their 

birthdays, and take them on family vacations (Coren, 2008; Holbrook, 2008; Walsh, 2009b).   

The idea of animals as being intelligent or having a personality (i.e. to anthropomorphize 

animals) is considered to be a “cardinal sin” by many human-animal bond researchers (Coren, 

2011). Even as I compose this literature review, I am aware of my decision not to comply with 



56 

 

 

the formatting requirements of the American Psychological Association’s Publication Manual, 

which warn against attributing human qualities to animals or inanimate objects (American 

Psychological Association, 2010). Without getting into philosophical debates about the existence 

of mental or affective states among animals (Skeen, 2011), I agree with the common-sense 

approach advanced by Stanley Coren and Jonathan Balcombe, two leading experts in animal 

behaviour. These experts explain that the tendency to anthropomorphize animals is not only 

widespread among pet owners, but is inevitable (Balcombe, 2009) and something that people do 

“quite automatically” (Coren, 2011). Neither pet guardians nor researchers can ask animals what 

they think or feel. Instead, they can attempt to understand the animals’ behaviour using qualities 

(i.e. human characteristics) with which they are most familiar (Balcombe, 2009; Coren, 2008).  

Some of the concerns raised about anthropomorphism lie in the way that it tends to be 

conceptualized in research (Balcombe, 2009). To illustrate, it has been suggested that people 

who view animals merely as an extension of themselves are less capable of empathizing with 

them (S.-E. Brown, 2011; Hirschman, 1994). This view of animals implies a social relationship 

wherein the person is erroneously projecting feelings onto an animal and the animal does not 

reciprocate (S.-E. Brown, 2011). Along with my Master’s research on people and companion 

dogs (Maharaj, 2013), studies show that people do believe that pets can reciprocate feelings and 

emotions (Cohen, 2002; Fine, 2011; Sanders, 1993; Walsh, 2009b). Many people regard their 

pets as sentient (i.e. possess feelings) beings, capable of demonstrating empathy and engaging in 

goal-directed behaviours (Hirschman, 1994; E. Power, 2008; Sanders, 1993).  

Even at an early age, children recognize that animals share many important similarities 

with people and also differ from them in remarkable ways (Pagani, 2011; Pagani, Robustelli, & 

Ascione, 2008). Acknowledging similarity and acknowledging diversity are two integral 



57 

 

 

components of developing empathy towards others (Coren, 2008; Lasher, 1998; Pagani, 2011). 

In child development research, diversity is considered a ubiquitous feature of human life, and 

represents anything that is “not the self” or the “present self” (Pagani, 2011). At any moment, 

humans are tasked with having to relate to diversity in the natural and built environment which 

can “mobilize their empathic abilities” (Pagani et al., 2008). For humans, being in the company 

of animals often evokes curiosity and fascination (Davis, 2011; Faver, 2009; Grandin, 2005). 

Considering the deep significance of animals for many people, it is not surprising that people 

spend much of their time trying to understand and communicate with their pets (Cohen, 2002; 

Coren, 2008; E. Power, 2008).  

Shedding some light on the role of anthropomorphism in research, Coren (2011) recounts 

a conversation he had with renowned psychologist Donald O. Hebb. Hebb was describing his 

work at the Yerkes National Primate Research Center, during which he was attempting to 

document the temperament and behaviour of chimpanzees using objective language, devoid of 

human qualities and emotions. While reviewing his notes, Hebb proclaimed that he “couldn’t 

find any order, pattern or meaning in that kind of data” (Coren, 2011, para. 5). Hebb went on to 

remark that the animal keepers, who had spent the most time caring for these chimpanzees, often 

used anthropomorphic statements (e.g. shy or friendly) to describe the chimpanzees. To do their 

job, the animal keepers needed to be able to understand and explain the chimpanzees’ behaviour. 

Anthropomorphizing the chimpanzees helped to provide predictability and consistency in the 

way that the keepers interacted with the animals in their care.  

Two important points can be gleaned from Hebb’s story that I believe are relevant to 

understanding the experiences of cancer patients and their pets: the significance of finding 

meaning in what appears to be chaos, and the importance of understanding people’s everyday 



58 

 

 

experiences with caring for a pet. On a fundamental level, people are driven toward finding 

meaning and connection (Bowlby, 1982; Frankl, 2006). In studies on cancer and meaning-

making, investigators have found that people actively construct a narrative of meaning as they 

adapt to the psychosocial consequences of living with cancer (Laranjeira et al., 2013; Molzahn et 

al., 2012; Vachon, 2008). While in previous work, researchers have tended to emphasize the 

negative sequelae of a cancer diagnosis, there has been greater interest in exploring the potential 

for growth and positive change among cancer survivors (Carver, 1998; Costanzo et al., 2009; 

Laranjeira et al., 2013). However, with the exception of research on animal-assisted interventions 

with cancer patients, the experiences of cancer patients and their pets have been virtually ignored 

in the field of psychosocial oncology (Larson et al., 2010). Accordingly, the aim of the present 

study is to develop an essential understanding of the nature and meaning of the human-

companion animal relationship for people with cancer.  

2.4 Conclusion 

In summary, I began this literature review with the objective of reviewing research on pet 

ownership among people living with cancer, prefacing this by commenting on the dearth of 

studies at the intersection of meaning-making and the cancer patient-companion animal 

relationship. Perhaps, as Katcher (as cited in Dotson & Hyatt, 2008) noted over 30 years ago, and 

still relevant today, reluctance toward sentimentality has turned some researchers away from 

studying the meaning of pets in people’s lives. As researchers continue to study the implications 

of pet ownership, it is important to remember that obtaining measurable and robust health 

outcomes is hardly what matters most to their human caretakers (Podberscek et al., 2000; Ryan 

& Ziebland, 2015). Caring for a pet provides continuity, enabling a person to contribute 

meaningfully to the welfare of another living being (Brooks et al., 2013). Pets bear witness to, 



59 

 

 

and participate in some of the most intimate areas of a person’s life  (Blazina, 2011; Maharaj, 

2013; E. Power, 2008). For some people, pets may be the ideal companions to accompany them 

as they discover what it means to live with and beyond cancer (Horowitz, 2008). This deeply 

personal and complex relationship should be considered worthy of formal scientific curiosity 

(Grandin, 2005). 

 

 

 

 

  

 



60 

 

 

Chapter 3: Methodology 

In this chapter, I outline my approach to addressing the research question: What is the 

lived experience of the human-companion animal relationship for people with cancer? I begin by 

describing the philosophical underpinnings of phenomenology. I draw upon Max van Manen’s 

work to situate the current study within the context of phenomenological inquiry. In describing 

van Manen’s work, I treat phenomenology as an attitude, method, and process of writing and 

reflecting. Next, I outline the research design including the study’s eligibility criteria, 

recruitment process, and research context. I describe the steps undertaken in data collection and 

analysis. For data analysis, I used a combination of van Manen’s (1997; 2014) and J. A. Smith et 

al.’s (2009) approaches, the former offering a framework to guide my reflections and 

interpretations, and the latter providing concrete analytical steps. The chapter concludes with a 

discussion of the criteria for assessing the trustworthiness of qualitative research. 

3.1 Phenomenological Approach to Inquiry 

3.1.1 Philosophical Underpinnings of Phenomenology 

Phenomenology has been described as a philosophy and a discipline. The suffix logy 

means word or study; phenomenon means “that which appears” without implying a specific 

domain or subject of study (van Manen, 2014). Phenomenology is comprised of a set of 

traditions embedded in 19
th

 and 20
th

 century European philosophy (Dowling, 2007; Langdridge, 

2007; van Manen & Adams, 2010). A common concern among these varied traditions is 

investigating the source of meaning in everyday life (van Manen, 1997; Yontef & Jacobs, 2011). 

In transcendental phenomenology, a tradition that originated in the work of Husserl, 

phenomenological reflection takes place through the method of the reduction (van Manen, 2014). 

Whereas, in natural science, reduction entails reducing something to its simpler or more 



61 

 

 

fundamental components, here, reduction means that we embrace the complexity and ambiguity 

of a phenomenon. The reduction requires that we pull away from the natural attitude (i.e. our 

everyday beliefs about the world), and remain open to how phenomena present themselves in 

lived experience (Dowling, 2007; van Manen & Adams, 2010). Importantly, phenomena are not 

simply retrieved in consciousness but are constituted in terms of what they mean for us (Husserl, 

1970). Proponents of Husserlian phenomenology consider description as being a key aspect of 

this approach, and interpretation as being outside the bounds of phenomenological inquiry 

(Dowling, 2007; Giorgi, 2000; Langdridge, 2007).  

Distancing himself from Husserl, Heidegger (2010) argues that phenomena are not just 

constituted in consciousness but are encountered in the world in which we engage with them. 

Heidegger proposes an interpretive phenomenology which rests upon the nature of being-in-the-

world. From this ontological premise, human existence is already anchored in a “world of 

meanings” (van Manen & Adams, 2010). All modes of being-in-the-world are already modes of 

understanding the world. Consequently, people cannot be understood apart from the 

circumstances that influence their lived experience. While Heidegger prioritizes understanding 

over description (Husserl does the opposite), he shares with Husserl an emphasis upon exploring 

the phenomenon itself rather than the theories about the phenomenon. This point is crucial to 

understanding what phenomenology does and does not do. In phenomenology, we remain 

oriented to an experience as a possible human experience, and attempt to capture it in such a way 

that others can experience it (J. A. Smith et al., 2009; van Manen, 1997). Phenomenology does 

not aim for accurate descriptions of the subjective thoughts and opinions of a particular 

individual (e.g. case study) or group of individuals (e.g. ethnography) (Dowling, 2007). 



62 

 

 

Like Husserl, Gadamer (1998) sees the methods of natural science as being antithetical to 

the aims of human science. Natural science is concerned with investigating objects and events 

using quantitative measurement, detached observation, and controlled experimentation (van 

Manen, 1997). In the field of human science (e.g. phenomenology, ethnography, symbolic 

interactionism, critical theory, etc.), researchers are interested in studying people and how they 

express meaning in the world, for which the preferred methods are description, interpretation, 

and critical reflection. Human science is based upon an epistemology of language and text (i.e. 

we know through language) (van Manen, 1997). While nature can be explained using causal or 

probabilistic explanations, human life is understood by explicating the meaning of a 

phenomenon (Dilthey, 1987). A phenomenological human science is manifest in a deep 

fascination with what is unique or singular about a phenomenon (van Manen & Adams, 2010). 

In striving to grasp the uniqueness or essence of a phenomenon, (Merleau-Ponty, 2012) 

emphasizes the study of prereflective experience, in other words the experience that we live 

through in daily life. The essence of a phenomenon is something that without it, the phenomenon 

would not be what it is (Merleau-Ponty, 2012). To investigate the essence of a phenomenon, the 

researcher must adopt an attentive awareness (i.e. wondering pathos) and style of thinking that 

occurs in the attitude of the reduction (Merleau-Ponty, 2012; van Manen, 2014). Through the 

reduction, we aim to bracket theories and assumptions that prevent us from being in contact with 

lived experience (Merleau-Ponty, 2012). Not all phenomenologists agree about when or if the 

reduction is necessary. However, phenomenology demands that we thoughtfully examine our 

assumptions (Dowling, 2007). 

Considering that lived experience is mediated by thought and language, it becomes 

possible to access lived experience through thought and language (van Manen, 2014). 



63 

 

 

Accordingly, a principal concern of phenomenology is “textual reflection” upon lived experience 

(van Manen, 1997). When we reflect upon a text, we disclose something that is meaningful to us 

based upon our relationship to the subject matter (Gadamer, 1998). The beliefs and assumptions 

that are unique to a particular researcher are part of what makes phenomenology a worthwhile 

form of inquiry (Langdridge, 2007; K. A. Lopez & Willis, 2004). Each phenomenologist has 

his/her own “personal signature” and style (van Manen, 1997). This is not to say that 

phenomenology relies upon idiosyncratic research practices, nor is it desirable to imitate the 

work of others. By grounding our work in the traditions of phenomenology, we begin to “see” 

and “transcend” our limits (van Manen, 1997). By examining and making explicit our own 

assumptions (i.e. the reduction), we can be more open and inclusive of others’ experiences 

(Heidegger, 2010).  

3.1.2 Situating Max van Manen’s Phenomenology 

Phenomenology, as proposed by Husserl and Heidegger, is considered to be a philosophy 

rather than a research method (Dowling, 2007; Giorgi, 2000; McConnell-Henry, Chapman, & 

Francis, 2011). Accordingly, I turned to the work of van Manen (1997) whose practical methods 

and techniques serve as a modern extension of the human science research tradition. Van 

Manen’s approach entails both the description and interpretation of lived experience (Dowling, 

2007). As with Husserl and Merleau-Ponty, van Manen (1997) regards phenomenology as the 

study of essences or universals but is careful to emphasize that an essence is not some ultimate 

core of meaning. Where van Manen departs from Husserl is in his treatment of the reduction. 

Husserl, a mathematician by training, sees the reduction as a process of bracketing our 

assumptions, almost as if we are meant to separate our assumptions and set them aside (K. A. 

Lopez & Willis, 2004; van Manen, 1997). Although van Manen considers the reduction 



64 

 

 

necessary, in his view, Husserl’s notion of bracketing is not possible in the sense of complete 

reduction (Langdridge, 2007). According to van Manen (1997), if we attempt to ignore or 

discard our assumptions, they are likely to “seep back” into our interpretations and reflections.  

Similarly, Heidegger (2010) suggests that it is not possible to separate our understanding 

of the world from our “being-in-the-world.” Van Manen (1997) argues that we should bracket 

our assumptions and preconceptions not by discarding them but by making them explicit. We 

should keep our assumptions at a distance without trying to forget them or abandon them 

altogether. Strategies proposed by van Manen include actively listening to other people’s 

experiences and engaging in reflective journaling. In line with van Manen’s (1997) point about 

the reduction being necessary, it is worth noting that we often begin a study by saying that “little 

is known about this” or “more research is needed on this topic.” Phenomenology invites us to 

consider that, perhaps, “we know too much” (van Manen, 1997, p. 46). Due to our preconceived 

notions about the world, we assume we know something of the phenomenon before we fully 

consider our research question (van Manen, 1997).  

In Chapter 1, I posed the research question: What is the lived experience of the human-

companion animal relationship for people with cancer? To paraphrase van Manen, my objective 

was to come to an understanding of what makes it possible to say that between a person and 

his/her companion animal, there exist the human-companion animal relationship. I drew upon six 

activities proposed by van Manen (1997) for conducting phenomenological research: 1) turning 

to a phenomenon which seriously interests us and commits us to the world, 2) investigating 

experience as we live it rather than as we conceptualize it, 3) reflecting on the essential themes 

which characterize the phenomenon, 4) describing the phenomenon through the art of writing 



65 

 

 

and rewriting, 5) maintaining a strong and oriented pedagogical relation to the phenomenon, and 

6) balancing the research context by considering parts and whole (pp. 30-31).  

Firstly, in carrying out each of these six activities, I strived to be reflective, continually 

questioning and reflecting upon the importance of the human-companion animal relationship 

(van Manen, 1997). Secondly, I remained oriented to gathering descriptions of lived experience 

rather than theories or concepts about this relationship. Thirdly, I treated writing as being 

inseparable from researching the human-companion animal relationship (van Manen, 1997). 

Lastly, I considered that the phenomenological text that I produced would be one example 

among other possible interpretations. Consequently, I would have been remiss in attempting to 

arrive at a single and exhaustive description of the human-companion relationship (van Manen, 

1997). Instead, my aim was to gather concrete examples or instances of the human-companion 

animal relationship in order to grasp the essences of this relationship for people with cancer. 

3.1.2.1 Phenomenology as attitude  

Phenomenology aims to break through the natural attitude, in other words, the kind of 

taken-for-granted attitude with which we approach the world. The natural attitude is reflected in 

our belief that the world exists independently of how we experience it (Husserl, 1970; Mensch, 

2003). In phenomenology, the intent is not to deny the natural attitude but rather acknowledge 

that our concepts and theories shape how we experience the world. In his seminal work, Husserl 

(1970) described the need for adopting an attitude of openness towards how things give 

themselves in lived experience. The phenomenological attitude is revealed in our attempt at being 

reflectively attentive to how people experience something before they conceptualize it. Van 

Manen (2014) uses the example of pain to illustrate the phenomenological attitude. We can rate 



66 

 

 

or quantify pain using instruments. We can conceive of pain as a sensation but, describing the 

actual experience is so difficult. It seems beyond words.  

As in the example of pain, our concepts and theories often originate fro m our everyday 

experiences, all of which are part of the natural attitude. Although there tends to be a distrust of 

theories that constrain our understanding of the world, theories do offer insights that enable us to 

access lived experience. Phenomenologists draw upon theories to expose what they potentially 

mask about lived experience (van Manen, 2014). Importantly, when we try to capture lived 

experience, we are already too late. We can only retrieve lived experience by reflecting upon it 

retrospectively, as when we recall a situation or event (van Manen, 1997). Accordingly, we are 

continually striving to capture lived experience and are faced with the impossibility of grasping 

lived experience. Rather than giving up, van Manen (2014) states that we should embrace this 

impossibility as part of what makes phenomenology so intriguing and demanding.  

Phenomenology compels us towards insights, understandings, and meanings that 

challenge our assumptions (van Manen, 2014). Through description and interpretation, 

phenomenology helps us to get at the structures of meaning embedded in lived experience. 

Phenomenology is not prescriptive in terms of its procedures and techniques. However, 

phenomenology does offer particular research methods that are developed in response to the 

research question, and are guided by a body of phenomenological scholarship (van Manen, 

1997). Phenomenology is ever renewing and reinventing itself as a collection of practices that 

are creative, poetic, and insightful (van Manen, 2014). In his poem, Malte Laurids Brigge, Rilke 

states, “Did I say it before? I’m learning to see—yes, I’m making a start. I’m still not good at it. 

But I want to make the most of my time” (Rilke, 1992). After considering the aim of studying a 

phenomenon as rich and complex as the human-companion animal relationship, I found it 



67 

 

 

peculiar to think of starting such a project with a pre-determined set of procedures. In the spirit 

of modesty and optimism, I tried to make a start and make the most of my time. 

3.1.2.2 Phenomenology as method  

Some theorists are wary of attempts to reduce phenomenological inquiry to a sequence of 

steps and yet, phenomenology is often described as a method (van Manen, 2014). The term 

method, however, is used to convey the aim of adopting a certain attitude and practising an 

attentive awareness to experience as we live it before we conceptualize it (Merleau-Ponty, 2012; 

van Manen, 2014). Husserl (1970) used the term “lifeworld” (Lebenswelt) to describe what 

people experience prereflectively without interpretation. Phenomenology aims to enrich our 

understanding of the meaning and importance of everyday experiences (J. A. Smith et al., 2009; 

van Manen, 1997). Perhaps better described as “meaning-giving methods,” phenomenology 

entails abstemious reflection, in that we abstain from theoretical or conceptual definitions of a 

phenomenon (van Manen, 2014). By reflecting upon prereflective experience, we can gain 

concrete insights into the meaning of a phenomenon. We may ask: What makes this experience 

distinguishable from others? Or, what is the nature, meaning, importance, or uniqueness of this 

phenomenon? As such, phenomenology is more a method of questioning rather than providing 

answers or drawing conclusions (van Manen, 1997).   

Phenomenology differs in important ways from other methods. Whereas the scientific 

method involves an objective and impersonal approach to inquiry, the phenomenological method 

calls for the use of the vocative by means of examples, images, and anecdotes (van Manen, 

2014). The vocative refers to the expressive power of language and text which enables us to 

reveal the essence of a phenomenon. Mensch (2003) refers to this as a shift from exploring what 

is abstract to exploring what is particular about a phenomenon. In contrast to the social sciences 



68 

 

 

that are concerned with explaining phenomena, phenomenology aims to describe and interpret 

phenomena. Another notable departure from other methods is that phenomenology does not 

necessitate repetition, comparison of outcomes, and indexing of data (van Manen, 2014). 

Phenomenology does not seek to analyze concepts nor does it help us to develop theories to 

explain why something happens. Instead, phenomenology may bring in theories and concepts to 

show where these are lacking in terms of experiential meaning. Ultimately, experience is 

saturated with meaning, and phenomenology helps us to grasp that which makes seemingly 

ordinary experiences meaningful and lasting (J. A. Smith et al., 2009; van Manen, 2014).   

3.1.2.3 Phenomenology as writing and reflecting  

Phenomenological writing is a process that entails both researching and reflecting upon 

the meaning of lived experience. Reflection takes place in the practice of writing, and writing is 

essential to the phenomenological method (van Manen, 2014). A related term is hermeneutics 

which is a methodology or philosophy that is concerned with interpreting text. Hermeneutic 

means that when we engage in reflection, we are aiming for discursive language as we interpret 

and ascribe meaning to the phenomenon under study (K. A. Lopez & Willis, 2004; van Manen, 

2014). Much of phenomenology has hermeneutic or interpretive aspects but not all hermeneutics 

are phenomenology (van Manen, 2014). In using the term phenomenology, I am referring to 

hermeneutic or interpretive-descriptive phenomenology. Interpretive-descriptive phenomenology 

uses a systematic approach of questioning and reflecting in order to articulate the meanings that 

are rooted in lived experience (van Manen, 2014). The result is a phenomenological text that is 

designed to “awaken” an experience and to create a “sense of resonance” in the reader (van 

Manen, 2014; van Manen & Adams, 2010).  



69 

 

 

It is common in phenomenological writing to use the pronouns “I” or “we” where 

possible. This linguistic device is intended to communicate to the reader that a particular 

experience could be his/hers, and also that the reader’s experience could resonate with others, 

including me (van Manen, 1997). Phenomenological writing requires interpretive skills and 

creative talents on the part of the researcher to express the meaning of lived experience. Between 

reflecting and questioning is what van Manen (2014) calls “reflective insight” and “narrative 

ability.” Phenomenologists make use of expressive, poetic, and vocative language to evoke 

particular meanings that cannot be done with formal prose. Often used are anecdotes, stories, and 

concrete examples. Such experiential descriptions speak to our cognitive and noncognitive 

sensibilities.  

As van Manen (1997) suggests, a phenomenological text is not meant to express 

something that we know, but instead the text lets us experience something that we do not know 

in an intellectual sense. Similar to poetry, meanings are strongly embedded in a 

phenomenological text such that the text cannot be easily summarized or paraphrased (van 

Manen, 2014). While phenomenology often borrows insights from poetry, phenomenology is not 

the same as poetry. Phenomenological themes make explicit, essences, whereas, in poetry, 

themes remain “implicit and particular” (van Manen, 2014). Phenomenology uses vivid 

examples to make the participants’ experiences more accessible, thus, allowing the reader to 

grasp what is singular about the phenomenon. 

3.2 Research Design 

Through systematic and empirical methods, I drew upon van Manen’s (2014) 

phenomenology to explore the relational meaning and importance of having a companion animal 

for people with cancer. In keeping with the attitude of the reduction, I did not treat the human-



70 

 

 

companion animal relationship as a concept, nor did I rely upon theories to make predictions or 

generalizations about this relationship. My objectives were to inquire about what makes this 

relationship unique and meaningful, and how this relationship arises in lived experience. To 

gather lived-experience descriptions, I used two methods described below: 1) the experiential 

data-gathering interview, and 2) photo elicitation.   

3.2.1 Methods for Collecting Lived-Experience Descriptions 

3.2.1.1 The experiential data-gathering interview  

My purpose in undertaking the interviews was to explore how people experience their 

relationship with their companion animal(s) as they were living with and recovering from cancer. 

I remained oriented to the meaning of the human-companion animal relationship as an 

“essentially human experience” (van Manen, 1997). I collected lived-experience descriptions by 

inviting participants to share anecdotes, stories, examples, and recollections (van Manen, 1997). 

As Merleau-Ponty (2012) stressed, I sought to elicit straightforward descriptions from the 

participants rather than their opinions or generalizations. My concern was less about the factual 

accuracy of the participants’ accounts, but rather the experiential quality (i.e. details, examples) 

of their descriptions (van Manen, 1997). 

Throughout the process of collecting data, it was valuable to keep in mind that lived-

experience descriptions are not the same as lived experience. Lived experience, by its very 

nature, is elusive; we are always too late to capture it. Lived-experience descriptions are already 

transformed in some way by the fact that they are being recalled retrospectively (van Manen, 

1997). Nevertheless, the experiential data-gathering interview allowed me to “borrow” other 

people’s experiences and carefully attend to their reflections on lived experience (van Manen, 

1997). My concern was with the nature of the human-companion animal relationship in terms of 



71 

 

 

the following kinds of questions: How is this experience an example of the human-companion 

animal relationship? Is this what it means to connect with a companion animal? 

3.2.1.2 Photo elicitation  

Prior to the interview, I invited the participants to bring in photos that depicted daily 

events or experiences involving their companion animal for discussion during the interview 

(Latham, 2003; Rose, 2003). I encouraged participants to share photos that were meaningful to 

them (Latham, 2003). My objective in using photo-elicitation was to bring the participants’ 

everyday experiences into the research process by encouraging them to reflect upon their 

experiences over a broader period of time than would have been possible without the use of 

photos (Latham, 2003; E. R. Power, 2013). I drew upon the following questions to elicit 

information about photos: Can you tell me what this photo means to you? What was it about this 

experience that you wanted to capture? Is taking photos of your pet something you would 

normally do? How are you experiencing the photo right now as we are looking at it? 

3.2.2 Study Procedures 

3.2.2.1 Participant selection  

I used a purposive sampling strategy (Flick, 2014; Miles, Huberman, & Saldana, 2014) to 

identify participants with the following attributes: at least 19 years old, fluent in written and 

spoken English, currently have a cat or dog, have received a diagnosis of cancer at least six 

months ago, and have had time to think about the importance of their pet since their diagnosis. 

There were no eligibility restrictions in terms of age, gender, or type of cancer. I focused on 

recruiting people with cats and dogs primarily, as these tend to be the most common pets in 

North America (Sandoe et al., 2015). Given variations in the life expectancy of cats and dogs, 

participants were not required to have had a pet prior to their cancer diagnosis. It was, however, 



72 

 

 

required that participants were currently living with their pet, and were one of their animal’s 

primary caretakers. With regards to sample composition, it was reasonable to expect that 

participants would be similar to one another in terms of being a pet owner, but could be 

heterogeneous in other respects such as age and occupational status. Heterogeneity was also 

anticipated among participants with the same type of cancer, considering the uniqueness of the 

cancer experience.   

The decision to recruit participants who were at least six months post-diagnosis was 

informed by research suggesting that this time period is useful for capturing changes which are 

important to a person’s adjustment trajectory (Linden, MacKenzie, Rnic, Marshall, & 

Vodermaier, 2015). In the first six months after diagnosis, it is likely that participants have 

completed a first wave of treatment. Within the next six months, participants are thought to have 

entered a “period of survivorship that is no longer overshadowed by acute treatment and its side 

effects” (Linden et al., 2015, p. 1392). Moreover, previous investigations have found that the 

stage of cancer can have a greater impact on a person than the specific type of cancer (Hopman 

& Rijken, 2015). It was preferable to recruit as many participants as possible at the stage of 

treatment completion (i.e. roughly 6 months post-diagnosis) and follow-up care given that these 

patient groups have not been studied as extensively as people who are more recently diagnosed 

(Hopman & Rijken, 2015; Linden et al., 2015; Waldrop, O’Connor, & Trabold, 2011b; 

Wenninger et al., 2013).  

3.2.2.2 Recruitment and research context  

Following ethical approval, I contacted organizations that provide psychosocial support 

to people with cancer, and sought their permission to put up posters in their clinics or centres 

(Appendix B). The program coordinators of two cancer care organizations allowed me to 



73 

 

 

advertise the study in their respective newsletters. These newsletters were emailed to cancer 

patients and professionals working in oncology settings who had opted-in to a mailing list. I was 

also permitted to put up posters in pet stores, veterinary clinics, community centers, and coffee 

shops. The posters were intended to attract the interest of people who saw their relationship with 

their companion animal as being important to their cancer journey. Lastly, I reached out to 

individuals involved in human-animal bond initiatives including animal behaviour research, dog 

clubs and shows, and pet therapy programs. Three of the people I contacted agreed to post the 

study advertisement on their Facebook page. Recruitment took place over a four month period. 

Upon being contacted by phone or email, I arranged a brief phone call to confirm the 

participant’s eligibility and provide more information about the study. I emailed interested 

participants a copy of the consent form and requested that they contact me if they agreed to take 

part in the study or had any further questions. Most participants responded within a day or two 

after reviewing the consent form. In a few instances, I waited a week before following up with 

participants. During our second phone call, I sought the participants’ verbal consent to take part 

in the study, and arranged a time and place to conduct the interview. I reminded participants 

about the use of photos in the study and the option of bringing cell phone images or printed 

copies for discussion during the interview (Latham, 2003; Rose, 2003).  

All in all, 20 individuals contacted me 14 of whom took part in an interview. Three of 

these participants were referred to the study by a friend whom I had interviewed previously. 

Among the three people who declined to participate in the study, two did not reply when I 

emailed them and one agreed to participate and did not show up for the interview. The three 

remaining individuals contacted me a few weeks after the fourteenth interview at which point I 

had decided not to conduct any additional interviews. This decision was informed by the 



74 

 

 

recommendations of researchers that it is appropriate to suspend data collection once enough 

concrete examples have been collected from participants in order to produce detailed 

descriptions and anecdotes (Langdridge, 2007; J. A. Smith et al., 2009; van Manen, 1997). After 

reviewing the tapes and my notes, I determined that it was appropriate to conclude data 

collection.  

In phenomenology, the issue of sampling is important for collecting a rich dataset of 

concrete and experiential descriptions from people with relevant experience, as opposed to 

obtaining a specific number of participants (van Manen, 2014). Smith et al. (2009) have 

suggested interviewing six to eight participants as a reasonable sample size. However, I found it 

useful to collect data from a larger sample size given the relative diversity of the participants 

whom I interviewed. Considering that phenomenology aims for uniqueness and singularity rather 

than frequency and repetition (van Manen, 1997), my primary concern was not with achieving 

saturation, meaning the point at which no new information arises from subsequent interviews 

(Braun & Clarke, 2006). Instead, I sought to obtain comprehensive accounts from both cat and 

dog owners, men and women, and people at different stages in their cancer journey. 

3.2.2.3 Interviews  

Eight interviews were held at the participants’ home, three at a university campus, two at 

a coffee shop, and one by phone due to geographical distance. Pets were present for interviews 

that took place at the participants’ home. At the start of our meeting, I reminded participants of 

the purpose of the study, and explained that the results would form the basis of my doctoral 

dissertation. Next, I gave the participants an opportunity to review and complete the informed 

consent form (Appendix C). I sought permission from participants to audiotape the interview and 

informed them that their names and pets’ names would not be included in any reports of the final 



75 

 

 

study. I explained that pseudonyms would be used for pets. I offered the participants a small 

honorarium of $25 to thank them for their time. One participant declined the honorarium; a 

second participant donated the money to a university program.  

After obtaining their consent, I informed the participants that the tape would begin 

recording. In an effort to build trust and rapport with participants, I began with the following 

statement: “I’m interested in what your relationship with your pet(s) is like, how it is important 

to you, and what it has been like over time and during your cancer journey.” I reminded 

participants about the photos and invited them to share these with me at any point during the 

interview. Some participants showed me collections of photos such as a photo calendar or 

memory book. Others shared video clips such as their pets’ birthdays, trips to the beach, and 

household chores. Still others opted to share only a few pictures that were particularly 

meaningful to them such as reuniting with their pet after being in the hospital or enjoying their 

nighttime routine with their pet. Some photos were taken recently while others were several 

years old. 

Early on in the interview, I asked participants to tell me about their diagnosis and cancer 

experience. Next, I asked participants to describe their pet and what makes this relationship 

important to them. My intent was to capture the stories of participants’ relationships with their 

pets during their cancer journey. The following question was used as an anchor point for the 

interview: When we go back to when you got your pet(s), what was it like then? Next, I 

followed-up by asking what their relationship had been like since then to get a sense of 

participants’ experiences with their pets over time. Some participants had their pet before 

receiving their cancer diagnosis whereas others had acquired their pet following their diagnosis. 

Considering that the chronological order of these two events (i.e. acquiring a pet, receiving a 



76 

 

 

cancer diagnosis) differed among the participants, it seemed wise to avoid using the time of 

diagnosis as an anchor point for the interviews.  

For participants who had their pet pre-diagnosis, I did not want to presuppose any 

changes to their relationship with their pets following their cancer experience. In addition, 

although a cancer diagnosis represents a significant life event, I wanted to be alert to other 

experiences that were pertinent to their relationship with their pet. For example, some 

participants emphasized the importance of their pets during other stressful periods such as ending 

a relationship with a romantic partner, dealing with addiction or substance use, and coping with 

mental health concerns. Moreover, I saw this approach as being consistent with the attitude of 

the reduction, which calls for the interviewer to listen to participants’ stories with openness and 

attentiveness to their lived experience (van Manen, 2014). 

Throughout the interviews, I remained oriented to the phenomenological aim of gathering 

detailed stories and anecdotes as opposed to general opinions and beliefs (van Manen, 2014). I 

drew upon a list of open-ended questions and neutral prompts to guide the interview (Appendix 

D). Examples of prompts were: What were you doing, What was your pet doing, Can you 

describe the place, How did you feel? The questions evolved over time with the aim of building 

rapport with participants and allowing them to discuss their interests and concerns (Flick, 2014; 

J. A. Smith et al., 2009). I refrained from asking participants to explain why something happened 

or what they thought about a particular issue (van Manen, 2014). More often, I opted to use 

silence or restate the participant’s last comment to elicit more information. When describing their 

pets, participants often mentioned recurring events such as meal times and daily walks. In these 

instances, I encouraged participants to recall a specific example or a recent experience and 

describe what was happening in as much detail as possible.  



77 

 

 

In determining when to conclude the interview, I tried to be mindful of participants’ body 

language and facial expressions. In some cases, participants appeared fat igued or requested a 

break. Some participants made comments such as “I think that’s about all I have to tell you” or “I 

can’t think of too much else to say.” Others asked me if I had any further questions for them. At 

this time, I inquired about whether there was anything else that participants wanted to share or if 

there was something we hadn’t covered up to this point. I sought their agreement to close the 

interview and stopped the recorder. Lastly, I asked the participants to provide demographic 

information by completing a short questionnaire (Appendix E). 

After the first three interviews, I met with my supervisors to discuss the interviews. 

During these conversations, we explored additional strategies such as emphasizing to participants 

the importance of providing as much detail as possible and describing what made a particular 

photo or story memorable to them. I also incorporated van Manen’s (1997) suggestions for 

eliciting information: active listening, being patient, paraphrasing the participant’s words 

sparingly, using silence, attending to the participants’ body language and facial expressions, and 

giving them space (van Manen, 1997). As a credibility check, my supervisor reviewed two of the 

audiotapes to ensure that I was refraining from asking leading or close-ended questions. In 

preparation for data analysis, I transcribed all 14 interviews myself. I kept the interview 

transcripts, audiotapes, and questionnaires separately from the participants’ contact information. 

All written and audiotaped material were encrypted and stored in password-protected electronic 

files, or secured in a locked filing cabinet to ensure the participants’ privacy and confidentiality.  

3.3 Data Analysis 

In developing a systematic approach to analysis, I focused on the following research 

activities: reflecting on essential themes, which characterize the phenomenon, and describing the 



78 

 

 

phenomenon through the act of writing and rewriting (van Manen, 1997, p. 30). One objective 

was to develop themes which render the human-companion animal relationship a unique and 

distinguishable phenomenon. A second objective was to describe the importance of this 

relationship for people with cancer, through reflective writing and rewriting. Guided by van 

Manen’s analytic approach, I treated reflection and writing as parallel activities. The use of 

reflective methods enabled me to engage with the transcripts repeatedly by: a) making initial and 

exploratory notes, and b) isolating phenomenological themes through concrete methods and 

questions (van Manen, 1997). I sought to identify similarities, differences, and nuances within 

the data (J. A. Smith et al., 2009; van Manen, 1997). Along with van Manen’s reflective 

methods, I incorporated strategies from Smith et al. (2009) for actively reading the transcripts, 

preparing initial and exploratory notes, and working with a relatively large body of data.  

Considering that phenomenology is fundamentally a writing activity, it was important to 

continually reflect upon my position as a researcher. I kept in mind Smith et al.’s (2009) not ion 

of the researcher as being “engaged in a double hermeneutic,” meaning that I was attempting to 

make sense of the participants’ experience as the participants were trying to make sense of their 

lived experience. I also considered the place of theme development within the context of 

producing a phenomenological text. For van Manen (1997), themes represent “creative 

shorthands” and “structures of experience” that enable us to get at the meaning of an experience, 

and bring order and coherence to our writing (p. 79). Themes help us to capture the meaningful 

aspects of a phenomenon without being exhaustive of a phenomenon. I drew upon van Manen’s 

methods for transforming lived experience descriptions into phenomenological descriptions: d) 

the experiential anecdote, e) the vocative method, and f) the data-interpreting interview (van 



79 

 

 

Manen, 2014). During data analysis, I employed these reflective methods in an iterative rather 

than linear sequence of steps. However, I describe them separately for the purpose of clarity. 

3.3.1 Reflective Methods for Exploratory Noting and Theme Development 

Throughout the analysis, I kept a research journal to record descriptions of the data, as 

well as, my understandings, questions, and insights. I developed themes through an inductive 

process by grounding my interpretations in the participants’ accounts as opposed to outside 

preconceptions or assumptions (J. A. Smith et al., 2009; van Manen, 1997). In undertaking 

phenomenological reflection, I regarded phenomenological themes as being similar to anchor 

points around which I could develop phenomenological descriptions and interpretations of the 

human-companion animal relationship (van Manen, 1997). Themes enabled me to express and 

give shape to this phenomenon using concrete examples and stories from participants. 

3.3.1.1 Making initial and exploratory notes  

During the process of transcribing the audiotapes, I began writing out my initial 

impressions and observations (J. A. Smith et al., 2009). Examples include: healing takes time 

and in the right conditions; people have a desire to let pets be in their natural spaces. The purpose 

of documenting my initial impressions was to become more aware of them so that I could then 

turn my attention to the participants’ words and meanings. Following data transcription, I 

selected an interview that I found to be particularly compelling with detailed stories and 

descriptions (J. A. Smith et al., 2009). I listened to the tape for a second time to remind myself of 

the participant’s tone of voice, pace, communication style, pauses in speech, and emotional 

responses such as laughter and tearfulness. Using van Manen’s (1997) wholistic approach, I read 

the transcript and highlighted phrases or words that were important to the research question. I 

pulled out data extracts that could be developed into an exemplary story or anecdote (van Manen, 



80 

 

 

2014). I took notes on the semantic content and the participant’s use of language (J. A. Smith et 

al., 2009). Employing a selective approach, I recorded phrases that were “particularly essential or 

revealing” about the human-companion animal relationship (van Manen, 1997, p. 93).  

Similar to van Manen (1997), Smith et al. (2009) have likened this process to “free 

textual analysis,” meaning that the researcher closely attends to the participant’s use of language 

to help make sense of the participant’s lifeworld or context (p. 83). Rather than dividing the 

transcript into segments and assigning codes to the data, my aim was to create detailed and 

comprehensive notes for each transcript. In my subsequent readings of the transcripts, I used 

three types of exploratory notes (J. A. Smith et al., 2009): descriptive comments, linguistic 

comments, and conceptual annotations (Appendix F). For descriptive comments, I took note of 

key objects, experiences, and events; for linguistic comments, I recorded the participant’s tone of 

voice, emotional responses, pauses, repetition, and pronoun use; for conceptual annotations, I 

engaged in an interrogative dialogue by asking questions and checking my interpretations against 

the participant’s account. This mode of questioning provided a critical foundation for building up 

to a more abstract level of interpretation, which is necessary for developing themes.  

3.3.1.2 Developing emergent themes  

I drew upon van Manen’s (2014) and Smith et al.’s (2009) recommendations for 

transforming my exploratory notes into emergent themes. In reading over my notes, I asked: 

What do these notes say about the participants’ relationships with their pets, what do they say 

about the participants’ cancer experience, what meanings do the notes convey, what kinds of 

words and phrases can I use to capture these meanings? I sought to develop concise and 

expressive statements to condense the volume of exploratory notes while also preserving the 

participants’ original words, as much as possible (Appendix F). Once I had produced a set of 



81 

 

 

emergent themes for the first transcript, I moved to the next transcript and repeated this sequence 

of making exploratory notes and developing emergent themes. Given the inevitability of being 

influenced by the previous transcript, I tried to set aside my findings and approach each 

transcript in its own terms (J. A. Smith et al., 2009).  

3.3.1.3 Isolating phenomenological themes  

In keeping with the attitude of the reduction (van Manen, 2014), it was important for me 

to be clear about what phenomenological themes are and are not. In terms of the former, I 

considered that themes are useful for bringing together my understandings and the participants’ 

understandings of their experiences. Regarding the latter, I considered that the process of 

isolating themes is not a purely cognitive or intellectual exercise (van Manen, 1997); themes are 

not derived by developing codes, taxonomies, or generalizations (J. A. Smith & Osborn, 2008; 

van Manen, 2014); themes are not merely constructed around a few vivid examples from the 

interview data (Braun & Clarke, 2006). Themes must retain their idiographic focus (J. A. Smith 

et al., 2009). In other words, they must be oriented towards the uniqueness of the participants’ 

lived experience while also remaining abstract enough to speak to the “essence of a certain type 

of experience” (van Manen, 1997, p. 97).  

Next, I returned to my research objectives, namely: to identify that which renders the 

human-companion animal relationship a unique and distinguishable phenomenon, and to 

describe the importance of this relationship for people with cancer. I typed and printed out the 

themes, cut them into strips of paper, and started arranging them. I used different colours of 

paper to keep track of the source (i.e. the transcript) of the themes. I identified patterns and 

connections by making note of emergent themes that were similar, parallel, or contradictory to 

one another (J. A. Smith et al., 2009). I treated emergent themes as examples or instances of the 



82 

 

 

human-companion animal relationship. I used the following questions as a guide for organizing 

emergent themes into phenomenological themes: 

 What is the meaning of these emergent themes?  

 What do these emergent themes reveal about the human-companion animal relationship?  

 How does this emergent theme relate to others? 

 Are there temporal relationships between the emergent themes? 

 Are there areas of convergence/divergence?  

 What is the overall narrative or context for these emergent themes?  

 How can I capture these emergent themes using a phenomenological theme?  

Reflecting upon these questions led me to revise some of the emergent themes while discarding 

others or setting them aside for further consideration.  

In addition, I used concrete methods to identify relationships between the emergent 

themes (J. A. Smith et al., 2009). In the method of abstraction, I grouped together similar 

themes. I asked the following questions: Does an emergent theme in this transcript illuminate or 

extend a theme in another transcript? Which emergent themes are common across the cases (i.e. 

transcripts)? Next, I returned to the transcripts and began grouping together interview extracts 

that were similar in terms of content. I kept track of the extracts using the transcript IDs and line 

numbers. I used Microsoft Word to compile interview extracts that supported a particular theme. 

Aside from looking for areas of convergence, I used polarization to look for differences or 

oppositional relationships between the emergent themes. A third method known as 

contextualization was instructive for determining whether emergent themes were related to 

significant life events such as undergoing cancer treatment, moving residences, changing careers, 

or ending a relationship.  



83 

 

 

Through the methods of abstraction, polarization, and contextualization, I developed 

eight phenomenological themes that were relevant to the sample of participants as a whole (J. A. 

Smith et al., 2009). I retained an idiographic focus by selecting extracts from the individual cases 

to show the richness and diversity of participants’ experiences (J. A. Smith et al., 2009). Another 

strategy used to further refine the eight phenomenological themes was “free imaginative 

variation” (J. A. Smith et al., 2009; van Manen, 1997). According to van Manen (1997), this 

method involves imagining changes to phenomenological themes and asking whether these 

themes are an essential part of the phenomenon. I asked the following questions: Can I imagine 

the human-companion animal relationship without this theme? Is the relationship still 

meaningful if I were to “imaginatively change or delete this theme from the phenomenon” (van 

Manen, 1997, p. 107)? Proposing changes to each of the themes allowed me to consider what 

was invariant about the themes.  

In working with a relatively large dataset, such as a sample of 14 participants, it was 

helpful to have a measure of recurrence, meaning how often a phenomenological theme appears 

across the set of interviews (J. A. Smith et al., 2009). Van Manen (1997) addresses recurrence 

when he describes a theme as an “element (motif, formula or device) which occurs frequently in 

the text” (p. 78). I used the following criterion to define what I considered to be an indication of 

recurrence: a phenomenological theme was considered recurrent if it was present in at least one 

third (n=5) of the interviews. However, as Smith et al. (2009) caution, I did not place too much 

emphasis upon frequency counts, instead using recurrence as a means of exploring patterns and 

commonalities across the interviews. Finally, I looked for connections between the 

phenomenological themes, using the method of subsumption to develop three super-ordinate 

themes. Phenomenological themes that shared higher order concepts were then arranged to form 



84 

 

 

a super-ordinate theme that was applicable to several cases. For example, the phenomenological 

themes, “It’s sort of silly, but” and “It’s a sense of responsibility,” were organized into the super-

ordinate theme, “Pulling you out of yourself” in an effort to reflect the higher order concept of 

pets as providing a meaningful distraction from their illness.  

3.3.2 Reflective Methods for Writing and Rewriting a Phenomenological Text 

In the process of writing, I aimed to create a text that would have resonance for the 

reader, meaning that he or she could recognize the participants’ experiences as plausible human 

experiences even if he/she had not experienced them personally (van Manen, 2014). I used the 

following reflective methods to transform lived experience descriptions into a phenomenological 

text: the experiential anecdote, the vocative, and the data-interpreting interview (van Manen, 

2014). In doing so, my intent was not to arrive at a fixed or normative understanding of the 

human-companion animal relationship but rather to show the uniqueness of the person’s 

understanding—both the participants’ understanding and mine as the writer (Gadamer, 1998). In 

line with van Manen (2014), I aimed for precision by using words and phrases that would 

highlight the tone, texture, and richness of the participants’ accounts.  

3.3.2.1 The experiential anecdote  

The process of developing experiential anecdotes required a close reading and re-reading 

of the transcripts to identify illustrative data extracts for each of the phenomenological themes. 

In accordance with the criteria of explicitness and vividness, I sought to edit or condense data 

extracts such that the participants’ lived experience could come through more explicitly and 

vividly (van Manen, 2014; Whittemore, Chase, & Mandle, 2001). A second purpose of editing 

the anecdotes was to enhance readability. I formatted the anecdotes using indentation, single-

spacing, and plain font. Where possible, I retained the words that participants had repeated for 



85 

 

 

the purpose of emphasis, and used dashes to show hesitation or pauses in speech. I used an 

ellipsis to remove identifying information (e.g. names of people and locations), as well as, to 

omit extraneous material such as minimal encouragers (e.g. hmm, um). I preserved pets’ 

anonymity by using pseudonyms from an online list of popular dog and cat names. I used 

rounded brackets to indicate the type of pet that participants were referencing in a particular 

anecdote. Square brackets were used to identify words that I had added to the text to maintain the 

participants’ anonymity, or to enhance the readability of an anecdote.  

Aside from using plain font, I developed anecdotes, shown in italics, based upon van 

Manen’s (2014) suggestions for creating an experiential anecdote. These italicized anecdotes 

share the following features: illustrate a particular incident or experience, contain concrete 

details, and feature a compelling story. I produced these anecdotes by putting them into the 

present tense, deleting pauses or repetitions, adding personal pronouns or pseudonyms for pets, 

and highlighting the emotions displayed by participants. In constructing anecdotes, my intent 

was not to make generalizations based upon the participants’ experiences. Instead, I considered 

whether their experiences were plausible, or, in other words, if they seemed true to what the 

reader would expect if he/she had encountered these experiences personally (van Manen, 2014).  

3.3.2.2 The vocative method  

While the reduction can be thought of as a style of thinking, the vocative refers to an 

expressive style of writing for developing phenomenological themes and experiential anecdotes 

(van Manen, 2014). In applying the vocative method, I drew upon narrative devices such as 

alliteration, repetition, imagery, and metaphor. For example, in the phenomenological theme 

“It’s amazing how in evolution,” I used the metaphor of pulling on a thread to illustrate the 

impact of cancer upon participants’ relationships with pets and people. In the phenomenological 



86 

 

 

theme, “It flickers by so quickly,” I referred to photos as moments flickering by, in an effort to 

describe the experience of loss. The process of transforming lived experience descriptions into a 

phenomenological text involved pulling out rich and detailed examples from the interviews and 

offering my interpretations of these examples. I used poetic devices to intensify the meaning of 

the text, and to draw the reader’s attention to the importance of the human-companion animal 

relationship. To illustrate, in the phenomenological theme, “It’s sort of silly, but,” I used 

descriptors for different bodily senses to capture what I referred to as “transcendent play.” In the 

phenomenological theme, “It’s a sense of responsibility,” I drew the reader’s attention to the 

home as a tableau and rich backdrop for the intimate moments shared between participants and 

their pets.  

3.3.2.3 The data-interpreting interview  

Through data-interpreting interviews, I sought the assistance of cancer care professionals 

and health researchers with analyzing extracts from the 14 original interviews. Specifically, I 

invited them to read a few anecdotes and share their impressions and insights with me. This 

analytic method differs from member-checking which involves returning to the original 

interviewees and asking them to confirm the accuracy of the interview transcripts or the 

researcher’s interpretations of the data (McConnell-Henry et al., 2011). By engaging in 

thoughtful and collaborative dialogue, the purpose of these data-interpreting interviews was to 

add interpretive insights rather than attempting to verify my findings (van Manen, 2014). These 

insights helped me to revise my interpretations and refine the set of phenomenological themes 

(van Manen, 1997). Interview prompts included: How does this anecdote resonate with your 

experience? What aspects are surprising or not surprising?  



87 

 

 

3.3.3 Trustworthiness Criteria for Qualitative Research  

In this section, I outline research conditions that helped to enhance the rigour of data 

collection and analysis. I discuss four criteria that were used to assess the trustworthiness of the 

findings. Trustworthiness refers to the “quality” of the research design, or, in other words, the 

use of systematic and verifiable methods that yield plausible and convincing results (Lincoln & 

Guba, 2016; van Manen, 1997).   

3.3.3.1 Conditions for data collection  

Prior to beginning the study, I familiarized myself with the historical and philosophical 

traditions within which the study is grounded (K. A. Lopez & Willis, 2004; van Manen, 2014). I 

consulted primary sources (e.g. Husserl, 1970; Gadamer, 1998), as well as, secondary and 

tertiary texts. With regards to the research design, I used a purposive sampling strategy to select 

participants who were diagnosed with cancer at least 6 months ago, and currently had a cat or 

dog. Importantly, this sampling strategy did not only apply to the eligibility criteria. I made use 

of purposive sampling to collect examples of “experientially rich descriptions,” meaning 

interview responses that contained vivid, concrete, and detailed descriptions of the participants’ 

experiences (van Manen, 2014). Toward this end, I made clear in the recruitment poster that I 

was intending to speak with people regarding 1) how they experience their relationship with their 

pet during and after their cancer experience; 2) what makes the human-pet relationship, unique 

and meaningful to them; and 3) how this relationship is important to their cancer journey.  

During the participant interviews, I kept in mind that my objective was to elicit detailed 

stories and examples rather than opinions or beliefs about pets in general. A second objective 

was to gain a shared (i.e. between myself and the participants) understanding of the participants’ 

lived experience. I listened to their stories with openness and curiosity (van Manen, 2014). I 



88 

 

 

sought clarification when needed. I avoided rushing participants. I used paraphrasing judiciously. 

I opted to use silence, open-ended questions, and neutral probes to encourage participants to 

elaborate upon their responses (e.g. tell me more about that, what happened next?). The use of 

audiotapes and verbatim transcripts helped to preserve the participants’ words and verbal cues 

(e.g. pauses, disfluency, laughter, etc.) that accompany speech.  

The recruitment of 14 participants is consistent with the goal of triangulating data from 

multiple sources to promote trustworthiness (Lincoln & Guba, 2016). However, rather than 

attempting to achieve a particular sample size or sample composition, I sought to collect a 

sufficient volume of concrete experiential descriptions that would enable me to explore the 

nuances and complexities of the human-companion animal relationship (J. A. Smith & Osborn, 

2008; van Manen, 2014). These experiential descriptions provided ample material with which to 

develop phenomenologically rich accounts that contained detailed examples and anecdotes. The 

term saturation typically refers to the point at which the data no longer reveal anything new or 

different from earlier interviews (Braun & Clarke, 2006). In an effort to reach saturation, I 

elicited a wide array of experiential descriptions from participants that captured unique and 

significant aspects of their relationship with their companion animals (J. A. Smith et al., 2009; 

van Manen, 1997).  

3.3.3.2 Conditions for data analysis  

Consistent with van Manen’s (1997) approach, I demonstrated objectivity by remaining 

focused on the overall aim of the study (the lived experience of the human-companion animal 

relationship for people with cancer). At the same time, I displayed subjectivity by considering 

each participant’s unique experiences and understandings. I used comprehensive exploratory 

notes and reflective questions to guide my analysis as opposed to analytic codes and frequency 



89 

 

 

counts. Some anecdotes were largely unedited while others were revised using van Manen’s 

(2014) approach to constructing an anecdote. By editing these pieces of raw data, I questioned 

whether I was falsifying the data or lessening their credibility. Once again, I returned to the 

principles that distinguish phenomenology from other approaches. According to these principles, 

phenomenology aims to show human experience in its possibility and variety (van Manen, 

2014). Its understandings are meaning-based. Phenomenology uses empirical material without 

making empirical generalizations (McConnell-Henry et al., 2011; van Manen, 2014).  

To assess trustworthiness, I considered four criteria that are relevant to establishing 

confidence in the findings and interpretations of a qualitative study: credibility, transferability, 

dependability, and confirmability (Lincoln & Guba, 2016). Firstly, I used systematic methods of 

data analysis, involving sustained engagement with and reflection upon the audiotapes and 

verbatim transcripts. Along with attending to negative cases, I employed triangulation of sources 

(i.e. 14 participants), investigators (i.e. data-interpreting interviews with professionals), and 

theories (i.e. comparison of study findings with relevant theories and investigations) (Lincoln & 

Guba, 2016; J. A. Smith et al., 2009; J. A. Smith & Osborn, 2008; van Manen, 2014).  

Secondly, in the methods and results chapters, I provided as much detail as possible 

regarding the research context and participant accounts, keeping in mind the aim of illuminating 

other people’s experiences (Lincoln & Guba, 2016). I considered how these detailed narratives 

could shed light on the experiences of people in other settings and contexts. As such, my intent 

was to promote the transferability of the findings without claiming that the results would 

necessarily hold true for other population groups; the ability to generalize study findings or 

interpretations is not an objective of qualitative research (Lincoln & Guba, 1985; J. A. Smith & 

Osborn, 2008; van Manen, 2014). Furthermore, I understood transferability as a quality that is 



90 

 

 

determined neither by me, the researcher, nor by means of particular analytic methods. To be 

clear, transferability is based upon the reader’s consideration of the text and the extent to which 

the study findings are applicable to him/her (Lincoln & Guba, 2016). Do the findings resonate 

with him/her? In accordance with transferability, the findings were intended to be rich in 

experiential detail so as to compel the reader to reflect upon his/her own experience. 

In line with the third and fourth criteria, I sought to achieve dependability and 

confirmability by keeping an audit trail (i.e. research journal) throughout the entire research 

process. This audit trail helped to ensure that the findings would be grounded in systematic and 

verifiable procedures that could be reproduced by other investigators. I began by recording my 

assumptions about the experience of cancer and the human-companion animal relationship 

(Creswell & Miller, 2000; Lincoln & Guba, 1985, 2016). An audit trail is also consistent with the 

method of the reduction as it allows the researcher to examine critically his/her role as an 

interviewer and analyst (van Manen, 2014). I continued recording my reflections on the research 

process, documenting the methods I used to arrive at my findings and interpretations. I solicited 

feedback from my supervisory committee regarding my data collection and analytic methods. I 

also sought the assistance of two human-animal bond researchers and three cancer care 

specialists to improve the rigour and coherence of my analysis (van Manen, 2014). 

The use of peer debriefing through data-interpreting interviews was important not just 

from the standpoint of intersubjectivity (i.e. shared understandings) but also triangulation (van 

Manen, 1997). The knowledge and expertise of these five individuals provided a credibility 

check, encouraging me to reexamine my analytic methods and develop more abstract 

interpretations of the interview data (Creswell & Miller, 2000). Several aspects of the data-

interpreting interview were especially illuminating with respect to understanding my role as 



91 

 

 

researcher. This method helped me to appreciate that phenomenological understandings are not 

fixed but, instead, are co-constructed by both the participants and me (Gadamer, 1998; van 

Manen, 2014).  

The data-interpreting interview was also useful for addressing the social desirability bias, 

which refers to the tendency among interviewees to try to say the “right thing” when responding 

to the interviewer (van Manen, 2014). Had I elected to undertake participant validation, for 

example by using the technique of member-checking, I could have run the risk of leading 

participants in a specific direction or encouraging them to express agreement with my 

interpretations (McConnell-Henry et al., 2011). Leading participants, even unintentionally, 

would have gone against the spirit of openness that exemplifies phenomenology. Furthermore, it 

would have been incorrect for me to assume that confirming the accuracy of the results would 

effectively determine the quality of the study as a whole (McConnell-Henry et al., 2011). As 

noted above, the criterion of dependability refers to the reproducibility of the research process 

(i.e. methods and procedures) not the results.   

 

 



92 

 

 

Chapter 4: Results 

This chapter begins with an overview of the socio-demographic characteristics of the 

participants. The eight phenomenological themes are presented in Figure 2. Using the method of 

abstraction, I have arranged these eight themes into three higher level themes, known as super-

ordinate themes (Smith et al., 2009). Each super-ordinate theme is introduced with an illustrative 

anecdote, followed by a brief definition and description of the phenomenological themes 

captured under the super-ordinate classification. Within each of the eight phenomenological 

themes are detailed anecdotes and quotations, drawn from the interviews with participants. In 

addition, I provide interpretive insights and commentaries that I developed using reflective 

methods such as the vocative and the data-interpreting interview. The chapter concludes with my 

reflections regarding the use of photo-elicitation during the interviews. 

4.1 Demographic Characteristics 

Table 1 presents socio-demographic data and cancer information collected from the nine 

women and five men who took part in the study.  

 

Demographic characteristics       Participant  

          n=14 

Age     30-39     1 

     40-49     5   

50-59     1  

     60-69     6   

     70-79     1 

Gender     Female     9   



93 

 

 

     Male     5 

Ethno-cultural background  Caucasian    12   

     Caribbean    1 

     Metis     1   

Highest level of education  High school    1 

Vocational    1 

University/college   10 

Graduate/post graduate  2 

Employment status   Employed     2   

     On-leave/on disability   5 

Retired     7 

Relationship status   Single     4 

 

Married/domestic partnership  8  

     Separated/divorced   1 

     Widowed    1 

Living arrangement   Alone     4 

     Partner/children   9 

     Roommate/friend   1 

Cancer type/primary tumor site Breast     5 

        Cervical    1 

     Ovarian    1 

Prostate    1 

     Lymph nodes    2 



94 

 

 

     Liver     1 

     Colon     1 

Intestinal/peritoneal   1 

     Bone marrow    1 

Type of treatment(s)    Surgery    1 

       Radiation therapy   1  

Chemotherapy    3 

Combination of treatments above 9 

Time since diagnosis   < 1 year    2   

     1-3 years    7 

10+ years    5 

Time since last treatment  < 1 year    9 

     1-3 years    1 

8+ years    4 

 

Table 1 Participant socio-demographic and cancer information 

 

As noted in Table 1, the majority of participants were Caucasian, over the age of 40, university- 

or college-educated, and living in a household with other people. Roughly half of participants 

described themselves as married or in a relationship. Of the participants who were unemployed 

at the time of the study, some had taken early retirement while others were on leave from work 

due to their illness. There was considerable variability in the type and site of cancer, with breast 

cancer being the most commonly reported cancer. Five participants reported having a tumor in 



95 

 

 

more than one part of their body. These tumors were either the result of a metastatic cancer or an 

unrelated secondary cancer. Nine participants described undergoing a combination of treatments 

that included surgery, chemotherapy, and/or radiation therapy. For more than half of the 

participants, between one and three years had elapsed since their initial diagnosis, and most 

participants had received some form of cancer treatment within the past year.  

 Information pertaining to pets is presented in Table 2. The results are presented by 

participant demographic characteristics and pet characteristics.  

 

Demographic characteristics      Participant  

         n=14 

Type of pet in their care  Cat    5 

Dog    6 

Both cat and dog  2     

     Fish    1  

Had a pet previously   Yes    14    

     No    --  

Acquired current pet(s)  Before cancer diagnosis 11  

     After cancer diagnosis 3 

Number of pets   Single-pet household  10 

     Multi-pet household  4 

  



96 

 

 

Pet characteristics     Cat  Dog  Fish  

       n=13  n=10  n=1 

Sex     Female   9  8  -- 

    Male   4  2  1 

Age     <1 year  --  --  1   

    2-5 years  5  4  -- 

    6-10 years  4  4  -- 

    11-16 years  4  2  --  

 

Table 2 Pet information 

 

A total of 24 pets (13 cats; 10 dogs; 1 fish) were currently in the care of participants. Of those 

living in multi-pet households, participants had two, four, or six pets. The age range was 2 to 16 

years (Mage=8) for cats; 3 to 12 years (Mage=7) for dogs; and one month for fish. Participants 

had a variety of cat breeds including Tabby, Maine Coon, Siamese, Tortoiseshell, and mixed 

breeds. Most participants had small- (less than 20lbs) to medium-sized (30 to 45lbs) dogs 

including the Cairn terrier, Miniature Pinscher, Shih Tzu crosses, Poodle mix, Pug, and Border 

Collie x Shepherd cross. Large-sized (55 to 80lbs) breeds were the Chocolate Labrador Retriever 

and Golden Retriever. The breed of fish was Betta, also known as Siamese fighting fish. All 

participants reported having a pet prior to their current pet, and two participants indicated that it 

was another family member’s wish to have their current pet. The most common reasons cited for 

having a pet were companionship, love of animals, desire to give pets a good quality of life, and 



97 

 

 

a perception that pets provide fun, humor, and joy. Other notable reasons were getting exercise, 

learning life lessons, and receiving acceptance and compassion.  

4.2 Findings 

 
Figure 1 The eight phenomenological themes organized into super-ordinate themes  

4.2.1 Super-ordinate Theme: (Dis)connecting with the Journey 

I feel pieces of stories coming up, it’s interesting. I’m having a difficult time. I’m thinking 

about my journey with her after being diagnosed like when I had just gotten her. It’s 

interesting being on the other side of it and seeing how disconnected in many ways I am 

to the journey, to the cancer experience where it was so raw for so long but I’ve done so 

much work on it, all the retreats, support groups, day healing sessions, yoga, and breath 

work and everything else I’ve done have definitely gotten me to where I am now. But then 

adding these two (pets) into it is a whole different facet of things (Female, cats and dogs).  

 

In cancer, the cells grow and multiply uncontrollably, defying normal biological 

processes of renewal and decline. This proliferation of cells takes root in the body, staying put or 

extending its reach into the surrounding tissues and organs. Some cancers are classified by the 

The Human-
Companion 

Animal 
Relationship 

(Dis)connecting 
with the Journey  

• It’s hard to erase those 
words 

• It’s amazing how in 
evolution 

• It flickers by so quickly  

 

Speaking Volumes 
with their Actions 

• It’s a silent kind of love 

• It mattered that they 
were there 

• It’s like each living 
thing has meaning 
 

Pulling you out of 
yourself 

• It’s sort of silly, but 

• It’s a sense of 
responsibility 



98 

 

 

cells and tissues from which they originate rather than the parts of the body that are affected if 

the cancer spreads. The disease we call cancer is as varied as the experiences of people directly 

affected by cancer. Much like the disease itself the experience of cancer often runs counter to 

people’s expectations about the normal course of events in their life. This insidious cluster of 

cells quietly dwells in the body until the silence is shattered by the words “you have cancer.” If 

participants were asked to draw a straight line from the onset of their symptoms to the beginning 

of treatment, the line would barely touch the twists and turns that they had encountered while 

going through the diagnosis phase.  

To paraphrase a participant, getting the trauma out of their body, called for swift action to 

remove or slow the growth of cancer. At the conclusion of treatment, participants felt as if they 

had been cut off abruptly and sent off into the unsteady terrain of living without the consistency 

and regularity of being a full-time patient. The once galvanizing force of a cancer diagnosis now 

seemed to lose its hold on the participants’ team of supporters, which included their family 

members, friends, co-workers, and health care providers. The loss of these relationships was 

compounded by the sense of chaos and uncertainty surrounding cancer treatment and the 

potential for a cancer recurrence or secondary cancer. It was apparent from the participants’ 

accounts that trauma did not begin and end with cancer. Like cancer, having a pet underscored 

the impermanence of life. For some participants, watching their pets languish from illness or old 

age became a painful reminder of the trauma that they had endured during treatment. 

This super-ordinate theme captures the meanings participants attributed to their cancer 

experience and the importance of their relationships with their pets. The term journey is 

suggestive of an experience that takes place over time, with an indeterminate beginning and end. 

The use of a parenthesis in the title highlights the tensions that arise in the experience of cancer 



99 

 

 

such as in the masking and unmasking of the disease, the doing and undoing of relationships, and 

the failing and unfailing grasp on moments shared with pets. Relationships with pets, although 

not impervious to the stress of cancer, provided a meaningful connection, and one that evolved 

from their shared journey. Participants seemed grateful for the time they had spent with their pets 

during treatment, both moments of quiet and stillness and those of joy and relief. This super-

ordinate theme is comprised of three themes: 1) It’s hard to erase those words; 2) It’s amazing 

how in evolution; and 3) It flickers by so quickly.  

4.2.1.1 It’s hard to erase those words 

This theme captures how cancer is unmasked and revealed to the person (i.e. diagnosis), 

and how cancer is revealing in the sense of leaving the person unmasked and revealed (i.e. 

effects of cancer and treatment).  

Firstly, the manner in which cancer was revealed had different meanings for participants. 

Some described experiencing unsettling and inexplicable symptoms prior to their diagnosis. As 

in the comments below, participants’ concerns grew exponentially amid curious bouts of pain, 

fatigue, and nausea, followed by doctor’s appointments and emergency room visits: 

I had a problem with neuroendocrine tumors or carcinomas. It’s not easily diagnosed 

because it’s masked by so many other things like panic attacks…It wasn’t until a large 

bulge started to grow right here that they thought it was twisted bowel syndrome and so 

they gave me medication to relax the bowels and of course it wasn’t going away and then 

it started to go ischemic. I went to the hospital because I couldn’t stop throwing up…I 

was in a lot of pain and then they found the tumor with the CT scan (Female, cats). 

 

I was starting to get some strange symptoms. I was going in and out of the doctors and 

nothing really came up. For the first half of the year my energy was just really starting to 

decline. My focus and concentration were starting to go and I was starting to look like I 

was six months pregnant. The doctor did a sonogram on me and I was absolutely terrified 

because I knew I was not pregnant. There were a lot of symptoms and that began the 

journey of going into see a specialist, then went for emergency surgery and four weeks 

later was diagnosed and started chemotherapy three days later (Female, cats and dogs).  

 



100 

 

 

These comments highlight the participants’ distress in response to the sudden onset of symptoms. 

These signs and symptoms alerted them to the possibility of something sinister in their body 

while also continuing to mask and conceal the cancer until it was disclosed to them.  

In the process of going through testing, participants described how their test results would 

come back negative or inconclusive until that which seemed inexplicable was now revealed with 

the words YOU--HAVE--CANCER. The once nebulous array of signs and symptoms, powerful 

and perplexing, took shape and was given the name cancer. In the words of a participant:  

Until you have that dreaded name cancer in your body—we’re just lucky we got it in 

time. Until you have it or somebody close to you, you don’t understand what that word 

means, not at all. Somehow she’s (dog) picked up that something was wrong and just her 

friendliness and wanting to be petted. It’s all part of saying I’m here to help (Male, dogs). 

 

That “dreaded name” seemed to cling to the body just like the cancer itself. As this participant 

stated, to truly know the meaning of this word is to have the word touch you or someone close to 

you. This word rang hollow when it came to pets who instead picked up on the sense that 

something was wrong. A second participant described the comfort she received from her dog:  

She gave me a lot of strength, bolstered me up into pushing through any of the fear and 

the kind of stories that I would create in my head, or if I would read or hear about other 

people’s stage IV situations…and this one oncologist actually said to me “well you might 

already be stage IV, the cancer might have already spread and we just don’t know.” She 

was very negative and after that it’s hard to erase those words. I would attach to those 

words and create a story based on those words. I would just get so much comfort from 

holding Stella and stroking her and just feeling her “My little love” (Female, dogs). 

 

Some participants attributed their cancer diagnosis to lifestyle choices with one 

explaining “in many ways my experiences and my decisions created my cancer.” Others believed 

that genetic and environmental factors had made them more susceptible to illness. In some cases, 

these beliefs were confirmed through genetic testing. Still other participants were confronted 



101 

 

 

with questions such as “why me?” and “why should I even bother?” Even in the absence of 

satisfactory answers, participants found solace in their relationship with their pets:  

I was at home and I was really depressed and trying to make a decision about how far I 

want to go and this and that. And I looked at Rocky and Penny who were sleeping by my 

bed and I was thinking, you selfish human being, I mean you adopted them. You 

promised them that you’d be there for the rest of their life. Just by taking them and 

adopting them, you made that promise to them (Female, cats).  

 

For many participants, being told that they had cancer came as a shock. One participant 

called it “a big trajectory change in terms of life, career and pretty much everything else.” In 

some cases, the diagnosis happened to coincide with other significant life events such as ending a 

long-term relationship. In others, it was the diagnosis itself that had prompted these events. With 

regards to career, some participants had to go on stress leave with a few commenting that they 

still have not been able to return to full-time work. Others reported taking early retirement such 

as a participant who exclaimed “it was the cancer that forced the retirement” going on to say “if 

I’m dying why am I working?” Another retiree expressed concern for fellow cancer patients:  

I’ve talked to people and they say that they have financial issues. They can’t work and 

they don’t have any source of income and I don’t know how they can do it because there 

are just so many other things demanding of your body and your mind and to have this 

other stuff weighing on you, it must just be totally overwhelming (Male, dogs).   

 

The shock of a cancer diagnosis seemed to heighten the emotions surrounding other life events. 

One participant recounted the precise moment she found out she had cancer, saying “I’d just 

gotten my dream job and it was the first day that I was there, the first hour at my new job and I 

got the phone call. I had surgery and took about five weeks off.” Similarly, a second commented:  

We found out when I had a colonoscopy. And right then the doctor came back and said 

“You have cancer” and I was sitting there, “whoa,” and he said you have it in two places 

at both top ends of your colon. Then he said I’ve already talked to the surgeon, and I’m 

still waking up from the drugs, and he said she’ll see you in two weeks so I walked out of 

there. I sort of woke up and I said oh I’ve got colon cancer (Male, dogs).  

 



102 

 

 

Akin to the experience of being roused from sleep, life changed in an instant with the words “you 

have cancer.” Unlike the transitory nature of sleep and dreams, once cancer was revealed, the 

words could not be called back; the words could not be excised from the body or radiated away.  

Secondly, participants’ experiences during and after cancer treatment were revealing in a 

number of ways. At the hospital or cancer clinic, participants recalled waiting for the elevator 

and the long walk through dimly lit hallways. They remembered the feeling of polished linoleum 

floors beneath their feet, the sounds of machines nearby, and the image of a blank wall staring 

back at them. The loneliness they felt while waiting in these rooms laid bare the gravity of their 

pets’ companionship. A participant with fish said “there’s nothing more soothing than looking at 

a water feature when I’m trying to sleep after chemo.” Another said of his dog “she’s a 

companion and it’s taken me a long time to realize the trauma I went through and what it caused 

to other people and how to try to get the trauma out of your system.” Two others said:  

I was involved in a clinical trial during my breast cancer treatment where we had to go to 

the gym two or three times every week during chemo…I would come home, and her and 

I would cuddle up on the couch and watch a show and have lunch. I would put the 

blanket and she would climb up on the couch and we would just sit there for a couple 

hours…That really became such a routine and it was very comforting (Female, cats). 

 

Duke’s been very good about it and when I first had chemo there was a lot of “oh my god 

where’s the bathroom” and after one of those sessions he always came and cuddled me. 

He would get in bed with me and cuddle (jingling noise), I can hear him. He knows I go 

once a month to the cancer clinic and when I come home he’s always here (Female, cats). 

 

Notably, pets were not always seen as a source of comfort during treatment. A participant with 

fish said “there were times when I did feel they held me back because I knew if I went anywhere, 

they probably wouldn’t make it.” Another said of her cat, “I didn’t take the best care of her 

because I couldn’t even do it for myself.” To avoid costly vet visits, a few participants recalled 

having to administer at-home treatments to their cats, one of whom shared the following story:  



103 

 

 

I did not do well with having an IV in my arm. My treatments were five days on and two 

weeks off. I did four rounds of that…so when I had to give her (cat) a daily IV, that was 

terrifying. I did because I knew it would help flush out her kidneys but I had a really hard 

time with it…and it was this particular needle I would put into the back of her neck and 

ugh that still makes me feel sick…there were experiences I had with her that reminded 

me of my cancer experience and brought it back up again (Female, cats and dogs).  

 

In deciding among treatment options, some participants felt moved by the resounding call 

to “get it out” of the body or “stop it from growing.” Others discussed having reservations about 

their doctors’ recommendations, fearing the outcome of treatment more than the disease itself. 

Such fears were confirmed in certain instances. For example, one participant described going 

into septic shock followed by a ten-day period during which he was in a coma and on life-

support. Another came close to dying more than once, after being overdosed with chemo and 

enduring a significant loss of mobility. A third described her experience by saying:  

When I started chemo I had a heck of a time with it. I just did not respond well 

whatsoever. I thought it was absolutely normal everything I was going through so I didn’t 

really speak up too much. I totally became that superwoman type persona and just kept 

pushing through until I had to be hospitalized. I started getting some energy work done 

through chemo and my cat Loki basically never left my side…I was bedridden for most 

of my treatments…and she was my bestie at the time (Female, cats and dogs).  

 

Responses to treatment varied considerably across participants. Some participants felt 

better after the first surgery or round of treatment, noticing less pain and discomfort. One 

participant, after having part of his colon removed, recalled waking up and phoning his friends 

soon after surgery. Another who had a growth that was obstructing his ability to swallow said:  

As soon as I started the treatment the tumor shrunk. The oncologist was quite amazed that 

it actually shrunk right away…When I started the treatment I didn’t feel that much nausea 

or anything, I was able to eat and I ate a lot, like five meals a day, just because I had lost 

so much weight...and then I was starting to get healthy again but as I say I didn’t feel—

like everyone said “aren’t you awfully tired?” I didn’t feel tired (Male, dogs).  

 

In contrast, others fared worse, such as a participant who experienced increased sensitivity to 

medication, making it difficult to treat an unrelated, chronic condition. Some participants 



104 

 

 

reported becoming anemic following chemo. The need to consume red meat came into conflict 

with their values. One participant called himself a “reluctant vegetarian” while another said:  

I really believe that animals have souls. I go through this moral dilemma about eating 

meat every once in a while. I have a really hard time with it. I know it’s necessary 

sometimes and I need the protein because of the illness but I tend to stick to fish if 

anything rather than meat. Eating mammals really bothers me. It’s not that I don’t think 

fish have souls but not as much as mammals (Female, cats and dogs). 

 

The effects of treatment also manifested themselves in participants’ outward appearance. 

To illustrate, one participant remarked “my white blood cells dropped and my skin took the 

worst of it.” Another said “there were kinds of disfigurations, I was doing prednisone; I had the 

moon face, skinny arms, and bloated belly, and [was] very self-conscious.” Another talked about 

changes in the texture of her hair after chemo, saying “losing my hair was such a trauma, as a 

woman I think, it’s our hair, you look in the mirror and you’re bald.” She went on to say:  

I have no problem being vulnerable around these two, people, it’s difficult to not feel 

judged and to not take things personally and be totally fine with your confidence and 

body image. She’s (dog) taught me it’s okay to go out first thing in the morning in your 

pyjamas with no bra on and your hair is a mess to take her out to go to the bathroom. 

Like years ago I wouldn’t be caught dead without makeup (Female, cats and dogs).  

 

Other notable effects reported by women were those related to the treatment of cancers affecting 

the breasts and reproductive organs. Some women described going into menopause several years 

before the expected age of onset, affecting their ability to conceive children. Others experienced 

hot flashes, changes in mood, night sweats, and/or weight gain. Two participants commented: 

With the breast cancer, I got fortunate, there was no chemo. It was radiation therapy. The 

last four treatments [caused] a horrific burn. It took all of the skin off of my breasts. They 

were treating me as a burn victim. For eight weeks I couldn’t even wear a bra. I was 

doing these saline compresses three or four times a day. With the breast cancer there were 

two lumpectomies because the surgeon cut too close to the margin (Female, cats).  

 

My tumor was quite large too about the size of a large mango so that was pretty decent. It 

was like I was carrying a child. I’ve always wanted to have a family and I haven’t even 

now. It’s been 10 years and I’m not sure my body can handle it anymore…the emotional 



105 

 

 

aspect of it has been absolutely horrible and the way my body has responded to it has not 

been great either. So it’s shown me a lot and it’s taken a lot (Female, cats and dogs).  

 

For the women and men at the center of treatment, cancer had the effect of showing and 

taking from them in ways that they had not anticipated. For one participant, cancer was a 

“culmination of [her] pushing too hard” with treatment prompting a “continual cycle of ups and 

downs.” Cancer revealed the cracks in what participants had envisioned for their future. Some 

participants expressed doubt about whether there was even such a future ahead:   

I was diagnosed with Cholangiocarcinoma, stage IV which is inoperable. I can’t get a 

transplant either. It’s not available for this type of cancer so they’re treating me with 

chemo to try in the off-chance to reduce the size of the tumor or stop it from growing so 

they may be able to operate. They said it’s a very long shot, it’s not successful in a lot of 

cases but the cancer has stopped growing so that’s a good thing (Male, dogs).   

 

Of the different types of breast cancer, most have drugs that are targeted therapies to keep 

the cancer from coming back. The one I have doesn’t have that yet. So the first three 

years after diagnosis are usually very stressful. There’s a lot of anxiety for triple negative 

patients because they don’t yet have a targeted therapy to keep it away. And it doesn’t 

seem to matter necessarily with staging…it’s a very aggressive cancer (Female, cats). 

 

Others found themselves having to deal with more than one type of cancer. One participant, 

treated previously for colon cancer, shared what happened while undergoing follow-up tests. He 

said “my GP suggested they do a bone scan while I’m in the hospital; so I go down and found 

out I have prostate cancer, so things seemed to progress.” Similarly, a fourth participant stated:   

I did the chemo, radiation and then surgery and then the next four years on pills and we 

all thought it had gone away. Then I had noticed some lumps on my head and my doctor 

thought they were cysts so he arranged to cut them out but when he made the first cut he 

realized that they were not cysts, they were cancer. So we started again and the breast 

cancer had metastasized to my ribs, lungs and spine (Female, cats).  

 

The examples above make clear that treatment is seldom confined to a single event. Even 

after the news of a clear PET scan or blood test, participants continually stopped short of 

referring to themselves as “recovered.” As one participant stated “it’s been this ongoing 



106 

 

 

challenge of doctors and specialists and nobody can figure out what it is; it’s all imagined and 

it’s not the case.” Two other comments highlight participants’ fears about cancer recurring:  

I have a deep-seated fear of what is going to happen. Is it going to rear its ugly head 

again? It’s always in the back of a person that’s gone through cancer. Is it going to come 

back? Is it going to kill me the next time? That was three cancer journeys and hopefully 

that’s it. If you want to hear about the kitty that really made my journey so much easier, 

that is Holly. Holly went through five surgeries with me, three for cancer (Female, cats). 

 

When we sign in [at the support group], we say what cancer we have but your cancer is 

not the discussion. The discussion is how you’re dealing with your life, having it so 

affected by cancer. Anybody that tells you, “oh I had cancer, I’m cured,” sorry, no, no, 

you’re never cured. It was in your body. It’s going to be there still, somewhere. It’s like 

an escape when I just get away from life and go for a walk with her (dog) (Male, dogs).  

 

These examples also speak to the role of pets in easing the journey and providing an escape. The 

story of a third participant suggests how pets act as a “bridge” when encountering people:  

It’s been very cathartic having her around especially as a puppy and getting myself out of 

the house and learning how to be a person again, how to approach life and people and do 

the whole face-to-face contact again. She was my bridge between that. She would greet 

people. I didn’t have to and the times where I really didn’t want to be seen and just hid, 

she would be that connection with the other person. It didn’t have to be me. I didn’t feel 

ashamed, not feeling okay in my body and walking down the street with her. She created 

a space where she was just being herself. I couldn’t do that. I’m still having a hard time 

with that. I’d watch her and see how she is in the world (Female, cats and dogs).   

 

In feeling unmasked and exposed, pets then provided a kind of shield, enabling participants to 

connect and disconnect when they didn’t want to be seen.  

4.2.1.2 It’s amazing how in evolution 

This theme begins with an analogy. Picture a loose thread hanging off a knitted garment. 

A common impulse is to pull at the thread with our thumb and forefinger after which one of three 

things can happen. The thread snaps and breaks off in our hands. The thread pulls away as the 

garment begins to unravel. Or still yet, the thread remains taut as the surrounding fibers become 

more tightly intertwined. Such is the experience of cancer and its impact on participants’ 



107 

 

 

relationships with pets and other people. The title of this theme highlights the notion that, despite 

our evolution as a species, human intellect and empathy can fall short when it comes to dealing 

with emotions. Through this analogy, this theme captures participants’ relationships as they were 

breaking apart, unraveling, and becoming more intertwined. 

Firstly, the news of participants’ cancer diagnosis had an almost magnetic pull. As one 

participant put it, “people came out of the woodwork” to offer support. Another said that her 

friend built “mini stairs” to help her get into the house. Over time, like the thread snapping under 

pressure, some relationships seemed to break apart rather abruptly. The comments below speak 

to changes in participants’ relationships with their health care team during and after treatment:  

The time I was in treatment the days seemed to be pretty full. And when you’re a cancer 

patient, you basically become a full-time patient trying to recover. My doctor’s 

receptionist said that my full-time job is to gain weight basically all the time that I could. 

And between eating, walking the dog and eating some more, walking the dog, eating 

some more, basically the day was gone…so I had no trouble filling the day (Male, dogs). 

 

During the time of the treatments, in some ways it was easier because you’re very 

focused on the physical and you have something to do every day. You feel like you’re 

participating in your fighting of the disease. Everybody’s attention is on you. You have 

the support of your oncologists and your whole team. There’s that level of support. Then 

that ends and the oncologist is like “Oh yeah, we’ll see you in six weeks” and you’re just 

kind of sent off…so I found it was harder once I stopped treatment (Female, dogs).  

 

As suggested by these comments, during treatment, the days were full and discernable from one 

another. Following treatment, as one participant explained, “you go into this strange place where 

the days just merge [and] everything becomes this sort of blur.”  

With regards to their significant others, having the support of a partner was important for 

both participants and their pets. One participant commented “during treatment my wife was with 

me all the time taking me down and everything. I see people coming in by themselves especially 



108 

 

 

elderly people. I don’t know how they can do it.” Partners also served as a welcome distraction 

for pets, giving them much needed attention, as one participant explained:  

There would be partners and boyfriends and stuff that would come in and distract them 

(pets) from whatever I was going through so they would get a little bit more attention 

from them. I had a guy who lived with me for a while and he was a really good guardian 

to the two of them for the period of time we lived together which was very short but he 

was very kind and generous to the two of them and [my partner] was really fantastic with 

Loki. He ended up getting her a beautiful cat tree and she’d get more Christmas presents 

than I would (laughing) half the time from him (Female, cats and dogs). 

 

While some relationships endured in the wake of cancer, others came to an end. Participants 

pointed to the diagnosis or recurrence of cancer as the catalyst for their break-up: 

Honestly, it was hell. It ended a long-term relationship I was in. He was just about to 

propose and he already asked for my hand from my parents and so it seemed to be one 

thing after the next and the losses were incredibly great (Female, cats and dogs). 

 

My ex-partner and I had a lot of friction between us, so there was a lot fighting. My 

refuge was going to the dog. And whenever we would fight I would just go and cuddle 

with the dog. That was my second relapse…I was kind of paralyzed from the rib cage 

down. I was told while being prepared for the MRI to be prepared for the palliative type 

thing. I was obviously devastated. My partner was still at work. I still had to work, so my 

dog was my companion. It was the only companionship I received (Male, dogs). 

 

In addition, friendships did not go unscathed by cancer. In a typical exchange between 

two people, one person says How are you? to which the other responds I’m fine, how are you? 

The unchanging rhythm and repetition of these phrases, provides an element of predictability. As 

one participant said “when you’re not sick, people ask you how you are, of course it’s just a 

figure of speech but if you are sick, a lot of people just avoid you, even close friends, because it’s 

awkward.” A second participant spoke about being in the hospital, saying “it’s funny that of my 

friends that came to see me are those that have had cancer or have had somebody in their family 

with cancer.” A third participant spoke about the loneliness people feel during treatment:  

You’d think people that you’ve loved and been in a relationship for a long time would be 

right there with you but it falls apart. People don’t know how to emotionally handle 



109 

 

 

watching their significant other or best friend go through this. It’s amazing how in 

evolution we’ve still not evolved that capacity naturally. It seems like as soon as a person 

is sick, we pull ourselves away from them. You see that in the animal kingdom all the 

time…but you’d think with our evolved brain that we would get past that emotional-ness 

and into the intellectual thought that it takes to be compassionate for the person you’re 

with…it’s a really harsh reality to come to terms with when you get sick (Female, cats). 

 

Normally, a simple exchange of pleasantries allows people to interact with each other at a safe 

distance. When someone is sick, this distance narrows, leading some people to pull away.   

Secondly, some relationships remained intact following the participants’ cancer 

diagnosis, only to unravel over time. Participants’ relationships with health care providers varied 

in duration and intensity, with some lasting a few weeks and others continuing for several years. 

One participant described his nurse by saying “she would come and see me and she got me up 

and walking way more than any physio.” Another said of the nurses at the hospital “it’s a special 

breed that can work in those kinds of environments, making you feel as calm as you could 

possibly be.” For other participants, the deterioration of the patient-provider relationship was not 

surprising given its tenuous foundation. One participant referred to his physician, saying “you 

hear about bedside manners, he was very blunt; that’s all he told me, cancer, and then sent me to 

this oncologist.” A second participant said “there was a lot of prejudice from the health care 

workers for me drinking alcohol…and judging how I’d been dealing with the pain.” A third 

participant said “after many times going to see different oncologists and emergency a couple of 

times, they didn’t think that I still had cancer and so they couldn’t accept it.” A fourth participant 

recounted her experience: 

Everything had gone so terribly wrong. My specialists kept saying “this shouldn’t have 

happened, something’s wrong.” Then when I went to see my hematologist, he went 

“she’s (oncologist) overdosed you with chemo.” He knew right away but she wouldn’t 

admit to it and that was before I actually ended up in the hospital but at that point, I was 

so low that if I didn’t have my pets I wouldn’t be here (Female, cats and dogs).  

 



110 

 

 

Friendships and intimate relationships were more likely to unravel among participants for 

whom several years had passed since their initial diagnosis. Some participants attributed the loss 

of contact and communication to a perception among people that cancer ends at the conclusion 

of treatment. One participant explained “other people perceive you as ‘Oh well she’s fine now, 

she’s well now, she doesn’t have cancer anymore’ whereas you live with that fear that it might 

still be there.” Other participants believed that some people are simply ill-equipped to deal with 

the emotional aspects of cancer. Prior to cancer, it was not unusual for people to drift in and out 

of their lives. Cancer put a spotlight on these relationships, and what some participants described 

as the inadequacy of human intellect and empathy. To illustrate, two participants said: 

My best friend shaved her head with me when I lost all my hair through chemo and she’s 

now in [another country] so we’re not very close anymore…it’s interesting when 

something like that happens versus now, zero people have been around. It’s this 

emotional aspect of things. I think people are really terrified of that. I’ve had one person 

stand by me through the last two years and these guys (pets) (Female, cats and dogs). 

 

When you first get diagnosed you have a lot of people around but when you have cancer 

for a long period of time, people kind of drop by the wayside. People can’t handle the 

impact of cancer. They’re just not capable emotionally of being able to do that. It’s an 

unfortunate thing but it happens to every cancer patient. People drop away because 

they’re not able to handle what’s happening and your pets don’t do that (Female, cats). 

 

Many pets seemed undeterred by the emotional aspects of cancer. According to 

participants, pets stand by you because they are kept as pets. One participant said “they don’t 

have a choice, they can’t earn money, they can’t be on their own.” And yet, participants 

repeatedly expressed that pets provide “unconditional love.” One participant echoed “it was that 

unconditional aspect that I knew I could depend on—people aren’t so much.” Even still, a few 

participants referred to “periods [when pets] would become a bit less bonded” to them:  

There were times I smelled really funny and she (cat) wouldn’t approach me after chemo. 

I smelled really weird and she wouldn’t give me hand licks and I felt really gross about 

myself …That was kind of a difficult time in our relationship and learning how to 



111 

 

 

navigate that. And there were a lot of times when I didn’t actually want her around like I 

really did just want alone time …I remember feeling kind of wrong and dirty because of 

chemo. It didn’t last too long but I remember that (Female, cats and dogs).  

 

My ex and I separated which was kind of devastating, not so much the separation, that 

had to be done. It was just a matter of how we transitioned and moved on. My biggest 

issue was the dog. How do we kind of share the dog? Unfortunately, while I was going 

through the chemotherapy I was not able to walk the dog. I was kind of bed-ridden and 

…because I was not physically able to participate in the dog’s activities, my ex-partner 

became alpha male. The dog became more loyal to him than with me (Male, dogs).  

 

In both examples, pets seemed to know that something—the smell of their skin, their energy 

level—was different, and this led them to pull away. Accordingly, such examples demonstrate 

that even unconditional love can unravel beneath the strain of illness and separation.  

Thirdly, some relationships neither snapped nor unravelled in response to cancer, but 

rather intensified as in the analogy of the thread becoming more intertwined. One participant said 

“when I had cancer my mum would stay with me and Loki (cat) got looked after mostly by my 

mum and my ex would come in a lot and help out.” Another said “I recouped at my parents’ 

initially. My parents are very close with Stella (dog). They don’t see her a lot but my dad has a 

really close, special relationship with her.” A third said “my mom is a great part of my healing 

too but she lives far away so she can’t be here the way she’d like to be so I have my surrogate 

parents (her pets).” As captured in the following comment, support did not only involve being 

physically present but also being there to validate participants’ feelings and experiences:    

I’m learning that with my family and my partner to be okay with letting go and receiving 

love. I’ve been in such a fearful place for so long not just because of cancer. It would 

have been many other things that have gone on and being able to come back to a place 

where it’s like I know that I’m accepted for whatever I’m going through. They’re not 

going to say anything and they’re going to treat me exactly the same way is really 

rewarding and it just feels good (Female, cats and dogs).  

 

Although participants were grateful to have support, they expressed some ambivalence 

about relying upon their loved ones for help with cooking meals and getting to medical 



112 

 

 

appointments. One participant explained “when you’re sick you don’t want to burden people all 

the time.” Interestingly, some participants reported dealing with these concerns by helping other 

cancer patients and developing a wider social network, such as in the examples below:  

I phoned him (support group leader) and we had a good hour and a half yak and he said 

come and try the Wednesday group. So I went and I got pretty emotional. I had a lot of 

tears and the three regular ladies have all gone through six operations and it’s just a 

whole different feeling. You just feel that you’re amongst long lost old friends that are 

able to talk about things and so I’m helping them now. [My wife] was pretty burnt out 

through this whole thing and at times I felt like I’m being a burden and all that sort of 

stuff and then we learned at the peer group that you’re not a burden (Male, dogs). 

 

Community, that’s another thing that’s become quite obvious to me. Before I was 

working so much and I had my friends but there was an idea of always being able to do 

things on my own and don’t ask for help and be self-sufficient. I don’t think that’s really 

now the way I think. We really do need community, connection with people and to have 

people that have your back. You want to help them and they help you (Female, cats). 

 

Similarly, a third participant described how his dog has helped him to build new connections: 

When I can’t walk her, neighbours come in and look in on us and take her for a walk. I 

guess it’s my support as much as anything else. Because of her I have people checking in. 

I guess they use it as an excuse to check in on Ginger so it really is beneficial having that 

one-on-one relationship with her and people checking in on both of us. And the same 

thing goes with my neighbour who has a dog. When his dog barks excessively I check in 

on him if his wife isn’t home…so dogs being the alert system is unique (Male, dogs). 

 

The sense of mutuality observed in their interpersonal relationships was also apparent in 

their relationships with pets. For participants and their pets, it was easy to give and receive love 

without reservation. One participant said of her cat, “we get along fine, he’s not too demanding, 

I’m not too demanding; there’s certain things in your life that are there so you have some 

stability as well.” Following cancer treatment, the sheer amount of time spent with pets, as well 

as, pets’ attentiveness to participants served to deepen their bond. Two participants commented: 

He’s given me a lot of comfort since I’ve been diagnosed. He’s like a constant 

companion for me so he’s making my journey with cancer a lot easier. I mean my wife 

helps too but when you’ve got a little dog that makes you laugh all the time just from 

things he does…Since I’ve had the diagnosis of cancer, he’s just been a little closer to me 



113 

 

 

than my wife. He used to be mummy’s boy, now he’s daddy’s boy…maybe I’m giving 

him more affection so he’s reciprocating (Male, dogs).  

 

Physically and emotionally you’re going through such a difficult experience so she (dog) 

gives you some sense of normalcy and routine. She’d give me laughter and joy because 

she’s got a quirky sense of humor. I guess I would have gotten through it without her but 

she made it bearable and she just gave me so much in that time and I think in some ways, 

definitely, I felt even closer to her after. We just really bonded (Female, dogs).  

 

Lastly, back to the thread analogy, a fourth scenario is possible in that we pull on the 

thread and nothing happens. This scenario reflects the experiences of participants whose loved 

ones did not come out of the woodwork, so to speak. One participant spoke about the importance 

of her pets, saying “I’m on my own, I don’t have contact with family and I don’t have a spouse 

or children or siblings, so there’s just so much unconditional love.” Two others said:  

I’m important to my family but not in the same way, not in the day-to-day. He (cat) 

accepts me as I am in my housecoat and slippers or grumpy or happy. He’s just accepting 

and another living being that apparently likes you. I think that’s important for everybody 

to feel that they’re important or necessary to somebody or something (Female, cats).  

 

The most important thing in the journey right now is they’re keeping me alive because as 

much as I love my daughter, there are times when I don’t always like her which is true of 

any human relationship when you live with someone. You love them but there’s times 

when their behaviour is such that you can really ring their necks. I never feel that way 

about the dogs and…there is no one else, no other siblings (Female, cats and dogs).  

 

Accordingly, pets did not seem encumbered by the same fears and expectations that people tend 

to have when a person in their life falls ill. Emphasizing this point, one participant said:  

[Pets] never leave you, they never leave your side and when you’re not feeling well, 

they’re the closest to you that anybody or any creature could possibly be and so you’re 

never suffering alone, you’re never doing this by yourself. And that’s another comfort 

that people really underestimate. Just their presence in your life will give you that feeling 

of connectedness even when there’s not a single human being around (Female, cats). 

 

Pets provided this feeling of connectedness even when emotions prompted others to pull away.   



114 

 

 

4.2.1.3 It flickers by so quickly  

The photos shared by participants were revealing of their relationship with their pets. 

Some photos documented meaningful occasions such as birthdays and Christmases. Others 

depicted ordinary events that had been repeated a multitude of times such as pets sleeping. Still 

others were blurry and out-of-focus just barely capturing the vigorous movements of pets. With a 

flash of the camera, it was as if these moments had been frozen in time. Drawing upon photos as 

living moments of experience, this theme delves into participants’ accounts as they were 

experiencing loss, anticipating loss, and fighting back against loss. 

Firstly, loss was a recurring theme in participants’ relationships with their pets. More 

than half of participants had experienced losing a family pet in their childhood. Such losses took 

on new meanings as an adult facing the uncertainty of a cancer diagnosis. Cancer brought home 

the impermanence of life and the need to preserve meaningful experiences that could otherwise 

“flicker by.” Participants documented pets through photos, videos, collages, paintings, and 

journaling. One participant described a memory book featuring her cat who had passed away:  

I got to design the whole thing which was really neat. It was really fun to do this and to 

go through the space of reliving what it was like to have her in my life. She had these 

gorgeous, gorgeous blue eyes… all the memories and experiences. I love that I have a 

book for her. Things change over time and I forget more of those things but I know it’s 

important to me to take the video and the images to have of her because she’s such a big 

part of my life and was my best friend for those years (Female, cats and dogs).   

 

A second participant described what it was like to look back at old photos, commenting:  

  

They just bring me so much joy that you want to capture that on picture to remember but 

then later you’ll look at the picture and it’s hard because it’s not the same as when they’re 

there. There’s lots of pictures of past fish that are moved on and you can remember what 

that feeling was like…but it’s still not the same as when they’re there (Female, fish).  

 

Photos of pets had a dynamic quality, retaining rich and vibrant memories. And yet, after 

the passing of a beloved pet, these same photos came to embody the sense of loss that 



115 

 

 

participants had felt. Of the participants who had lost a pet following their cancer diagnosis, most 

were at least one year post-treatment or were facing a recurrence of cancer or secondary cancer. 

One participant spoke about undergoing multiple surgeries for cancer and for knee injuries:  

Holly was the most comforting of all our cats. The others were to a certain extent but not 

as much as she was. I was so worried that she wasn’t going to be there from the first knee 

replacement. She only lasted for three days because she was having trouble breathing but 

she hung in there long enough to greet me when I came home (Female, cats).  

 

A second recounted how one of her fish outlived his expected lifespan despite having a tumor:  

The fish hung on and I knew he was with me. That one seemed really special, so 

intuitive. He had the tumor and everything the same time as me and survived my being 

gone back and forth…I had been thinking the treatment at the cancer agency is coming to 

an end and my fish has done this journey for me. It’s probably time for him to pass on. 

As much as I’d like him to stay, he passed just about the same time I got my discharge 

papers. And it was sort of like we were done with that chapter of our life (Female, fish). 

 

A third participant described her experience with having to put her cat to sleep:   

When I had to put her down, that was like losing my best friend who was there for me 

through this journey. She was there for me two years pre-diagnosis and then Hazel (dog) 

came into the picture…I brought Hazel into the vet when I decided to put Loki down. 

I’ve heard that animals, if they leave the home and never come back, they just continue to 

look for them…I had the two of them side-by-side. As the drip went in and her life 

drained out Hazel paid zero attention to her anymore. It was interesting to observe how 

they see life force. After it was like there was nothing there (Female, cats and dogs).   

 

The examples above suggest that the loss of a pet did not happen all at once. Signs of 

aging became apparent with growing patches of white fur and changes in their pets’ gait and 

mobility. Although many pets’ personalities remained largely unchanged, there was a noticeable 

decline in their energy level. Pets couldn’t jump as high as they used to and daily walks became 

shorter and shorter. For participants, coming to terms with having an aging pet was entangled 

with the knowledge that their pet’s life could be in their hands. The same participant above said 

in reference to Loki, “it became a bit of wanting to extend her life and I did extend it a little 

longer than was probably okay with IV treatments and syringe feeding; I just didn’t want to let 



116 

 

 

her go.” What’s more, in the experience of cancer, losing a pet was overlaid by a sense of 

remorse from witnessing their pets hanging on and clinging to life for the participants’ sake.    

Although not the same as the death of a pet, having to separate from a pet was 

experienced as a loss, nevertheless. Some participants recalled having to leave a pet behind after 

moving away from their family or needing to return a pet to a friend after assuming temporary 

guardianship. In other cases, this kind of separation was the result of an ill-fated adoption. Aside 

from cancer or other health challenges, the need to consider the welfare of other people or pets 

influenced participants’ decision to relinquish a pet. One participant commented “I attempted to 

adopt another cat to grow the family and the older cat said no way.” A second participant said:  

I found this cat that I absolutely just loved and I brought her home and I was sick right 

away. I missed four weeks of work…An old lady who had her, had passed away and she 

ended up at the SPCA. The vet said she was too nice of a cat to put down…so I brought 

her home and went out and actually spent a couple hundred dollars getting her a scratch 

post and toys…I just got her feeling comfortable that this was her home and she was such 

a great cat. It broke my heart…but I had to because I was too sick (Female, fish). 

 

A third participant described how he had surrendered his dog, Leo, to a friend with an agreement 

that Leo would have a permanent home. Without the participant’s knowledge, Leo was then sold 

to a buyer on Craigslist. This participant shared what happened after this experience:  

Everybody agreed that Leo was in good care so up until knowing that, I was very 

depressed thinking I did something really bad. He was on Craigslist. There’s a lot of dog 

fighters who will pick up these rescue dogs and basically feed them to vicious dogs. The 

thought of it just terrified me. Because of what happened with Leo I decided I couldn’t 

keep a dog anymore. A couple months later, I was completely socially isolated. A friend 

of mine had a dog that had been abused and abandoned…so I said I’ll foster her for a 

couple of days and I just fell in love with her…she’s just an amazingly sweet, loving, and 

caring dog. I honestly could not ask for a better companion (Male, dogs). 

 

As with the untimely death or relinquishment of a pet, some losses were clear and 

indelible while others were less tangible in their effects upon participants. For example, 

participants described forgetting particular memories in the years fo llowing cancer treatment, 



117 

 

 

with one participant lamenting “it’s funny you lose a lot of memory when you go through chemo 

and I don’t really remember a lot of her as a puppy.” A second said while describing her dog 

“it’s hard to remember back because it’s 12 years ago now and my memory is not so great since 

going through chemo and radiation.” Fortunately, such memories were not altogether lost but 

could be recalled by looking at a photo or sharing a story about their pets. During an interview, 

for example, one participant whose cat had passed away suddenly exclaimed “oh I have no 

pictures of that—she would hug me, so she would put both of her arms around my neck and I 

totally forgot that actually, because I really miss that with her.” Another participant spoke about 

losing a memory card which contained hundreds of pictures of her two cats, saying “for him he 

was sort of grown up but for her, it’s like losing baby pictures, it’s heartbreaking because you’ll 

never get that time period back.” Two others described how photos helped them to hold onto 

precious memories: 

I cherish the moments. I cherish having these pictures, these experiences with the two of 

them. There’s little things that happen and I’m like [Partner’s name] “get the phone, get 

the camera, we need to take a picture of this.” I can remember that because they flicker 

by so quickly and unless we write them down or capture them in a way, often we forget 

about them and how important they were to us in those moments. The important things 

just seem to get piled up with stress—yeah I cherish these guys (Female, cats and dogs).  

 

I like to document her…I think sometimes we really think of ourselves as a family, so it 

was kind of a way to welcome her into the family, document that, have it to look back on. 

I took pictures of her when she was in her little cage at the SPCA. Sometimes we’ll look 

back and remind ourselves where she came from, when she came into our lives. In a way 

I do feel like she has helped save my life and we also helped save her life hopefully. As I 

would take pictures of friends or family members, it kind of feels similar (Female, cats).   

 

While it was important to safeguard memories of their pets, some experiences during cancer 

were better left undocumented, free to flicker by and be forgotten, as one participant explained:  

I don’t think I have any pictures of myself when I was lying in bed or anything like that. 

Like those were a lot of images that I chose not to have taken I guess. I do have a few of 



118 

 

 

myself when I was going bald but for the most part I did not take pictures of my 

experience. I just I hated the whole thing (Female, cats and dogs).  

 

Secondly, in looking through photos of their pets, participants remarked that it was hard 

to remember one moment from another. One participant said pets are “somewhat repetitive.” The 

experience of cancer brought these moments into suspension, prompting participants to 

contemplate the thought of dying. One participant said “I’m just praying that God gives me 

enough time that these guys are gone,” expressing concern for her pets in the event of her 

demise. Two others expressed fear for their cats’ well-being if their cancer were to come back:  

I felt very protective of her because of her age and I also was really worried that if my 

cancer came back there’s not really too much they can do. They say it’s about a nine-

month window between a recurrence and the average time of dying. So I was also really 

nervous that she would be left alone again and I could kind of understand how her first 

home dropped her off. She’s just such a sweet cat that I can’t imagine anybody giving her 

up so but it made me nervous that she would be left on her own again (Female, cats). 

 

I really hope we go at the same time because I don’t know how I would feel if Duke went 

before me and then you worry about what would happen if I go before Duke. I know 

some people would not have a pet because of that but we had Duke before I was 

diagnosed. I don’t like to think about it. He’s an important part of my life and some 

people might think that’s pathetic but they don’t have Duke, the cat (Female, cats). 

 

From the participants’ accounts, it appeared that cancer was not alone in reminding 

participants of the brevity and fragility of life. Being a guardian to a pet also meant having to 

face the inevitability of loss. One participant who had lost her cat previously said in reference to 

her dog, “I’m terrified, this brings me to tears; I’m terrified of having to go through that with her; 

I really hope that she lives many, many years longer.” A second participant said: 

I do worry about her dying (tearful). Since she is already old I know that when she 

does—I mean hopefully there’s lots of years left but it will definitely be a part of my life 

that I will always remember because it will be so tied to my cancer experience. I mean 

people always say if they get another pet it will never be the same as that pet or 

something. But her relationship with me is so surrounded and encapsulated in that 

experience that it will always be quite an intense memory I think for me (Female, cats). 

 



119 

 

 

Another wished to be reunited with her pets in their final resting place and in the afterlife:  

My final wish is that all of our ashes will be put together. One of my cats passed away 

and his ashes will be put with mine and hopefully all these guys will be put with mine. 

We’re going to try and find a meadow and have the ashes sprinkled. It’s probably silly, 

but in my head the idea of heaven is being in a meadow with my pets, being with nature, 

having them all around me. There’s a wonderful poem called the Rainbow Bridge. That 

to me is heaven, to be reunited with all my ones that have gone (Female, cats and dogs). 

 

While some participants retreated from the topic of death, others felt that cancer was an 

inescapable reminder of their mortality. One participant remarked “after I’d gotten this cat my 

nana had passed away from breast cancer so when I was diagnosed, that was synonymous to 

death for me.” A second participant said that cancer “galvanized” her, prompting her to plan her 

own funeral, and spare her family any added stress. A third participant contemplated the meaning 

of dying:  

Thinking about dying, in a way, is necessary because our culture doesn’t really allow you 

to process those concepts. No one wants to talk about it. They don’t really even want to 

talk about you being ill. I’m glad I did have that time to think about it. It’s painful but it 

happens to everybody. There’s ways that you can live your life so that when you get to 

that time of dying, you’re not going to be regretting how you lived your life. So to be 

conscious of the fact that you are going to die perhaps you’ll live your life 

differently…When you’re facing your mortality, you start to question “What am I doing 

with my time, what have I done so far, what kind of life have I lived” (Female, cats)? 

 

This same participant described a “switch” from thinking about dying to thinking about living, 

saying “I feel like I have more permission to enjoy…this is my time to be living and enjoying.”  

Thirdly, not captured in participants’ photos were the moments that had yet to occur, 

moments that were often overshadowed by cancer and a sense of impending loss. Cancer pulled 

death from the periphery, leaving it hanging over them like an ominous shadow. Participants 

were left to confront past losses while also considering the consequence of future losses for 

themselves and their pets. One participant described his experience in the following way: 



120 

 

 

Animals are just, when you have cancer, it’s such a unique feeling. If you don’t have 

cancer it’s really hard to understand what the journey is like because you’re looking at 

mortality. Every day is your mortality and when you have an animal, it takes you away 

from all of the stuff in here and the energy is now focused on this animal (Male, dogs). 

 

Although losses were inevitable in the experience of cancer, pets allowed participants a 

momentary reprieve from dwelling upon loss. As suggested in the following comments, pets 

became a “beacon of light” in some of the darkest moments of their cancer experience:  

I had been in the hospital about four weeks and I was really missing them. I would talk 

about the dogs and the therapist said “why don’t you bring them in, there’s a lot of 

people here that would love to see your dogs.” They came in and everybody was crying 

and the dogs were so excited. All three dogs were trying to kiss me and love me. They 

jumped onto the bed, curled up with me, and we had a nice visit. When I had left for the 

hospital, it was so sudden and my dogs didn’t really understand. I think it brought them 

some closure because they settled down after that. After they left I was really depressed. 

It made me more determined to find a way to get home (Female, cats and dogs). 

 

I was in the hospital for 10 days and these guys were my impetus to get out of bed and 

move and get home as soon as possible…it’s amazing how much they play a role in all of 

that...that initial impetus. When you’re really low even the faintest hope you hold onto 

and these guys were the hope I needed to continue to push and survive. Later it became 

for me and everybody I loved but these guys were the beginning (Female, cats). 

 

 Perhaps, it is not sufficient to say that pets simply gave participants hope. Rather, pets 

were someone participants could grasp hold of when such hope seemed beyond their reach. 

Finding hope was akin to the experience of dragging an anchor beneath a boat waiting for it to 

catch hold of the seabed. Participants’ resolve to remain hopeful while facing the possibility of 

dying was a decision in and of itself, the alternative being that they would give in to the disease. 

Two participants said:  

She’s been an integral part of my healing and she’s given me a lot of hope. I kept 

thinking, oh my god, I might actually die…there was this sense in me that, I couldn’t. I’d 

never considered the possibility that I would leave her. She is my little baby. I’ve been 

lucky that she’s come into my life…she’d probably be fine without me. She’d live with 

my parents but I wasn’t prepared to let that happen so she gave me that will to fight and 

to think “I’m going to be one of the 50 percent that survive and thrive” (Female, dogs). 

 



121 

 

 

These guys are at the mercy of who is left to care for them and I couldn’t bear for me to 

go and know they’re not going to be properly cared for…They’re my reason for fighting 

as long as I can and to keep going. I could have given up twice now, I nearly died in 

February and I knew I had to fight back because of them (Female, cats and dogs). 

 

A third participant talked about what it means to fight back against cancer: 

 

I’m a fighter, I like to fight and if you give me something to fight for that’s even better. 

At first it was for Rocky and Penny and now it’s for the three of us. It’s a brutal way of 

happening but it was a journey that has been well worth it for me…they’ve really been 

the reason why I fought so hard and in the healthiest way…I’ve integrated them so much 

into my life that they’ve become a huge part of the healing process. Without them I 

wouldn’t be where I am right now. In fact, I don’t know if I’d even be alive to be honest 

or had the strength or power to make the hard decisions…it would’ve been really easy to 

go off into the other direction and give myself up to the disease (Female, cats). 

 

Together, these comments bear out participants’ fears of dying, and of continuing to live in spite 

of these fears. Pets not only gave participants the impetus to fight but also the impetus to hope. 

4.2.2 Super-ordinate Theme: Pulling you out of yourself 

All of her toys are everywhere. We play constantly. It’s a great impetus to get out of bed 

even when you’re not feeling well. They give you that willpower to get outside of yourself. 

It’s very easy to get stuck in being ill and when you have two beautiful little animals that 

pull you out of yourself and get you out of bed to make sure their litter is clean and 

they’ve got nice fresh food in their dishes and the floor is clean. You know that you have 

somebody that needs you and depends on you to be as healthy as you can (Female, cats). 

 

This super-ordinate theme reflects participants’ experience of their pets as providing a 

meaningful “distraction” from their illness. Pets took their minds off of cancer and what some of 

them referred to as “the inevitable,” meaning the inevitability of dying and leaving their loved 

ones behind. With fears of cancer progressing or recurring, participants sought to distract 

themselves from their illness. Such a reprieve came in the form of playful exchanges with pets 

and participants’ caretaking responsibilities towards their pets. Whether participants were 

actively engaged in play or simply observing their pets play, play allowed participants a 

semblance of routine and normalcy. Play provided a way for participants to distance themselves 



122 

 

 

from cancer, making laughter and silliness permissible and even necessary for healing. At times, 

play had a calming quality. In other occasions, play meant being patient and making allowances 

for chewed up furniture or broken keepsakes. For participants with aging pets, play meant 

coming to terms with pets slowing down and losing interest in cherished games and rituals.  

As with play, caretaking responsibilities prompted participants to turn their attention from 

being a cancer patient to being a guardian and caretaker to their pets. Being a guardian required 

patience and understanding. It meant caring for their pets with the same degree of love and 

attention as if they had been a human family member. In upholding this responsibility, 

participants felt compelled to attend to their own well-being, knowing how much their pets relied 

upon them to be in good health and spirits. Others saw themselves as parents, treating their pets 

as their own children with the accompanying joys and trials of parenting. The process of learning 

to anticipate and respond to their pets’ needs served to strengthen and nurture their bond. Similar 

to play, caretaking not only helped to shape participants’ daily routines but also changed in 

response to the needs of both pets and people. These two aspects, play and caretaking, are 

described in the following themes: 1) It’s sort of silly, but; and 2) It’s a sense of responsibility.  

4.2.2.1 It’s sort of silly, but  

The view of pets as being playful was shared by all participants. Play had different 

meanings and expressions for participants and other people with whom pets interacted. Seven 

facets of play are described: humorous play, predictable play, unpredictable play, mutual game 

play, rough-and-tumble play, instinctual play, and transcendent play.    

With regards to humorous play, pets seemed to have an unlimited capacity to make 

participants laugh. One participant remarked “I don’t whether he (dog) has had anything to do 

with my cancer sort of being in remission or not but they say laughter is the best medicine, so 



123 

 

 

maybe he does.” Pets were effective at keeping things light. Pets’ silly and goofy behaviours 

provided a common source of laughter for people. In these moments, everyone was focused, 

however briefly, on what their pet was doing. When pets were present for the interview, 

participants often laughed as they saw their pets snoring loudly, hiding in a corner, eating a treat, 

or jumping on my lap. Even when pets were not in attendance, participants appeared more 

animated, smiling and laughing as they recounted stories about their pets such as those below: 

Stella used to go to doggy daycare…and apparently she would be the ball police. Her 

favourite thing to do would be to go around…the daycare and collect all the balls and she 

would actually put them in a line and then she wouldn’t let anybody else touch them 

(laughing), they were like her balls. And she actually, she can flick them. She puts them 

in her paws and she puts it together and they fly out. So she can actually entertain herself 

quite well with them. That’s kind of her party trick I guess (Female, dogs). 

 

Rocky is a [certain breed] and they’ve got a very distinct character like they’re very 

playful, very needy, and one of the descriptions is, the males tend to be clownish 

(laughing) which is Rocky to a tee. I mean you just couldn’t get more clown-like when 

he’s in that kind of playful mode. You’ll play mousy-mousy with him and he’ll get all 

excited and everything and then he’ll scare himself and he’ll run away. It’s like he runs 

away from stuff but it’s not the toy, he scares himself, it’s just hilarious (Female, cats). 

 

A second facet of play that elicited laughter was the unrelenting predictability of pets. 

Take the analogy of a comedic joke. Humor is often heightened by the unexpectedness of an 

effective punchline. However, it was as if pets had mastered the art of comedy, eliciting 

boundless laughter at the same old jokes and often with no punchline. Participants delighted in 

being able to anticipate certain behaviours from their pets after years of studied observat ion. 

Examples of recurring behaviours from cats were: sleeping with a grimaced expression, drinking 

from the sink faucet, making funny poses for the camera, purring excitedly, and favouring 

particular toys to the exclusion of others. Examples from dogs were: moaning when it was time 

for a walk, hiding under the bed at the sight of the nail clippers, nudging the participant’s hand 

for a treat, refusing to give a ball back after fetching, and biting the garden hose. As evidenced 



124 

 

 

by their wagging tails, boisterous barks, and resounding purrs, pets displayed an infectious zeal 

for seemingly mundane routines. With pets, everyday occurrences could take on the whimsy of a 

time-honoured tradition or battle of wills. Two participants shared the following stories: 

If you’re cleaning the deck, Sadie always has to help and same if you’re vacuuming the 

house, she just started doing it. She chases the vacuum and she just barks her head off, 

ruff, ruff, ruff and she’s running around. She makes the job longer but it’s a lot more fun. 

You see down here, if you sweep the deck, one of her favourite things is, she just grabs 

the broom. I don’t know why, even if you’re raking the leaves she’s got to come out and 

grab the broom…like usually you’re in a hurry, you only have so much time…but you 

don’t mind because the dog needs exercise and she needs activity (Male, dogs). 

 

The other thing she does, it always makes me laugh, whenever we’re out on walks she 

tries to eat food all the time and so I tell her “don’t eat that” and I tell her not to do it. 

And then what she’ll do is she’ll put it in her mouth and she’ll just pretend that it’s not in 

her mouth and then as we start to walk along I’ll see her turn her head and (laughing) 

she’s eating it without showing me, she’s quite sneaky that way and she never forgets 

where there’s food outside. She’ll always want to go to that area and she’s also 

exceptionally stubborn so…she just won’t walk certain directions and she only usually 

likes walking downhill (laughing). She has some strange little desires (Female, dogs). 

 

Thirdly, in some instances, it was the apparent unpredictability of their pets’ that 

participants found amusing. Participants repeatedly described being surprised by their pets’ 

behaviour. Common descriptors for pets included “trickster” and “mischievous” such as the case 

of a cat who would camouflage herself under pillows and suddenly pounce at her human 

caretaker while bearing full teeth and claws. Another recalled how her dog seemingly ignored a 

box of chocolates for weeks only to surprise her one day by climbing on the couch, devouring 

the last piece of chocolate, and leaving the box empty and crumpled on the floor. A third 

participant shared the story of an eventful exchange between her dog and a neighbour’s dog:  

One time recently we’re walking along and Rosie is minding her own business and this 

sweet lady comes up with some little toy dog. The dog comes up and starts to sniff and 

poke its nose into Rosie and bark. After several seconds, Rosie turns on this dog and goes 

“Rah” and puts her paws on top. She’s not biting the dog but she lets out some rather 

intimidating noise and pins it to the ground. The little dog stops and the lady freaks out 

and I burst out laughing and start apologizing and take Rosie away. I remember saying 



125 

 

 

something like “I don’t think she wants to play” and I just could not stop laughing. That 

lady was not reading signals at all. Rosie didn’t do anything harmful to her dog except 

teach her a lesson. So we have the occasional moment like that where it’s us against the 

world. We totally get each other and that’s very fun too (Female, dogs). 

 

Along with being a witness to their pets’ humorous antics, participants described 

instances of mutual game play between themselves and their pets. Games had two notable 

features, namely, mutual engagement and movement. Some games were brief and unstructured 

while others had rules and expectations. Examples of unstructured games are provided below:  

He likes to play, we play tug all the time. He’s got lots of chewy toys, plush toys and he 

likes to play tug with me so we play tug until he tires out and goes and lays down for a 

while or I throw his toy. He likes playing fetch and he brings it back and then we tug 

some more and then I throw it, so yeah. He’ll play with other dogs but one-on-one 

usually not in the dog park so that’s about Jackson in a nutshell (Male, dogs). 

 

Duke has his little rituals like my friend there, she is Aunty Scrubbler because when she 

comes in, she scrubbles him. He lies down there and she has longer finger nails than I do 

and he loves that. And then sometimes I’ll pick him up and say ‘I’m going to scrubble 

your tummy’ (low and booming voice) and just little things like that (Female, cats).  

 

Examples of games involving rules include the following:  

We have this game where this carpet gets laid out and vacuumed. Then at night time she 

pulls it all up. She sharpens her claws on the under carpet so there’s little blue pieces of 

foam everywhere and I come in and go “Penny did you make this mess” (animated voice) 

and she looks so proud. So I clean it all up and she gets all mad at me and at night she 

rips it all back apart again. It’s become our game, it’s a perpetual game for her but she 

has all her toys out. Everything is all over the place. We’ll put them back in a pile and 

they’ll be back out overnight again. I’ve never seen a cat play like her (Female, cats). 

 

When I couldn’t really walk a heck of a lot my cat was an awesome goal tender. I would 

take a little foam ball throw it down the hallway and she’d bring it back to me, she was 

like having a dog it was really bizarre…she was an awesome goal tender and we would 

often play ball down the hall bouncing the foam ball. She was super quick, she’d jump 

three feet in the air and would catch this. It was unbelievable (Female, cats and dogs). 

 

Peek-a-boo is one of their games. So when I look at him, he gets excited and will look 

and then kind of go away. He’ll do a loop around his bowl and come back just stopping 

right before me to check to see if I’m looking and then if I look he’ll go the other way 

sort of in a circle, come back again and stop…and then when I look again, he goes back 

around, so we play this game (laughing). It’s sort of silly but they do this (Female, fish).  



126 

 

 

 

In general, pets tended to rely upon subtle cues to initiate play such as making eye-contact, 

crouching down, or growling. Descriptions of these games are as follows: 

If I’ve been out in the car, I come back through the basement and he’s usually down there 

at the basement door, he must hear me coming and there’s steps down to the basement 

and he’ll sit at the bottom of the stairs and…he’ll wait to be petted and have his head 

scratched and make like he can’t possibly climb these stairs (exaggerating) by himself so 

you go to pick him up and he races up (laughing) yeah so he has his habits (Female, cats). 

 

One cute little quirky thing about Holly was when we would have staring contests. It was 

usually me that gave in and looked away. She would sit on the cat perch beside my 

recliner and stare and stare and stare at me not moving a whisker. I would say “Holly stop 

staring at me, you’re creeping me out.” It did not work and this would go on for the 

longest time. It was like she was playing a game with me. She just wouldn’t waver from 

her stare, and I said “you’re nothing but a demon kitty” (laughing) (Female, cats). 

 

These examples highlight the importance of being mutually engaged. Both parties had an end 

goal and needed to act in certain ways to fetch the ball or win the staring contest as it were.   

Mutual game play was especially important for participants who were on-leave from 

work or largely house-bound due to their illness. Participants believed that being physically 

active, even for short periods, was beneficial for them and their pets. Despite experiencing pain 

and fatigue, participants felt compelled to take their dogs for walks or visits to the park. Indoor 

cats were seen as needing more play time and interaction compared to outdoor cats. Play 

provided the participants with a sense of purpose and routine, helping them contain their worries. 

One participant said “it’s made my life richer, calmer, less anxious; I feel an unconditional love, 

laughter, humor, sense of peacefulness, connection and enjoyment; it feels safe.” 

A fifth facet of play was “rough-and-tumble” play, wrestling, or play fighting. To 

illustrate, one participant said that his son would often wrestle and tease their dog whereas his 

daughter tended to hold and cuddle their dog. His dog seemed to be tolerant of both types of 

play. Likewise, a second participant said that while her partner would tease their cat until she ran 



127 

 

 

away, she tried to be mindful of her cat’s “subtler looks” to avoid pushing her “to a place of not 

being happy.” A third participant described how her cat would quickly escalate from playing 

gently to clawing and biting her in what she called his “play-play” or “killer” mode. She often 

tried to deter her cat from getting too worked up whereas her roommate would encourage this 

behaviour. Rough-and-tumble play was seen as more acceptable when pets were playing with 

other animals or when pets were known to enjoy this kind of play. Illustrating the former case, 

one participant proudly exclaimed “my dog can hold her own” when playing with other dogs. 

Regarding the latter, another described her cat’s curious enjoyment of a particular activity:     

Holly was the one kitty that had perfect balance and never slipped. She would jump over 

two railings to get to the neighbour’s side. Holly loved to be swung all around the room 

in her nylon tunnel, long it what would be a five, six foot nylon tunnel. All the time I was 

swinging her I would say “zoom, zoom Holly” and as I swung her higher and faster she 

loved it, she was the only one of our cats that wanted to play like this (Female, cats). 

 

Somewhat related to rough-and-tumble play is instinctual play, meaning pets’ tendency to 

engage in dominant (e.g. pouncing or mounting another animal) or submissive (e.g. bowing or 

rolling onto their back) behaviours. For example, one participant reported that her fish would 

expose their bellies to her during play as a “sign of submission” and trust. A participant with an 

outdoor cat, recalled “running around in [her] nightgown with a towel trying to catch a mouse in 

the middle of the night.” Another reported that her cat was “quite feral” when she adopted her, 

explaining “she would attack me in bed and run after my ankles and I have plenty of scars to 

show for this one.” Yet another described his cat in the following way:   

I think it’s instinct, I think it’s bred into the breed. He’s a hunter. There’s other cats who 

might be docile but this guy is a hunter. And you see evidence of it. He will sit there for 

hours and I feel there’s no way he can catch a bird but he will sit there for hours and you 

go somewhere and there is a bird carcass …and it’s uncanny…he will sit there and watch 

the raccoons and the raccoons will be in the yard and he will be sitting there and sitting 

there. So long as they don’t make a move, he won’t make a move (Male, cats).  

 



128 

 

 

Such hunting behaviours, though regarded as acceptable for cats, were generally discouraged in 

dogs. For example, one participant talked about avoiding tug-of-war games with his dog to 

maintain his position as “alpha” and prevent behavioural issues such as aggression. Another 

lamented about her dog’s uncharacteristic display of aggression on a particular occasion:  

I’m not proud of this whatsoever. She attacked a gosling and harmed it to some degree 

and I felt very responsible like there were kids around. It was just a nature thing that 

happens but I didn’t have full control of her and it really brought me to, as much as we 

train and domesticate them they are still wild animals at heart (Female, cats and dogs).  

 

A seventh facet, transcendent play, refers to occasions when participants ventured outside 

of their homes with their pets. In some instances, transcendent play meant being an onlooker to 

their pets’ lively pursuits and athletic feats while in others, participants were actively engaged in 

play with their pets. Transcendent play was the kind of play that happened when participants 

were absorbed in nature with the sights and sounds of leaves rustling, blades of grass crunching, 

wind blowing through the trees, wet sand sinking below their feet, or puddles rippling with each 

drop of rain. The following comments provide some insight into this facet of play:  

Walking out in the forest with a dog just makes the walk even so much more profound. 

You take them with you and…it’s like having a small child with you. It’s seeing it 

through a whole different set of eyes. Yeah, such a good boy, such a good boy 

(whispering to her cat), what do you think Rocky (cat grunts) (Female, cats). 

 

I’m very grateful to have her and to have those experiences with her…and she pulls me 

along (laughing), like hiking up that mountain the other day I was like I don’t know…if 

we can do this and she’s like “Come on mom lets go”…It’s like I get to be a kid again. I 

get to re-experience maybe things I didn’t do a lot of or feel comfortable doing when I 

was little so to have this creature that’s like a kid all the time and never really changes 

from that. It’s like being able to re-experience that and I know with that my partner as 

well it’s really increased an element of fun and play into my life (Female, cats and dogs). 

 

Given the importance of nature, transcendent play was more common among pets who were 

given access to outdoor spaces. Even among indoor pets, participants found ways to bring nature 

to them. One participant said that she prefers to put live plants in her fish bowls, explaining: 



129 

 

 

It’s very beautiful because they glide and so I try to sort of strategically arrange their 

plants because he needs leaves as sort of shelves to sit on and also to hide in for privacy 

but also then I want to allow him enough room in there to be able to swim and have him 

glide and it is really beautiful to see them go across (Female, fish). 

 

In the case of cats, time spent outdoors meant playing on the balcony or backyard. Some 

participants felt conflicted about letting their cats go outside due to the threat of wildlife. One 

participant reported that her cat had been injured twice, likely following a confrontation with a 

raccoon. Another expressed guilt, saying “we’ve taken her on a couple of leash trips outside to 

the park and I need to do that more often because I feel bad that they just get stuck in these 

concrete places.” Despite their reservations, all but two of the participants did in fact let their cats 

out regularly. One participant described his cat by saying “he does have his wild side…it’s been 

a real problem keeping him in, especially in the nice weather, he will scream.” Another said:  

He’s nocturnal and I’m nocturnal…he goes out and has his, whatever cats do outside at 

night, and then comes back in. That’s our routine. I thought that Duke was going to be an 

indoor cat because some people have the opinion that if you let your cat out you’re a bad 

cat person because they could get run over but Duke did not want to stay inside. My 

husband who was a great gardener and loved being outside would be out there. Duke 

would be at the front door with his paws out there going (groaning sound) so my husband 

thought it was cruel to keep him in so he became an outdoor cat (Female, cats).  

 

In the case of dogs, play tended to spill out into a wider range of recreational spaces 

including parks and beaches. All sense of time was lost as participants watched their dogs shake 

off their outercoat of domestication. One participant said of his dog “she’s like I’m outside now, 

I’m a wild animal, I’m not a pet.” A second said that “being out on the earth and being around 

the nature” had a revitalizing effect upon her dog. Another recalled how his dog immediately 

took to the water, remarking “we were afraid that she would just swim away and never come 

back.” Two participants commented about the significance of going to the beach: 

She actually hates going in the water...but what she loves is barking at the waves and 

running in and out on the sand…it’s so funny to watch her, she just looks hilarious 



130 

 

 

(laughing). It’s like she’s sort of managing the waves and she seems completely in her 

element like she’s full of this energy and full of life…I’d be able to take off her leash and 

just see her just go full power, like she’d go a hundred miles an hour, it was pretty fast 

and the sand would be flying up in the air and she’d just be going. It’s like everything 

unleashed and it would give me this real, I don’t know, incredible joy (Female, dogs). 

 

The waters tend to be very peaceful and the dogs race up and down the beach. You know 

Max, he’s a very calm dog at home but he gets here and he just lets loose and runs up 

and down the beach. He’s scared of the water which is hilarious but he gets in there and 

digs lots of holes. Daisy and Molly, their favourite thing to do down there when it’s a hot 

day is to go in the water up to their necks. That water is pretty cold but they just love it 

and they get in there and hunker down. Then a boat comes down and and they run off 

again. The beach is the one place I can get Ellie to run (Female, cats and dogs). 

 

Participants described feeling better after being outside with their pets. As one participant said 

“you get a better outlook on life when you’re outside more than sitting inside all the time.” 

4.2.2.2 It’s a sense of responsibility  

Many participants found it deeply humbling to know that they were responsible for 

another living being. Others expressed that they would not have made the effort to heal without 

their pets. This theme captures the responsibilities of caring for pets as a parenting experience, 

bonding experience, and restorative experience for participants.  

Firstly, being responsible for a pet meant keeping them safe, happy, healthy, fed, and 

groomed. As one participant stated “they are bred as pets, so we are responsible.” Another said 

of his cat “he didn’t ask to come into our family; we went and sought him out so we have to look 

after him.” While it was not uncommon for participants to use the word “pet owner,” many felt 

that the terms “parent” or “guardian” more aptly reflected their relationship with their pets. A 

participant with children said “they’re like my kids, they’re who I talk to, they’re who I 

administer to.” A participant without children commented “[when] you have a dog, you basically 

have a kid and they don’t grow up right.” Two others made contrasts between pets and children:  



131 

 

 

When I have to care for her there’s less focusing on myself. I want to keep her safe and it 

takes some of the focus on your own health away from you. At the same time because I 

don’t have children it’s not a stressful thing. There’s not some of the stress that comes 

with having kids that you have to be continually there. I just have to open up a can of 

food, it’s much more simple. I can’t say she’s similar to having a child but there’s 

probably some similarities for having another being to care for (Female, cats).  

 

Dogs are stressful like anything else. You can love your children but they’re still 

stressful. And she’s just been a huge support in my life. I honestly couldn’t imagine my 

life without her. Some days I wish I didn’t have a dog. I would just go and kind of do my 

own thing, but coming home and having her there is absolutely amazing. It’s absolutely 

crucial, that companionship…just having that one-on-one with somebody (Male, dogs).  

 

For participants, being responsible for their pets’ well-being stirred within them a mix of 

emotions from fear and doubt to pride and contentment, as demonstrated in the comments below:  

And I do remember feeling this intense kind of fear and panic that I suddenly was now 

responsible for this little creature here. And it’s learning the process of being able to 

communicate. So I found that…it took time and just learning the best way I could take 

care of her (Female, dogs). 

 

It creates quite a bond for one thing and trust between the two of us and there’s meaning 

for me as well to be responsible for her and to be the guardian of her life right now and 

make sure that she’s kept safe and healthy (Female, cats and dogs).  

 

Participants’ beliefs about parenting seemed to have their roots in early memories and 

experiences. One participant said “we grew up with dogs and had lots of animals when we were 

children and we always felt very passionate about dogs in particular.” Two others recalled being 

drawn to animals since their childhood: 

I’ve always had a relationship with animals, always (emphasis), my whole life. I was the 

kid that went out and rescued kittens and brought them home, but maybe that’s different 

because I’m more in tune with them and understand [them] than somebody who has 

never had a pet and never understood (Female, cats and dogs).  

 

Every cat we’ve ever loved has taught us something. They all have their special quirks, 

their own individual personality. It’s like having children. They’re our four-legged 

children and that’s how we think of them. I’ve had cats all my life, we did have 

dogs…but from the time I was living on my own I always had a cat (Female, cats).  

 



132 

 

 

Other participants reported growing up without pets or not being allowed to have a pet. 

Interestingly, the parents of participants who had been adamant about not having pets went on to 

acquire a cat or dog in the years after their adult children had moved out of the family home: 

When we were younger, my dad didn’t want us to have pets, particularly cats. Now he 

loves cats, it’s so weird but when we were kids we weren’t allowed to have cats or dogs. 

The first thing I did when I moved out was I got a cat and it’s been a huge part of my life 

ever since. It’s my affection for cats. I’ve always had an affinity for them and so when I 

adopted these two it was for the mutuality…that’s why I went to the [animal shelter] 

because I wanted to adopt cats that really needed somebody (Female, cats). 

 

In contrast with the previous example, a third participant described enjoying the company of cats 

and dogs as a child, only to have to avoid them in her adult years. A combination of allergies and 

the effects of cancer treatment left her with a compromised immune system. As she explained, “I 

would play with other people’s pets but then I’d get sick and be covered in hives.”  

As we delve into this parenting experience, imagine the home as a tableau of people and 

pets engaged in various caretaking practices. Picture the kitchen as the site of meal preparations 

and gatherings; the living room, with cozy couches and blankets, as a space for rest and refuge; 

and the bathroom, with its bright lights and floor tiles, as a place where pets often accompanied 

participants in some of their most intimate and vulnerable moments. Within these vivid tableaux, 

these static images would come to life as participants paused to look at their pets, holding them 

in their gaze, as they scanned their pets’ face and body. One participant shared her experience: 

They’re stuck in this bowl and they’re whole world is me. So that’s why I feel it’s so 

important to connect with them several times a day so that they’re not just sitting there 

because…I’ve tried to give these fish the best life I could and it’s been my therapy and in 

return they’ve blessed me tenfold (Female, fish).  

 

Another emphasized the value of these intimate moments through the practice of grooming:  

Touch is really important, she’s so soft. It’s so nice to touch her and there’s kind of a 

symbiotic. I know she feels good if I touch her and pet her and brush her with her comb 

and then that makes me feel good. She’s so soft it makes me feel good that I can keep her 



133 

 

 

healthy by relaxing her and combing her hair out so she doesn’t get hairballs and throw 

those up. For me the tactile nature of it, it’s so soft, it makes me feel better (Female, cats).  

 

Secondly, participants spoke about caretaking responsibilities in the context of their 

overall affinity toward animals, and their unique bond with their pets. This affinity for animals 

led participants to welcome a pet into their home, and yet bonding meant something quite 

different. In describing this distinction, one participant made reference to therapy dogs, saying 

“meeting somebody else’s dog is not at all the same as having your own dog.” A second said:  

I think the hardest part was when I was in the hospital and after my surgery because I 

couldn’t see her and I couldn’t be with her and also when I would go and get my chemo 

treatments because they’d bring other dogs to the hospital and it would irritate me 

because I would want Stella to be there with me, but she wasn’t allowed (Female, dogs).  

 

To explain the importance of bonding, some participants described feeling an immediate or 

instantaneous connection with their pet. As one participant said “as soon as we saw Rocky that 

was it, we fell in love with him…when we picked him up he was nuzzling under the chin right 

away, he was super affectionate.” Another summarized her experience accordingly:  

There’s a special bond between pets and their guardians and we have been blessed to 

experience this with ours. Our kitties currently and all the ones no longer with us have 

given of themselves wholeheartedly to us. Their love for us has known no boundaries. 

We have been so fortunate to share our lives with such wonderful pets. We cannot 

imagine life without our most treasured kitties (Female, cats).  

 

In addition to displays of love and affection, the element of fate seemed to heighten the 

experience of bonding with a pet. Participants spoke about events in their personal life such as 

beginning a new relationship or overcoming challenges with substance use, and how these 

circumstances came together to make it possible for them to welcome a pet into their life. One 

participant stated “dogs come into your life when they’re supposed to.” Offering her perspective, 

a second participant shared her experience of bonding with her cats:  



134 

 

 

It’s unconditional love. It’s not even like any human interaction because, the love is just, 

for me at least, an automatic bond. And I really have always loved animals but with them, 

I hate using the word pets but they’re more like my children…the relationship I have is 

much more like children. I coddle them and love them and cuddle them and it’s just [an] 

absolute and total love, that’s pretty well what I can describe it as. I look forward to when 

I get home…when I’m not feeling well, they’re right there with me (Female, cats).  

 

Other participants remarked that bonding took time, often months and years. One participant said 

of her dog “it wasn’t like I just got her straight home and I immediately felt this overwhelming 

love, I didn’t necessarily, it’s like that love had to develop as my relationship and bond grew 

with her.” Bonding tended to occur through daily caretaking responsibilities such as: feeding 

pets, taking them to relieve themselves, and providing them with a space to sleep and rest.  

Furthermore, caretaking often went beyond a pet’s basic needs. For example, some dogs 

held sway over when and how often they would go for walks. Cats who were resolved to avoid 

using the litter box were let out at their discretion. In regards to feeding, dogs were seen as less 

discerning about their food preferences, with a few having some unique predilections. For 

example, one dog would happily crunch away on her hormone pills without any complaints. 

Another dog would eat discarded marijuana joints off the street, getting stoned in the process. 

Some cats had specific feeding challenges. For example, one participant recalled trying to feed 

her cat after being injured by another animal, saying “I got some kitten food and watered it 

down. We were syringing it into his mouth, force-feeding him and it took a week before he 

started drinking water on his own.” A second described the feeding regimen for one of her cats:   

They call her a special needs kitty…and the first year of her life she’d be eating her food 

and she’d bring it up right onto her plate and it hadn’t even hit her stomach. Our vet 

finally found out she was born with a narrow esophagus. She’d be eating hurriedly and 

the food would just “whoop” out it goes. So he says feed her on an eight inch raised 

bench many meals throughout the day. It’s lucky I was working from home…so I could 

every four hours, a heaping table spoon or else she’d starve to death (Female, cats).  

 



135 

 

 

Providing a contrasting example, another participant talked about how her fish altered their 

eating habits when she was travelling frequently for radiation therapy: 

I had somebody come in and feed them every day and they were fine throughout this. I’m 

amazed because that’s never happened before. They usually don’t eat for anybody else 

but they did. It’s like they seemed to know that I needed them here for when I was done 

[with radiation] and for when I was home on the weekends (Female, fish). 

 

Thirdly, participants viewed their responsibilities towards pets as a restorative 

experience, helping them strive toward healing and recovery. Participants recalled needing to 

remain calm while struggling against the uncertainty of not always knowing what their pets 

needed. Participants felt helpless while watching their pets throwing up or having a seizure 

without any foreseeable cause. As one participant said, “you worry about them when they’re not 

feeling well, and part of you is wounded as well.” Another said “when they get sick and because 

they can’t talk to you…it’s just kind of devastating because they bring you so much happiness.” 

Participants were at a disadvantage having to look for signs as to how their pets were feeling. 

Pets too were at a disadvantage seeing their once healthy human companion beset with fatigue, 

nausea, and pain during cancer or other types of illness. As one participant commented: 

With Loki honestly I was just a robot for years. I didn’t know what I was doing and I 

didn’t do a great job of it when she was around. I was not home enough with her. I felt 

quite guilty as her health started to decline. Before I was sick I was a healthy twenty 

something year old. I was out and about a lot and her health was not good when I first got 

her. She was thin and not well. So for me to rebuild her health and then thinking about 

what I went through just a year or so after, wanting to rebuild mine…There was a lot of 

times I didn’t want to play with her anymore. I didn’t have the energy for it so it’s been 

very different between the two (cat and dog) of them (Female, cats and dogs).  

 

Just as pets could not communicate in words that they were sick or in need of help, 

participants could not simply tell their pets that they were trying to heal and recover from cancer. 

They had to show them. Even the seemingly small act of getting out of bed each day was 

revealing of their commitment to caring for their pets. As one participant said, “this morning I 



136 

 

 

was like, I don’t want to get out of bed, she just jumps straight on to my chest. It’s like okay, it’s 

time to go out. I’m hungry so get me some food.” Similarly another said: 

And Duke is very good at making sure I get up in the morning because if I don’t he 

comes and pats my face because he wants to be fed and I know I have to feed him 

because he’s my responsibility (Female, cats). 

 

Moreover, participants discussed making lifestyle changes that they saw as beneficial to their 

health. Examples were eating a healthy diet, taking nutritional supplements, reducing their 

alcohol intake, increasing physical exercise, and using organic cleaning products in the home. 

One participant stated “we try our best to give her a healthy life because I think it’s an extension 

of your life…she stays healthy, you stay healthy.” A second said “I feel very responsible for her 

health which in a sense is a reflection of my own,” going on to say: 

Especially with having Hazel in my life, I’m not sure what it would be like without her 

regarding my health. I’m not sure I would have made the effort that I have and been 

consistent with reaching for a better space in my health. I want to be out and having fun 

with her. I want to be out and going on these hikes with her. I want to be feeling better so 

that she gets to do these things (Female, cats and dogs).  

 

With regards to diet and nutrition, some participants discussed choosing organic foods for 

themselves and their pets, and treating ailments with natural remedies such as essential oils. 

Others stressed the importance of cutting down on sugar, fat, and toxins in order to reduce 

inflammation in their body and slow the growth of tumors. To illustrate, two participants spoke 

about the importance of their pets while they were dealing with alcohol addiction: 

When I gave up drinking I went through a lot of depression and some other mental health 

stuff around some pretty serious trauma that I’d experienced so she (dog) was there 

through a lot of tears and a lot of my own healing. So in some ways I feel like when I had 

this cancer experience she’d already sort of been there with me through so many 

emotional experiences that we already had that deep bond and connection (Female, dogs). 

 

I now regret that I drank at all when I first got them. You kind of look back at it and go “I 

could’ve been so much better of a parent.” But they were the first thing I thought of when 

I got home from work and I played with them all the time and cared about them so I don’t 



137 

 

 

think I ever neglected them when I was drinking because they were more important to me 

than even I was. When I got sick, they were definitely the reason why I fought so hard to 

start off with, and they still are the major reason I continue to fight so hard (Female, cats). 

 

From these examples, it seemed that pets were not only there to witness trauma but also provided 

a window into what motivated participants to heal from trauma.  

In the case of exercise, many participants believed that walking their dogs was mutually 

beneficial with one participant calling it “part of the treatment and recovery.” Others said that 

they would feel guilty if they didn’t take their dogs for a walk. One participant stressed “you 

can’t sit at home and feel sorry for yourself when you’ve got a dog looking at you saying it’s 

time to go.” Another said “as you get older, sometimes you feel you’ve become a bit sedentary 

and she pushes us out of that.” Two other examples highlight the benefits of dog walking: 

I’m sure for myself that my health is much better because of walking the dog…In some 

ways it gives me a feeling of pride in my own accomplishment that we are getting out 

with the dog and making sure she gets exercise and it shows some fortitude on our part. 

Like, it’s pouring rain and “so what, you got to go out.” It’s interesting when we walk up 

to [the park] this morning, there was a lot of people there but if it starts pouring, it just 

clears out. No matter what we’re still going to be there…it’s like a badge of honour to say 

that we have a [dog] and we walk her (Male, dogs). 

 

She’s certainly been good company and fun for walking. It kind of gives you an excuse 

because you have to get all this exercise and having the dog makes it imperative that you 

get out and do all of that walking because it’s for the dog too and the neighbours don’t 

that think you’re going in and out of your house like a yoyo for no reason (Female, dogs). 

 

Taken together, the decision to get up in the morning and feed and exercise their pets was the 

embodiment of participants’ attempts at healing and recovering from cancer. Caring for a pet 

was not only a source of bonding but also renewal and restoration. 

4.2.3 Super-ordinate Theme: Speaking Volumes with their Actions 

Their presence in my life made me heal faster and in a much more profound way. It 

would have been a really lonely journey without them and I’m not sure if I would have 

had the strength to do it on my own. With them being part of the whole process—I mean I 

still have cancer but I’ve achieved a level of healing that I don’t think I would have done 



138 

 

 

on my own without their help, their presence, their love. It’s an unconditional love. It’s a 

very profound, very silent kind of love. They never come out and say “I love you” like a 

human being does but their actions speak volumes (Female, cats). 

 

This super-ordinate theme delves into the complexities of human-pet communication.  

For participants, the knowledge that their words and actions could undermine their pets’ well-

being made them more mindful about their tone of voice, choice of words, mannerisms, and 

body language. Participants tended to see their pets not as inanimate vessels, passively absorbing 

their emotions, but rather, as intuitive confidants who were no less vulnerable to the sting of 

harsh words and sounds. Accordingly, participants often spoke to their pets using an exaggerated 

and animated form of speech known as motherese or baby talk. The purpose of motherese was to 

acknowledge pets, and encourage their involvement in everyday routines such as sitting down for 

coffee in the morning or cuddling on the couch to watch TV. Being in their pets’ presence was a 

tangible reminder that they were not alone. The ease with which participants could talk to their 

pets, along with the comfort of knowing that they didn’t have to talk, allowed participants to 

experience both companionship and solitude.  

The term language typically brings to mind spoken and written forms of communication. 

Participants and pets often communicated with each other through nonverbal and intuitive 

means. The language of the human-pet relationship could be understood as a means of 

exchanging care and affection. Human-pet communication was subtle, yet explicit in the sense 

that it was comprehensible to both pets and people. Such communication relied upon much more 

than the exchange of words to facilitate mutual understandings. In fact, words served as a way of 

communicating intimacy inasmuch as they were an impediment to such intimacy. One important 

mode of nonverbal communication between people and pets was their physical nearness or 

proximity with one another. Proximity seeking appeared to be fluid and dynamic, with pets most 



139 

 

 

often establishing the parameters for these interactions. Even when separated by walls and floors, 

participants were very conscious of where their pets were in the house. Likewise, pets seemed to 

have an uncanny awareness of when to seek physical contact and when to keep their distance. As 

highlighted in the following themes, pets had much to say through their physical proximity, 

mattering presence, and capacity to tune-in to others, respectively: 1) It’s a silent kind of love; 2) 

It mattered that their pets were there; 3) It’s like each living thing has meaning.  

4.2.3.1 It’s a silent kind of love 

For participants, the invariable question of what their pets were thinking and feeling, 

stirred within them a profound sense of curiosity and attentiveness to their pets’ subtle looks, 

sounds, and gestures. In the words of a participant, “I’m always wondering, it’s like that constant 

mystery of how they think.” Another described the relationship as a “one-on-one love and 

affection without having to say anything—it’s so intuitive.” The language of the human-pet 

relationship could be most aptly described as an “unspoken connection.” This theme is 

comprised of two facets that illuminate the dynamic nature of human-pet communication: 

developing intimacy through proximity and distance, and being explicit without having to speak.  

Firstly, human-pet communication was manifest in the degree to which participants and 

pets maintained physical proximity. Proximity could mean simply being in the same room, or 

experiencing the kind of closeness described by a participant: “She would lie down on me and 

then we would have some sort of intimate time and just exchange care and love.” Participants 

derived comfort from the softness of their dogs’ fur and the warmth of their bodies. Similarly, 

dogs yearned for closeness with people. One participant said “[with] Max, I cannot lay down for 

a nap without him being right beside me; he curls up in the small of my back and stays there.” 



140 

 

 

Another described his dog by saying “he’s a lapdog…he always wants to be part of what’s going 

on.” A third said “we joke and call her shadow because she just follows me around the house.”  

Examples of proximity were not unique to dogs. Fish readily followed the participants’ 

gaze and movements. One participant said “the fish can be sitting there and as soon as they know 

you’re looking at them they start swimming like crazy.” In the case of cats, some were quite 

discerning, only willing to approach a select group of people. Others cats were eager to socialize, 

expressing affection by curling up with participants under their chin or sleeping on their chest. 

One participant said referring to her cat “she liked to come under the covers and she would push 

her little warm paws under me and it was just such a comfort.” A second said “if I’m cleaning, 

they’re with me the whole time, [my friend] calls them my entourage.” A third commented “she 

was a total lap cat and loved to snuggle, so it was having that affection when I really didn’t want 

to be touched by anyone else.” A fourth shared the following example: 

He will voluntarily climb onto my lap without the treat temptation and he will come and 

snooze by me. He’ll sit beside the bed and look up at me and meow until I say ‘upy, upy.’ 

I know that’s childish talk but he understands it. So he chooses to spend his time with me. 

He doesn’t have to but he chooses to (Female, cats). 

 

For participants and pets, proximity seeking conveyed their mutual interest, love, and 

affection. However, there were some instances when pets and participants sought distance and 

separation from one another. Over time, the kitten or puppy that would follow participants 

underfoot, developed into an adult pet in need of quiet space as in this example:  

She follows me into the bathroom a lot. She’ll just come in, sit somewhere and wait for 

me. If I don’t let her in then, when I open the door she’s lying on the floor right outside 

waiting for me…sometimes we’ll be like “where is the dog” and realize that she’s come 

in here and is having a nap in her crate. If she does something bad...she looks terribly 

sheepish and…she actually will go to her crate and give herself a timeout (Female, dogs). 

 



141 

 

 

As with this example, many pets were given wide-ranging access to indoor spaces with a few 

even having their own room in the home. As such, it was not uncommon for pets to venture off, 

seeking a sunny spot by the window or a warm place to hide. One participant said referring to 

her cat “If I noticed she wasn’t in the room I would be like oh, why is she under the bed…then I 

would coax her out and let her know it was okay to come out.” Another said: 

She’s under the bed, that’s her go-to place. It’s weird with my mom, she’s not like this at 

all, she comes right out when my mom is here…but anybody else she’s gone, you never 

see her. A lot of people joke, “she’s just a figment of your imagination” (laughing) but I 

have pictures to prove it so she does exist…she and I are really interconnected. She 

knows exactly how I’m feeling and…hers is a quiet kind of love (Female, cats). 

 

Some pets were well-disposed to being picked up and held by people. Others resisted 

such attempts at being embraced, especially among pets who had a history of abuse. One 

participant said “she doesn’t like being picked up but she does like to cuddle but it’s sort of on 

her own terms.” Echoing this point, a second participant remarked:  

You have to be really patient; you can’t push yourself on a stray. You have to gain their 

trust and allow them to make the rules about how intimate you’re going to be. At first all 

you could do is scratch under her chin and then go to her cheek and then a little more. 

Now, she still doesn’t like me picking her up. I can stroke her or rub her belly and she 

sleeps with me now but it took a long time for her to build that trust up (Female, cats). 

 

Similarly, dogs were not uniformly accepting of being touched and cuddled with one participant 

remarking “she’s not a lap dog; she doesn’t come over and lick and wag but she does want to be 

near us most of the time unless she’s busy sleeping somewhere.” Another said: 

She’s not like an over-the-top cuddly dog like some dogs are. I think it’s part of [her 

breed] so I often have to force her to cuddle. I mean she is very affectionate, she’s just 

not overly clingy. Some dogs like to be on you all the time and she’s not really like that. 

She likes to have a little cuddle and then she likes a bit of space (Female, dogs). 

 



142 

 

 

Furthermore, there were times when participants found it difficult to reciprocate when 

their pets were initiating play or expressing affection towards them. A lack of energy or a need 

for space left participants wanting to be alone, even avoiding their pets:  

I’m having a hard time connecting with Loki (cat) who I know that I pushed away a lot of 

the time. I just didn’t want to be touched but she would either sit on the edge of the bed 

or she’d come up and lie next to me. I specifically remember when I was going through 

chemo and lying in bed and having the energy worker there and she would come in …I 

was frustrated and took it out on them. I wouldn’t allow even Hazel (dog)…it’s like 

“don’t go near mummy right now, she’s not in a good space” (Female, cats and dogs). 

 

Through their unspoken connection, pets and participants learned to navigate when it was best to 

disengage, and when closeness and intimacy were needed.  

Secondly, human-pet communication was often unspoken, yet explicit in that pets tended 

to display consistent and recognizable behaviours. Even the most stoic of pets could not conceal 

their joy at being reunited with their human companions after a brief separation. Cats would rub 

up against participants’ legs, curling their tails and rolling onto their backs. Fish would swim 

around vigorously, producing voluminous bubbles. Dogs, in particular, were known for their 

effusive greetings. One participant commented “those cold wet black noses, licks, kisses, and 

wagging tails…you come in the door and you’d think I’d been gone for days.” Another said:  

Just coming home and having that unconditional love. I have so many names for her, 

Happy Feet, because she does her little dance with her bum wiggling all over the place. 

Just acknowledging coming home and having this creature love you and happy that 

you’ve made it home. And I’m equally happy that I did make it home (Male, dogs). 

 

When communicating their displeasure, pets made no bones about expressing their feelings. One 

participant said that his dog knocks over the garbage can when he comes home late, saying 

“she’s basically telling me this is not acceptable.” Another said that her cat once scattered the 

contents of his litter box because “it was offensive to his dignity.” A third said “he’s a majorly 



143 

 

 

affectionate cat but he definitely has a problem with me being gone for any length of time, so 

going to a hospital was agonizing because I knew what it was going to be like for him.”  

Participants often described their pets as being attentive to their words and gestures. One 

participant said “just the word intuitive, she (dog) can pick up on moods.” Another commented 

“she (dog) can figure out what’s going on, or interpret your facial expressions to see if she’s 

doing the right thing.” A third participant described her fish by saying “they do what you’re 

doing. If you’re sitting there looking ahead they’ll face the same way but when I talk to him, he 

turns around and looks at me.” With orchestra-like precision, pets reacted to the slightest change 

in participants’ inflection and intonation by tilting their heads or raising their ears. Rarely did 

participants need to utter a word before pets knew that something was wrong:  

When I would come home from the treatments, I had a lot of nausea and vomiting. I was 

having radiation every day and chemo every week and surgeries during that time. It was 

a very intense period because of the treatments and I always feel like she was sort of 

virtually and metaphorically holding my hand. She became much more cuddly and 

wanting to be attached to me, to help me, and to just be there. I don’t know how I would 

have gotten through that without her. She’s this little stoic presence (Female, dogs). 

 

It seems like since I’ve been diagnosed, he’s closer to me. He’s always sitting on my 

knee or leaning against me or sleeping next to me…yeah, maybe he’s got a sixth sense, 

he knows something is going on, I don’t know, but he’ll just sit there and stare at me. He 

can do that for an hour, just look at me…if they could only talk (Male, dogs). 

 

Similarly, one participant saw a remarkable shift in her cat’s behaviour after experiencing a 

death in the family. This cat went from biting her ankles and peeing on her clothes to faithfully 

sleeping by her side by the time she was diagnosed with cancer. Two others commented:  

There were times when I don’t know if there was food poisoning but I would get so sick. 

I was literally laying on the floor vomiting and thinking I should go to the hospital. And 

she’s laying beside me the whole time. She just would not leave my side and my 

neighbours were aware of my health challenges. If they hear Ginger barking excessively, 

they’ll always come over…And the one time when I was sick on the floor, she barked 

excessively and it alerted a neighbour who found me and kind of helped me…and it was 

all because of Ginger. She basically saved my life (Male, dogs). 



144 

 

 

 

There was one time the summer before and I had just started recovering. I had taken the 

dogs down to the beach for their run…but as I transitioned onto soft sand, I lost 

balance…I went down. I hit my head on a log and all three dogs came and laid beside me. 

Somebody yelled for help and…those dogs never left my side until I was vertical again 

and everybody was just like “wow you have such great trained dogs.” It’s just they know 

when you’re sick. They know when you’re not well (Female, cats and dogs).  

 

In homes with multiple pets, one pet would often assume the role of the participant’s 

protector. One participant said “when I finally got out of the hospital, Zoe (dog) became little 

miss bossy pants, nobody could go near me and with every noise, she was barking.” Participants’ 

belief that pets had an intuitive or sixth sense was further reinforced when they observed their 

pets carefully avoiding certain areas of their body when they were recovering from surgery:  

Holly seemed to know when I was hurting and in pain after the surgeries and her 

comforting presence was so welcome and had me soon feeling better. If I was lying in 

bed, she would carefully lay herself beside me never once stepping on my chest. After the 

mastectomy I was in a lot of pain. Her quiet and calm presence were a blessing to me. It 

was especially nice when she would lie next to me under the covers. Her little body 

pressing against mine was pure heaven. Holly was such a sweet kitty (Female, cats).  

 

Rocky was so good he never left me pretty well, like he slept with me the whole time. He 

was right underneath my chin and he learned really quickly not to walk on my stomach 

and little Penny slept with me for the first time too during that surgery and for a stray, 

that’s a big, big thing. It takes a long time for them to bond with a human (Female, cats). 

 

In addition, participants described how their pets would zero in on any changes in their body’s 

appearance or odour. One participant said that her dog would chase her around, determined to 

lick one of her toes that had gotten infected. As the infection cleared up, her dog’s licking 

declined, providing a “good barometer” of its healing. A participant with a history of prostate 

cancer said that his cat would always make a “beeline” to him, jumping on his lap. He went on to 

say “he knows that something is up, so that’s his way of helping me through the process.”   

 Lastly, human-pet communication seemed to rely upon a subtle interplay between 

decoding and responding to each other’s facial expressions and body language. Without saying a 



145 

 

 

word, a tentative gaze from participants signalled to their pet that it was time to pull out the 

favourite blanket or grooming brush. The prickly feeling of their dog’s tongue licking away at 

their hands or feet beckoned vigorous head scratches and belly rubs. The rich sounds of their cats 

purring reverberated through their body producing a “calming sensation” and a “sense of 

serenity.” The following examples highlight the reciprocal and ineffable qualities of interacting 

with a pet:  

There’s sort of this unspoken connection. Sometimes I try and talk to her when she’s 

meowing and see how she’ll react. And if I tap the couch or the bed, or if I make a sound 

like tick, tick, tick, there’s sort of like a little communication. There’s a few things that 

she’ll do regularly so she’s not necessarily trained like a dog but there are a couple of 

things that feel like our language that’s developed (Female, cats). 

 

It’s neat to share that with an animal other than a human being. It’s like having this 

connection with something different, like she can’t talk to me. It’s all very little nuances 

of how you are doing. It’s eye contact or how she’s holding her body or how her ears 

are…I can tell if there’s something going on in a person’s eyes or with their body 

language and you pick up on those things having a dog (Female, cats and dogs). 

 

As in the second example, it was difficult for participants to put into words the precise 

meaning of their pets’ gestures, for example, how participants knew that an upturned ear meant 

doubt in one situation and curiosity in another. And yet, participants came to develop an intimate 

knowledge of their pets’ needs and preferences by attending to the nuances of their behaviours:  

I’m really attentive to his cries. I have a pretty good idea as to when he wants to go out 

and when he wants to be fed. I can’t tell you a detailed picture of what it is, but it’s 

something I sense. Somehow I just feel like he’s in a hurry to go out and that view is 

reinforced when I bring him out because usually he goes and hides but he comes straight 

to the door so I know that it’s a different need other than feeding (Male, cats).  

 

I find it so interesting that she’s so complicated and all of the times she’s trying to 

communicate in very subtle ways…the communication becomes much more ingrained 

and I see the ways that she’s asking for things. Sometimes I’ll go and pick her up from 

my parents and they don’t seem to have that ability to know what she needs. I’ll get there 

and I’ll be able to tell right away she needed to go and do a poop…they don’t have the 

level of relationship, that intuitive sense that you develop over time (Female, dogs). 

 



146 

 

 

Another remarked “it’s a very profound, very silent kind of love; they never come out and say ‘I 

love you like a human being does but their actions speak volumes.” 

4.2.3.2 It mattered that they were there  

When participants needed a companion who would just listen without giving advice; 

when they wished to go for a walk in silence; when they couldn’t sleep; when their work-life 

ceased to provide structure for the day; when they were anxious and alone, it mattered that their 

pets were there. This theme addresses how participants experienced their pets’ presence in the 

context of their illness, by considering three facets of human-pet communication: upholding the 

silence, filling the silence, and enriching the silence.  

Firstly, pets were effective at upholding the silence, lifting the burden of having to talk. 

By contrast, some interpersonal relationships were saddled with conditions and expectations for 

how people should act. At times, people’s well-intentioned efforts were overlaid by an almost 

palpable sense of discomfort, heightened by the feeling of not knowing the right thing to say. 

With pets, participants felt relieved of any obligation to talk:  

I found that when I was feeling very ill, it’s hard to talk to people. My wife is always 

saying “Come on think positive.” You can only take so much of that. I’m the one that’s 

sick. I’m recovering but I still have some issues to deal with and sometimes it’s easier to 

be with a dog than to be with family members or friends that are very concerned about 

your health and “What’s going on? How are you doing?” Sometimes you get tired of it, 

so I find that the dog is a great companion because she just wants to go out (Male, dogs). 

 

My family is very supportive but they’re not here. Duke’s (cat) here and quite frankly 

Duke is the kind of comfort you want when you’re really sick because he’s not persistent. 

He’s not always asking how you’re feeling. He’s just there. He’s warm and he’s purry 

and it makes a big difference. He gives you a reason to go on. He seems to know when 

you’re not feeling well…He has a big advantage over a person in some ways. I can put 

his food out and go back to bed if I’m not well and that’s okay with him (Female, cats). 

 

With pets, silence was a permissible and acceptable way of responding to illness. One participant 

said of her cat “he doesn’t give judgement; he doesn’t give advice (laughing) unless you count 



147 

 

 

the wagging of his tail.” By allowing silence, pets left an impression that words were 

unnecessary and, perhaps even, a hindrance to intimacy and connection. The energy required to 

engage with another person led some participants to retreat from these kinds of interactions:  

A year and a half ago I could barely leave the house, I had so much anxiety. I would 

spend a lot of time on my own but she was a comfort and was there for me during that 

time when I didn’t want to see people and wasn’t relating to a lot of people or didn’t have 

the energy. She was company so I actually didn’t feel really alone (Female, cats). 

 

Another notable instance of pets upholding the silence was in the experience of walking 

with a dog. Participants derived comfort from the rhythm and repetition of their shoes hitting the 

sidewalk as they moved in unison with their dogs. One participant referred to walks as his 

“meditation” and “quiet time,” explaining “she (dog) just walks alongside and every so often 

looks up.” A second participant said “[it’s] the most relaxing thing when you’re away from 

cancer and you can just sort of be one with nature and the dogs.” Another said:  

I’ve changed a lot as a human being. I’m a lot more compassionate, wanting to help 

people. Even though she’s four legged and can’t talk to me, I know she’s part of it. I just 

have to mention that word (W-A-L-K) and she’ll be right over here saying “when are we 

going”…she’s the one who gets me out for walks because she enjoys it and I enjoy her 

company. When I walk down there in the woods it’s like a gentle massage in the back of 

my mind being with her and talking to her. We’d sure be lost without her (Male, dogs). 

 

The effects of cancer treatment affected participants’ regular walking routines with their dogs. 

For instance, one participant said “when I got home with the walker I could go about three 

houses, and within about two months I could walk a mile.” For others, daily walks increased in 

frequency, especially, for those who were retired or on leave from work. One participant said:  

At the beginning of each cycle, like every three weeks I had to go in for treatment, I had 

to take prednisone, and it just makes you manic. It was like I couldn’t sleep for probably 

two or three days so I would find it was really good to have a dog because I would take 

her, we would go for walks at least three times a day for like an hour each time so it was 

really good for me to have a companion and she’s a very good listener (Male, dogs).  

 



148 

 

 

Not all dogs were equally enthusiastic about walking. Some required an incentive such as a treat 

or car ride while others rushed to the door with the mere mention of the word W-A-L-K. One 

participant said “I just have to look at her and say let’s go and it’s brought peace to me.”  

Secondly, pets were adept at filling the silence, acting as a “conduit” for communication. 

One participant said that his dog “helps to ease communication because she’s just there and 

everybody wants to scratch her and talk to her.” There was an ease in being with a pet such that 

participants were often unaware of themselves talking to their pets. A participant with a cat said 

“I do probably talk to her a lot more than I think but when you’re alone you don’t always know 

that you’re doing it.” Another with fish said “I call him names like Love and Precious, sort of 

silly I guess, if you were listening you might think I was a little crazy.” Two others said: 

If we’re out walking I’ll say “which way shall we go, let’s go over here,” just like talking 

to a person really. Or if it’s getting close to her meal time, the tickedy, tickedy following 

everybody around will increase and she’ll become sort of more in your face and finally 

somebody will say “oh Rosie have you been fed?” And when the kids come home, she’s 

always the first person they talk to, “oh Rosie the Dosie how are you” (Female, dogs). 

 

Having this lingering death at your door, the dog helped a lot…you can always talk about 

the dog, you can always talk to the dog and our family, we would all laugh at the things 

that she would do and especially when you have young adult aged children, there’s not a 

lot of communication going on even when someone is seriously ill and the dog is just 

something there and “aw Sadie did this and Sadie did that” and everybody is always 

interested, not “oh gee I felt really sick today.” No one wants to hear that (Male, dogs).  

 

To understand human-pet communication, take the metaphor of walking along the beach. 

Everyday routines with pets created a secure foundation akin to standing on packed sand. The 

waves lapping against the shore mirrored the ebb and flow of their conversations with pets. What 

cancer did was make the participants more cognizant of where they placed their feet on the sand. 

To illustrate, participants recalled talking to their pets during cancer treatment: 

One of the hardest times [was] in the morning when I was having treatment. She (dog) 

would come in and jump up on the bed. And just being there as a presence, I’d scratch 



149 

 

 

her around her neck and she’d like that. And she’d just lay there sometimes for an hour. 

She was very calming and not being demanding, just being there because sometimes I’d 

be up in the middle of the night just unable to sleep and restless and everyone else would 

be asleep and she didn’t mind if you came over and talked to her…but sometimes her 

presence is, even if it’s a quiet presence, is better than loneliness (Male, dogs).  

 

With Rudy, most of the things I said when nobody was around were directed to her. She 

was the one that was around every day that I cried. I was in such rough shape physically 

that I couldn’t leave the house. I could barely walk around my apartment for months and 

months after treatment…Rudy was that consistent piece (Female, cats and dogs).  

 

Not only did pets fill the silence by prompting conversation, they also elicited particular 

vocal cues from people. To illustrate, the following statements were made by a participant at 

different points during an interview: “Stella, are you having a nap sweetie?” “Hey, sweetheart, 

been my little belly.” “Stell- what is it sweetheart, you okay, would you like to contribute 

something sweetheart? “Stella, you’re such a sneak, yes you are, yes.” During another interview, 

in response to her cat making an aggressive motion, another participant said “oh Rock-, whoa, 

whoa, whoa, hey cut it out.” A second warning came minutes later: “hey no claws, you can 

cuddle but no claws, good boy.” A third warning ended with “Rocky, you’re so beautiful, you’re 

so pretty, you’re so gorgeous, look at this belly, no bitey, bitey, that’s not very nice.” Such 

examples revealed participants’ affection toward their pets through their use of repetition, 

nicknames (e.g. Stell-), and elongated words (e.g. bitey). Two participants reflected upon this 

tendency to modify their speech when addressing their pets:  

I’m really conscious about sounds…maybe Luna can’t understand the words I’m saying 

but I feel like she can probably understand the kind of intonation you’re using to talk to 

her. So I feel like I don’t want to, even if it’s joking around, use words and sounds that 

she can take negatively and I guess maybe that comes from some of the cancer stuff too 

because they say to stay positive and stay with good vibes (Female, cats). 

 

Ginger is very much a lap dog. She just wants to be loved. But she always knows when 

I’m angry. I tend to vent and slam things. When I see her cower and run away, it means 

I’m out of control and my dog is afraid of me. I have to tone it down which helps me to 

center myself, so I can comfort her and let her know that I’m sorry and it’s going to be 



150 

 

 

okay. So I really do watch my tone, mannerisms and behaviours. If I’m in an emotional 

state that I can’t seem to control, I’ll just go for a walk and calm down (Male, dogs). 

 

Thirdly, pets were effective at enriching the silence and fostering a sense of solitude. 

However, this silence was not devoid of sound, and this solitude was not tantamount to 

loneliness. Pets stirred participants’ sensory capacities through their sights, sounds, and smells. 

The discernible beauty of pets was not lost on participants many of whom found themselves 

captivated by their dogs’ expressive eyes and flowing fur, their cats’ agility in navigating a tall 

scratching post, or their fish’s ability to blend into their surroundings. A participant with a dog 

said “she’s so pretty and her ears are so soft, we just really like admiring her and playing with 

her.” Participants felt soothed watching their pets sleeping or sitting still. With the rise and fall of 

their pets’ ribcage, participants felt their own breathing slowing down. Two participants 

commented:  

It’s a little bit like when you see your kids sleeping, you just get this peaceful feeling that 

everything is okay in one compartment of your life…you tuck your kids into bed and 

they actually go to sleep and it’s like “oh perfect (sighs), they’re healthy and peaceful and 

comfortable” and [it’s] just very reassuring. And so with the dog it’s a little bit like that. 

She’s clearly not suffering if she can go have a nice peaceful little nap (Female, dogs). 

 

If she’s (cat) cuddled up with me…I’ll focus more on our connection rather than letting 

my head go off into “Why is my back sore? Or what’s that little headache? Is that rash 

skin cancer?” So there’s just kind of a peaceful feeling that she brings over me so I don’t 

have as many of those thoughts. I guess I don’t feel alone when she’s with me. There’s 

less of a feeling of anything bad coming to me even though that maybe isn’t rational. I 

just have more of a sense that things will be okay when she’s with me (Female, cats). 

  

Along with their visual appeal, pets made their presence known through their expressive 

vocalizations. The pulsating hum of their cats’ purr and the pitter-patter of their dogs’ feet 

provided a soothing backdrop to their daily life. A participant with a cat said “her purring, if 

she’s on my lap or on my chest, there’s such a nice sound and vibration that goes through me and 

helps calm me down.” Two others spoke about the meaning of their dog’s company:  



151 

 

 

It’s been nice having the company in the house. I think any dog owner finds that if your 

dog’s not there in the house all of a sudden, the house feels really empty, you’re listening 

for the tick, tick, tick of the feet on the ground and so it magnifies it a little bit just that 

I’m not working, so I’m around more. She’s been a very good dog. Once in a while if 

I’ve been kind of blue she’s come up to put her nose on my knee (Female, dogs). 

 

There is someone when you come home. If you come home to an empty apartment, it’s 

cold and it’s quiet and it’s boring. Sometimes I think boredom is the worst thing that you 

can have and it really makes you seem like your life is not worthwhile at all. So just the 

company is a big thing anytime (Male, dogs). 

 

As for smells, some pets were affectionately described as being “stinky” while others 

were prized for their remarkable cleanliness. One participant referred to his dog, saying “her 

paws are completely wiped, it’s like the dirt just sheds off her.” Aside from the odour of kitty 

litter and the occasional discovery of pee and poop in the house, the smell of their pets appeared 

to be a familiar and comforting scent. Pets groomed themselves, licking their paws and rubbing 

their bodies on items of clothing and furniture. One participant remarked “you can probably see 

cat hair everywhere in this house but that’s part of living with a cat.” A second said of her dog, 

“she’ll flop in one direction and then she’ll get up and flop in the other direction on the sofa and 

it’s like she’s trying to smell up the whole thing evenly.” Another said referring to her dog “she 

had her own couch for a while but it’s been given away because it had too many hairs on it.” 

For participants, the confluence of these sights, sounds, and smells gave rise to a feeling 

that their home was abuzz with life and activity, and that all of this could recede into silence 

when they needed quiet and stillness. For participants, it mattered that their pets were there:  

She went through my entire diagnosis. She was there and that was all that really mattered 

like it didn’t matter if nobody else could take me to an appointment. Well, it did matter 

but having her and knowing that she was around and that I could come home to her and it 

was consistent—that made it okay (Female, cats and dogs). 

 

Their presence in my life made me heal faster and in a much more profound way…it 

would have been a really lonely journey without them. I’m not sure if I would have had 

the strength to do it on my own. I still have cancer, but I’ve achieved a level of healing 



152 

 

 

that I don’t think I would have done without their help, their presence, their love...I wake 

up and they’re both sleeping on me and I’m nice and warm under my blanket and I just 

revel in that. It’s a small thing, but it’s quiet and serene and relaxing (Female, cats). 

 

4.2.3.3 It’s like each living thing has meaning 

Participants tended to use terms such as creature, being, living thing, and living being to 

describe their pets. The impact of these so-called living things and beings did not go unnoticed 

by participants. Through their actions, pets embodied particular qualities or ways of being in the 

world that participants aspired to emulate. Pets exemplified the importance of demonstrating care 

and compassion to others, and to oneself. This theme addresses these ways of being in the world 

by examining the role of pets in helping participants become more in-tune with the experiences 

of others, as well as, their own. 

Firstly, it was clear that no two pets are alike. Some pets elicited awe and admiration 

while others inspired envy. For example, one participant said “they have such a fantastic frickin’ 

life, they get fed well, have a warm place; they have cuddles and if only people could have lives 

like that.” Similarly, cats and dogs were described by some participants as having notable 

differences. One participant said her cat “was very different, the personalities and with regards to 

independence; the cat can stay at home for three or four days at a time with a bowl of food and 

water; you can’t do that with a dog.” Another remarked “cats are quite happy to be by 

themselves, dogs are not.” Two others alluded to these differences, saying:  

People say “are you a cat person or a dog person?” To me, cats are just like things that 

will be there when they want to be there. They have such a different personality. Some 

cats are different. I think dogs are just more companions. My wife is allergic to cats but I 

couldn’t really see us owning cats. I find a dog just seems to be more enthusiastic about 

doing things…You’ve got to walk them and everything but for me it’s part of the 

enjoyment of the dog. It’s work that I don’t mind (Male, dogs). 

 

I love cats but all cats are autistic and they don’t have the ability to show emotion the 

way a dog does. These guys (dogs) when I was diagnosed, and especially when I was in 



153 

 

 

the hospital, it was like they knew right away something was wrong, they picked up on it 

right away… the cat really couldn’t care less (laughing) (Female, cats and dogs). 

 

The suggestion that cats are less in-tune with people compared to dogs did not hold true 

for all participants. One participant spoke about her relationship with her cats, explaining “it’s a 

mutual thing; these two needed a home and somebody to love and care for them, and I definitely 

needed the love and care that I always seem to get from cats.” Another participant commented:  

Loki (cat) is very comforting. Hazel is (dog) more about the action and fun. Hazel is not 

as open to it. If I’m balling my eyes out and I grab hold she’s kind of like “Yeah I’m 

okay with that” whereas with Loki she’d be all over it. She’d be like “Okay, what can I 

do to help you?” She’d lick my tears you know it was a different relationship. The idea of 

being vulnerable is difficult in this society. What meant a lot to me was being able to do 

that with these guys and not feel like I was being judged (Female, cats and dogs).  

 

Furthermore, some participants described their dogs as being quite discerning about the people 

and animals with whom they interacted. One participant said “Stella (dog) doesn’t bond with 

everybody; there’s just certain people that she’s more drawn to than others.” Interestingly, 

another striking example of pets being in-tune concerned neither cats nor dogs but rather fish: 

I knew something was wrong but I didn’t know what and that was about the time my fish 

started acting funny… and here this tumor kept growing in me and it was weird. It was 

like he was so in tune with me and the same thing kind of happened to him. He had a 

great big growth around his eye and before I even knew what was going on with me, it 

was like “oh my fish has this tumor” and then I was diagnosed. So we were right in sync 

with each other…when I had my surgery, his tumor went away too (Female, fish). 

 

Although participants were careful to avoid calling pets, people or human beings, it was 

seldom that they talked about pets without making reference to human attributes or interpersonal 

dynamics. One participant said “I don’t want to humanize him (cat) but I see him very playful, 

like a child.” A second participant said “I recognize that he’s (cat) an animal and has his own 

dignity and space.” A third remarked “to have this other—I won’t say human being—but this 



154 

 

 

other living person (dog) helping us and she really has been good to everybody.” In describing 

the differences between pets and people, participants discussed the importance of emotions: 

I’m pretty sure he likes me and that makes life worth living when something maybe loves 

you. It’s hard because cats are cats. They’re not people and yet we use people words to 

describe their feelings. That’s why I say like rather than love but I think in his own cat-

way he does love me but it’s not the same as a people-love (Female, cats).  

 

Another participant went further to suggest that not only do pets have distinctive qualities but, in 

fact, they tend to elicit these very same qualities from people: 

Most people like to think of animals as being a lesser creature. I don’t think that at all. I 

think actually human beings based on our behaviour are far less on the scale of goodness 

and I think having a relationship with them makes human beings—it brings out, in some 

people abuse, but with most people it actually elevates them as a human being. It makes 

them more compassionate, understanding, and caring (Female, cats). 

 

In the case of interpersonal dynamics, pets were considered to be family members, 

children, siblings, and friends. Along with having distinct personality traits, pets seemed to 

develop unique relationships with each member of the household, being standoffish with some 

and affectionate with others. The experiences of a participant with fish suggest that pets tended 

to display human-like attributes, as well as, those characteristic of other kinds of pets:   

I’d always liked the Betta fish because they’re very beautiful with long tails and fins and 

colourful. I’d got one after a break-up and it was nice to have something living in the 

house. They’re very responsive and take to one person. If you’ve left the room for even 

five minutes and come back and look at him, he just gets so excited. He will start 

swimming and it’s like a dog if you think of a puppy and how they get so excited and 

knock everything over with their tail…They can’t live together because they fight and 

have problems and I can kind of relate to that. I’m by myself and kinda like it that way 

but it is quite lonely and the fish has been a good companion for me (Female, fish).  

 

Apart from this example, conflicts between pets living in the same household, tended to be 

spontaneous and short-lived, akin to the kind of jealousy and rivalry observed among human 

siblings. Without warning pets would erupt into play and then just as suddenly begin fighting. 

Some pets would tease their sibling by growling or pawing at them while others were often 



155 

 

 

found cuddling and sleeping together. One participant shared a photo of her cats, explaining “oh 

that’s them curled up together…this is what they used to do all the time and she’d just basically 

curl up on top of him and almost disappear.” A second participant recalled her family’s 

experience with getting their dog, Ellie, after which they decided to adopt Zoe (dog) as a 

companion for Ellie:  

I said to my daughter “okay we’re just going to look” and of course came home with a 

puppy. We had her for a year and I was still working full-time and my daughter was at 

school and I thought in all fairness, she’s left alone, it would be really nice if she had a 

companion so the following summer, we went online again and saw Zoe. Zoe had been 

beaten to a pulp and forcibly removed from a home…We went out there and I took Ellie 

and they seemed to get along, so I ended up taking Zoe home (Female, cats and dogs). 

 

This participant went on to describe how Zoe then responded to the addition of their cat, Oscar:  

My daughter was working at [the mall] and hears this “mew” and finds Oscar in a 

dumpster…so we took him home and…I spent time introducing them and Zoe just 

realized it was a baby and started walking it all over and tucked it between her legs…and 

from that point on, Oscar became Zoe’s pup and she raised it (Female, cats and dogs). 

 

The examples above demonstrate the meaning participants derived from watching their 

pets receiving and embracing another animal. In a similar vein, participants expressed the 

importance of socializing their pets such as a participant who said “before she (dog) was a year 

old, I introduced her to ducks and all the animals around and I was like these are your friends.” 

Socialization was seen as a necessary measure to ensure the safety of both pets and others around 

them, and to enact specific values that participants held dear. For example, one participant 

recalled the time when she and her partner had kept a stray dog overnight, telling her own dog 

“I’m really proud of you for allowing another animal in our home.” 

 Aside from these interactions between pets and other animals, participants spoke about 

occasions when their pets showed compassion towards people. Such instances evoked similar 

feelings of pride and gratitude from participants towards their pets. One participant described the 



156 

 

 

impact of having pets, saying “it’s teaching me a bit more about compassion and to read the 

nuances of people.” A second participant recounted how his dog reacted to a close friend who 

was gravely ill with cancer, pointing to a blurry photo of his dog running into his friend’s house:   

The door was open. I couldn’t hold her (dog). She ran away from me and ran right into 

him. He was just sitting there and she went right to him. Unfortunately, that’s the only 

picture I got because it all moved but she just ran right to him. You wonder how dogs 

treat people. She knew he was sick and stuff. She ran right to him and put her head there 

(on his friend’s lap) and wouldn’t move. And that says a thousand words (Male, dogs).  

 

A third participant described how his dog would readily offer comfort to people, even strangers:  

One day we were walking by and there was a woman in a blue hospital gown and a 

fellow with his arm was around her, obviously in a lot of distress. I have an extendable 

leash and all of a sudden Jackson wasn’t following me. He was sitting up on the bench 

next to them about 15 feet back. I came back and said “come on, Jackson, get down” and 

I saw the woman. She had her hand on him and was patting him and she said “no, it’s 

okay”…He changed their whole demeanour from being sad, unhappy…and totally 

dissolved the problem…yeah he’s done his fair share of healings (Male, dogs). 

 

Such encounters tended to be more common among dogs who were taken out for daily walks. 

Nevertheless, even when pets were not physically present, participants found opportunities to 

connect with other people through their shared affinity for pets such as the example below:  

He’s a good conversation starter. “Oh yes I have a cat, do you have a cat, what kind of 

cat?” When I go to the cancer clinic, there’s a wait between dropping off my prescription 

and picking it up, so sometimes there’s people waiting for rides. Last month there was 

this older lady and we got to talking about our cats and she told me a lot about her life 

and it was nice…She obviously wanted to talk to somebody and it made my time go 

quicker so we talked about Duke-the-cat and then talked about her cat (Female, cats).  

 

Secondly, having a pet reinforced the value of treating oneself with care and compassion. 

One participant said “it’s like each living thing has meaning and whether it’s to teach us a lesson 

that’s not so nice or to be there as comfort and guidance.” Another remarked “I find I get quite 

emotional sometimes and it’s not typically like me whether it’s reminding me of the treatment, 

and the dog can almost absorb excess feelings.” The effects of cancer were like powerful winds 



157 

 

 

that unearth the roots of a tree, leaving the tree standing but the roots exposed. With their roots 

laid bare, participants found themselves learning and re-learning to care for themselves. One 

participant said “I’ve been doing other kinds of supportive care since my chemo and 

radiation…to help heal myself and my body.” Another commented: 

I continually work on skills like lowering my anxiety. I do a lot of meditation and yoga. I 

did a yoga teacher training course and that was like exercise, spirituality, creativity, 

community building...there’s so much that is being studied now with the mind and 

meditation and how that changes your cells and everything and tumors…I’ve changed my 

diet completely…so a big part of it is cooking and getting my groceries and, so putting it 

in practice. I started Tai Chi and Qi Gong, so those are both spiritual and exercise. I did 

an art therapy class I really enjoyed…so that’s creativity and spirituality (Female, cats).  

 

The comment above highlights the importance of physical activity, creativity, and 

spirituality. Other participants referred to these three aspects while also emphasizing how their 

pets help them stay active, creative, and spiritual. To illustrate, one participant said “they make 

me much more in-tune with myself.” With regards to physical activity, pets encouraged play and 

exercise. Calling herself “the girl with the little white dog,” one participant spoke about the 

meaning of daily walks with her dog:  

I look and see how she’s being responded to and how she responds to things and it’s like 

I really don’t have to take all of this stuff so seriously. It’s really not the big deal I’m 

making it out to be. It allows me to switch gears in that moment (Female, cats and dogs). 

 

Another participant shared how walking helped her to understand her own and her dog’s needs:  

When she (dog) was younger I would spend hours walking her around because I’d be 

convinced that she needed to do a poop but then she wouldn’t do one. Because she’s a 

girl, it takes her forever to go to the toilet. She needs to find the perfect spot...so I would 

find that frustrating sometimes because there was that conflict between her needing her 

slow time and me being in a rush so that was a point of frustration, learning how to 

navigate those two conflicting places. Now, it’s like the more I’m in tune with myself, the 

more I’m in tune with her. I’m able to be in that intuitive part of myself (Female, dogs).  

 

In the case of cats, one participant described her experience of doing yoga and meditation:  



158 

 

 

If I try to do yoga, forget it. They’re climbing all over me. It ends up being more funny 

than anything because Rocky crawls right on top of me…Penny just stares at me like 

“what are you doing?”…but meditation is much easier...Rocky will curl up underneath 

my throat or sit on my chest or legs and Penny will usually curl up on my legs. I’ll sit 

there with or without music and just relax and breathe and control my thoughts and he’ll 

be right there on top of me. He’s not a distraction the way he is with yoga. His breathing 

becomes calmer with me and almost hits a relaxed state as well. It’s a luxury that most 

people don’t have time for or don’t give themselves the time (Female, cats). 

 

The link between pets and physical activity was not surprising. Somewhat unexpectedly 

was the way in which pets provided an outlet for creativity. One participant described creating a 

video, explaining that her dog, Stella, is the narrator of the film and “it starts with Stella on the 

beach and she’s having this philosophical dilemma [about] her relationship to the beach and the 

waves and nature; it’s like her narrating the story of our family.” She went on to say “it was a 

creative practice of me being able to actualize my profound love for her, and also have some play 

around that.” Other participants described making portraits or photo collages of their pets:  

I started drawing Rocky when I couldn’t get out of bed, just as drawing exercises and 

something creative to start doing again, getting the creative mind going. I had wanted to 

start writing children’s stories about Rocky, the adventures of Rocky, so I started taking 

pictures of him in different sleeping positions because that’s the basis of the book. All of 

his adventures are actually in his head while he’s sleeping (Female, cats).  

 

Along with creativity, pets helped participants become more in-tune with different 

aspects of themselves, from the emotional to the spiritual. Participants described losing a sense 

of structure and routine following cancer, such as a participant who spoke of getting through the 

“bumps and bits and pieces” with her pets. Another participant said that when her dog first came 

into her life, she was “going through some personal struggles and having some issues around 

drinking.” She remarked that, after going through cancer with her dog at her side, it feels like the 

“narrative has come full circle.” Similarly, a third participant said:  

When I allowed myself to get swelled by everything, work and an abusive relationship 

and alcohol, I just sort of let go of all of that. The only positive glimpse I ever had of real 



159 

 

 

love and connection was with animals…they were the beings that really I connected to 

completely and wholly and felt any kind of real spiritual love and oneness with. And 

when I got sick, they helped me to really start healing and I re-found that poor, neglected 

part of me that just needed to be cared for with diet and exercise, reconnecting with the 

more spiritual side of myself and just caring about myself again (Female, cats). 

 

Another notable example pertaining to spirituality came from a participant who described taking 

part in a spiritual practice known as the Blessing of the Animals. She explained:   

It coincides with the Feast of St. Francis of Assisi. It’s usually held late September or the 

first week of October. There’s a special service in the afternoon and people can bring 

their animals to church…and they are blessed by the priest…It’s amazing, there’s quite a 

few people who come out who wouldn’t normally go to church but they’ll bring their 

animals in to be blessed…There was the time when I had Ellie and Zoe (dogs) and two 

cats and a guinea pig. That was pretty memorable and keeping them all organized in the 

pew. And it’s amazing, they do seem to know, they all behaved (Female, cats and dogs). 

 

Only a handful of participants expressly used the word spirituality. More often, 

participants discussed the importance of their pets for their “healing process” or “healing 

journey.” For some participants, healing was not just a matter of recovering from illness but 

straddling the line between life and death. One participant suggested that his dog “could be the 

salvation” for him. Another said of her cat, “I feel like she’s helped save my life; I said that 

already but I don’t know how the last year and a half would be without having her relationship.” 

A third participant shared how her cats have influenced what it means to heal from cancer:  

It’s hard to even put in words how much they’ve been part of that whole process. And not 

just healing from the cancer but kind of re-finding myself, giving myself back to myself. 

I didn’t like myself much before and I wasn’t taking very good care of myself. I was just 

simply going to work, coming home, drinking, going to sleep, and repeating the pattern 

over and over again and when I started going through the whole process of healing from 

the cancer, it became healing the whole, the complete self (Female, cats). 

 

For this participant and others, one aspect of healing was addressing patterns in their life that 

prevented them from caring for themselves. A second aspect of healing involved attending to the 



160 

 

 

whole, complete self, something that did not always come easily to participants. One participant 

stated “it’s easier to give to an animal your love and affection and dedication.” Another said:  

I’m just really grateful to be a guardian to these guys and they’re able to be who they are 

with me. Something I’m learning to do is to just be who I am and not be so concerned 

about what everybody else thinks. We have a lot to learn from animals and especially 

domesticated ones and the wild ones…and I honestly don’t know where I would be if it 

weren’t for them in my life. I would be going through so much grief and sadness and 

anger and frustration, and taking it out on them…They’ve honestly just taught me so 

many little things, a lot of patience, a lot of calm, a lot of time for play…it’s been 

learning a lot about letting go, receiving love, letting things in (Female, cats and dogs).  

 

In the process of becoming more in-tune with their pets, participants were able to reclaim aspects 

of themselves which had been neglected or consumed by illness and the stresses of daily life.  

4.3 Reflections on the Use of Photo-elicitation 

The discussion of photos took place at different points during the interviews, with some 

participants sharing photos early on, and others continuing to reference photos throughout the 

interview. Participants shared photos by swiping their finger on a screen, flipping through a stack 

of pictures, or turning a page in photo album or calendar. Along with photos, the sharing of 

videos added movement and sound, helping to animate the telling and re-telling of vivid 

memories and anecdotes. These still images and video clips allowed me to see how participants’ 

relationship with their pets had evolved over time. Moreover, they provided insights into 

important relational dynamics between pets and people, and between pet siblings. To illustrate, 

one participant pointed at a picture of her two cats, saying “that’s a cute shot of those two, 

they’re face to face.” The photos had a visual and tangible appeal, inviting participants to talk 

about pets who had passed on, and pets who were currently in their care. As suggested by the 

comments below, looking at photos helped to transport participants back to a time when their 

pets were young and new routines were beginning to take shape:  



161 

 

 

I know I’ve got pictures of her when we first got her. We were just looking at them the 

other day, they disappeared. Oh here we go, did I say 2011, it’s 2012, so that’s her when 

we first got her, that’s my wife and you see, she was about nine weeks. My wife saw 

her—we had a dog that passed away in 2009. We had her for 14 years. It was a border 

collie cross. So in 2009, for a couple of years, we didn’t have a dog. So you sort of feel 

like your home is empty in a way because even though we still have two kids, it’s a lot 

less responsibility (Male, dogs). 

 

So did you want to see any pictures? I don’t know whether these are in any particular 

order. I’ll try starting them off. Yeah that’s when he was pretty young. He was just a 

puppy there. You see the size of the couch and the size of him. That’s my wife and him. 

He loves sitting on my wife’s knee and in the morning she has coffee and reads the paper 

and he’s always laying on her lap or sitting on her knee. And that’s where he is first thing 

in the morning and then he gravitates over to me (Male, dogs). 

 

We have lots of pictures of him in these baskets. Let me see if I can show you one. I sent 

one to [my daughter] especially now that she’s away to show what her cat is up to…a lot 

of these women are always showing pictures of their grandchildren, well with me I share 

pictures with her of Dusty (Male, cats). 

 

Other comments seemed to suggest that pets are not only important to participants but are also a 

ubiquitous presence in their life:  

I went on a couple of cancer retreats and we were asked to bring pictures of significants, 

you know most people brought pictures of their kids or something or their spouses and 

family pictures, and I took pictures of my fish (Female, fish).  

 

It’s interesting to see her change. Now I know when she wants her hugs and I know when 

she wants her snuggles. She does this certain position and she really loves my partner, 

that’s him (pointing to a picture), actually you can see, he’s the guy in the middle. That’s 

our vision board up here and that’s me. I put a little picture of Hazel next to me on here 

because honestly, she goes pretty much everywhere with me (Female, cats and dogs).  

 

Participants seemed to revel in the opportunity to talk about their pets and showcase their 

unique quirks and attributes. The following comments highlight the humor and playfulness 

exhibited by participants while telling me about their photos:  

That was another Christmas, Jackson dressed up as a reindeer. And that’s a picture of 

Jackson and I. Yeah he’ll sit there with his head right on my shoulder here and behind 

me. It’s like a parrot…I remember taking all those pictures of him and that’s not all of 

them either, I have a lot more but didn’t want to bore you with them (laughing). I think it 



162 

 

 

was 70 pictures but it just makes me feel how lucky I am that we have a dog like that and 

I guess everybody’s dog is their best friend and Jackson is definitely mine (Male, dogs). 

 

I should show you a picture if I may. [I] talked about it and you reminded me of it. “Taz 

(talking to neighbour’s cat) it’s not of you.” How could you resist that (pointing to a 

photo of her cat)? He has a cat door but that doesn’t mean he wants to use the cat door, 

no, no, no. That means that he wants you to get up and let him in. I’ve got a beautiful one 

of him hiding in the garden. There he is. You see how he blends in. It’s not me, I’m not 

really here. No, I’m not doing rude things to your garden (Female, cats). 

 

In the first comment, the participant likens his dog to a parrot, calling to mind a comical image of 

his dog perched on his shoulder. He jokes that he doesn’t want to bore me, knowing that I’m the 

one who asked to see photos of his dog. In the second comment, the participant addresses both 

me and a neighbour’s cat who has stopped by for a visit. She begins by remarking on her cat’s 

chameleon-like beauty, and then seamlessly adopts her cat’s persona by speaking in first person. 

Such examples of playful banter were common across the interviews, attesting to the joyful and 

endearing nature of the human-pet relationship: 

I’ll show you a picture of her. She’s just so funny and she just barks her head off. She’ll 

put her mouth right up to the [hose] nozzle and gets sprayed right in the head, she just 

goes crazy. It’s quite funny. She just chases it all over like a lunatic (Male, dogs). 

 

But yeah he’s a ridiculous cat (laughing), he’s sort of like, the first ones, if you just keep 

going (pointing to pictures) you’ll see. Okay, so that’s just him sleeping. He’s so funny 

like even when he’s sleeping, he’s comical…There’s a good picture, he loves getting 

pictures taken of him (laughing), he’s funny, oh my god (Female, cats). 

 

She (dog) loved running up and down next to the waves, barking at the waves, sort of like 

her little passion every day. So I made a video of her on the beach and sort of narrated 

this little film (laughing). My parents are very sweet. They still watch it apparently and 

text me and say, we were just watching the movie of Stella (Female, dogs).   

 

In the examples above, photos evoked smiles and laughter while, in other instances, they 

prompted silence and tears. Participants seemed to appreciate each and every one of their pets for 

the meaning that he or she had brought to their lives. Discussions about photos provided a 

window into their intimate experiences and their individual journeys toward healing and 



163 

 

 

recovery. For example, only a few participants showed pictures of themselves during cancer 

treatment, remarking that some moments were just too painful and raw to remember. Among 

participants who shared photos of their cancer experience, some of their comments were: 

I remember I had this picture of myself holding her as a puppy and my hair is very, very 

short and I still look kind of not myself and I was just so, so happy. Like I was just so 

thrilled but terrified to make the decision to bring her (dog) into my home, going back 

with Loki, the cancer experience was horrid. Like none of it was fun, none of it was 

good, none that I can remember anyway (Female, cats and dogs). 

 

I mean I look at the pictures and we can remember them and stuff. There’s lots of 

pictures all over of her. I do remember when I got out of the hospital I was sitting right 

there and I do remember she wouldn’t leave, like “where have you been all this time, 

what’s wrong?” I would say you know besides the person with cancer, it’s what the dog 

does for the family too (Male, dogs). 

 

That’s when I lost my hair, “hey Sadie” (dog). But she’s just a very gentle dog and in 

some ways when she was younger she used to be quite intimidated by other dogs at the 

park, not so much now she’s quite into rough and tumble playing with other dogs. It’s 

always fun taking her out because she’s excited to go out for walks (Male, dog).  

 

Interestingly, the third comment is from an interview that took place at a coffee shop where the 

participant’s dog was not present. Simply looking at the photo prompted this participant to speak 

to Sadie as if she had been there. The words of another participant powerfully summarize what 

these photos mean to participants, and how it feels to relive them time and time again: 

A friend of mine shared with me years ago, take as many photos and videos as you can 

because it goes by so fast and the next thing you know they’re gone and what do you 

have to show for it right. I came across a video that I’d taken of Loki…and the two of 

them were in it and I was playing with her and yeah, it was nice to revisit those moments 

and just have them (Female, cats and dogs).  

 

 

 

 

 



164 

 

 

Chapter 5: Discussion 

In this chapter, I discuss the meaning of the findings in light of theoretical constructs and 

empirical research. I begin by reviewing the theoretical framework outlined in Chapter 1. With 

reference to the eight phenomenological themes, I discuss key findings that confirm or expand 

our understanding of the lived experience of the human-companion animal relationship. Some 

themes replicate previous research while others offer new insights into the importance of this 

relationship for people with cancer. Next, I describe the implications of the study for research 

and practice in supportive cancer care. The chapter concludes with a discussion of the limitations 

of the study and directions for future research.  

5.1 Overview of the Study 

The purpose of the study was to explore the lived experience of the human-companion 

animal relationship for people with cancer. The study is unique in psychosocial oncology as one 

of only a handful of investigations whose primary objective is to explore the phenomenon of pet 

ownership among people with cancer (Larson et al., 2010; Nitkin, 2014). As noted previously, 

more research has been aimed at evaluating the therapeutic benefits of companion animals. The 

present study contributes to the literature by highlighting the importance of meaning-making in 

the context of people’s relationships with their companion animals. In framing this discussion, I 

drew upon the concepts of attunement, resilience, and thriving to help explain why people’s 

relationships with their companion animals can be especially meaningful and rewarding in the 

experience of cancer. Consistent with the method of the reduction, I strived to set aside these 

concepts as I gathered lived experience descriptions and reflected upon the essential themes 

which characterize the human-companion animal relationship (van Manen, 1997).   



165 

 

 

5.2 Theoretical Framework Revisited 

The model proposed by Carver (1998) posits that an individual can experience some kind 

of growth or gain following a stressful life event such that he/she may function more effectively 

when confronted with similar events. This kind of growth is considered to be an example of 

thriving. In this study, my aim was not to assess whether people demonstrate evidence of 

resilience or thriving following their cancer experience. Instead, my concern was with exploring 

meaning-making strategies that help to account for instances of resilience and thriving among 

people with cancer (Carver, 1998). While some people experience distress or a loss of meaning, 

others are able to draw upon particular strategies to help make sense of their experiences. It is 

here that I focused my efforts on understanding the ways in which people engage in meaning-

making in the context of their relationships with pets (Berscheid & Regan, 2016). I argued that 

intimate connections, although not a precondition for meaning-making, can help people find 

greater meaning from their experiences (Yalom & Josselson, 2011).  

Through phenomenological reflection, I identified three super-ordinate themes that align 

with the following meaning-making strategies: disengagement/acceptance, distraction, and 

support seeking. These meaning-making strategies find support in the coping literature as 

examples of problem-focused, emotion-focused, and meaning-focused coping (Folkman, 2010; 

Folkman et al., 1986; Waldrop et al., 2011a; Wenninger et al., 2013). Problem-focused coping 

refers to a person’s attempts to change or confront a stressful situation while emotion-focused 

and meaning-focused coping refers to strategies used by an individual to manage negative and 

positive emotions, respectively (Bigatti et al., 2012; Folkman et al., 1986). These three types of 

coping, although different in their functions, tend to operate in conjunction with one another 

(Folkman, 2010; Folkman et al., 1986; Waldrop et al., 2011a; Wenninger et al., 2013). Meaning-



166 

 

 

focused coping may prompt an individual to reconsider his/her beliefs, values, or priorities in 

life. This type of coping is substantiated by empirical research suggesting that cancer patients 

experience both positive and negative emotions during periods of stress (Folkman, 2010). 

Meaning-focused coping encourages people to see a stressful situation as a challenge rather than 

a threat, and helps them persist in coping. 

The super-ordinate theme, (Dis)connecting with the Journey, reflects participants’ 

attempts to disengage from, as well as, accept difficult or challenging aspects of their cancer 

experience. Research suggests that strategies involving disengagement from the cancer 

environment or the experience of being a patient, tend to be associated with greater distress while 

those characterized by acceptance are linked to lower distress and depression (Alcalar, Ozkan, 

Kucucuk, Aslay, & Ozkan, 2012; Kvillemo & Bränström, 2014). In this study, 

disengagement/acceptance strategies were not mutually exclusive. For example, thoughts of 

dying were unavoidable, from the looming threat of a cancer recurrence to the trauma of 

surviving a near death experience. In such occasions participants felt the need to reflect upon the 

meaning of dying, even preparing themselves or others for this outcome while, in other 

occasions, thoughts of dying shifted to thoughts of living, and living more consciously. 

Participants believed that it was important to their pets that they were alive and trying to heal and 

recover from cancer.  

In many cases, pets provided a reprieve from thoughts of dying and, for some 

participants, the “will to fight” and be “one of the 50 percent that survive and thrive.” 

Accordingly, participants were not necessarily avoiding the subject of death but instead were 

trying to reframe the meaning of dying (i.e. emotion-focused coping) and redirect their thoughts 

to caring for their pets and living more consciously (i.e. problem-focused coping). Participants’ 



167 

 

 

efforts to confront their mortality can be viewed as instances of problem-focused coping. This 

type of coping is associated with better adjustment to cancer in the short-term and lower distress 

overall (Drageset, Lindstrøm, & Underlid, 2016). The present study makes clear that existential 

concerns are not limited to thoughts of one’s own death as participants were left to confront the 

inevitability of losing a pet. Such findings echo those of similar investigations which suggest that 

a person’s attempts to confront existential concerns can lead to a deepening of relationships, a 

redefining of one’s priorities in life, and a greater sense of compassion towards others (Drageset 

et al., 2016; Molzahn et al., 2012; van der Spek et al., 2013). 

The super-ordinate theme, Pulling you out of yourself, reflects the ways in which 

participants tried to make meaning by seeking a source of distraction. Also considered to be a 

form of emotion-focused coping (Folkman et al., 1986; Waldrop et al., 2011a), distraction is a 

defining feature of play with pets, as well as, caretaking responsibilities towards pets. Play and 

caretaking helped to shape participants’ daily routines, offering a sense of structure and direction 

for their everyday life. As in other investigations, participants tended to have fewer thoughts of 

cancer when they were able to focus their attention on a particular activity (Drageset et al., 

2016). Some authors have described how people use distraction by seeking positive or neutral 

experiences (Webb, Miles, & Sheeran, 2012). These examples of distraction differ from 

avoidance or emotional distancing which has been found to exacerbate stress (Boehmer et al., 

2007; Yeung et al., 2014). While play and caretaking shared some positive elements, it would be 

more appropriate to characterize these strategies as a meaningful distraction rather than positive 

or neutral. To illustrate, some participants described themselves as being their pet’s guardian or 

parent which has both positive and negative aspects. Moreover, while play was often 



168 

 

 

accompanied by humor and laughter, there were times when play evoked anger or distress such 

as when pets destroyed participants’ possessions or displayed signs of aggression towards them.   

Along with seeking distraction, participants engaged in meaning-making by seeking 

connection. The following quote seems appropriate here: “rarely can a response [i.e. verbal] 

make something better; what makes something better is connection” (The RSA, 2013). 

Participants turned to their pets for support and companionship. The super-ordinate theme, 

Speaking Volumes with their Actions, is concerned with the relational dimension of meaning-

making. When participants were in need of support, pets would climb onto the couch or bed, 

cuddling or sleeping with participants. When participants wished to be left alone, pets would 

physically distance themselves from their human caretakers, giving them space or going into 

another room. Through their ability to respond and adapt to participants’ needs, pets were able to 

convey powerful meanings through simple and subtle gestures such as pressing their chin on the 

participants’ knee or leaning in and making eye contact. Some researchers regard these gestures 

as a form of emotional support that can promote strength and resilience (Brooks et al., 2013; 

Walsh, 2009b). 

The supportive functions of pets confirm findings from previous studies regarding the 

relationship between social support and improved well-being (Boehmer et al., 2007; Bultz & 

Carlson, 2006; Cavanaugh, Leonard, & Scammon, 2008; Costanzo et al., 2009; Maller, 

Townsend, Pryor, Brown, & St Leger, 2006; Marcus, 2012b; Wills & Ainette, 2012). Social 

support is broadly understood as the degree to which a person feels integrated in his/her 

community, and believes that he/she can rely upon others for help (Wills & Ainette, 2012). 

While there is little dispute that social support can be protective for health and well-being, not all 

support is created equal. Social support can be measured by the number of social connections a 



169 

 

 

person has (i.e. structural measure) or by the quality of support that a person actually receives. 

Support can be categorized into different types (i.e. functional measure) including emotional, 

informational, instrumental (e.g. transportation, childcare), and companionship support (Brooks 

et al., 2013; Wills & Ainette, 2012). As trusted confidants and leisure companions, pets provide 

emotional and companionship support, respectively (Wills & Ainette, 2012).  

Based upon the participants’ accounts in this study, connection seeking rather than 

support seeking seems more applicable in describing meaning-making. Firstly, the term 

connection highlights the intimate, reciprocal, and enduring nature of the human-companion 

animal relationship. Previous studies suggest that structural measures of social support are not 

strongly correlated with functional measures (Wills & Ainette, 2012). Consequently, a person 

can have a wide social network that includes primary relationships (e.g. spouse or partner, 

children, etc.), and be lacking in intimate connections. Secondly, the use of functional measures 

to assess support from pets, paints a limited picture of the ways in which pets impact a person’s 

well-being. I would add that pets offer what can be described as validation support by affirming 

or validating the meanings participants derived from their experiences. Validation support is 

especially relevant in the experience of cancer. In this study, participants remarked that cancer 

patients are often advised to “think positive” and “stay with good vibes,” as negative thoughts 

are believed to accelerate the progression of disease (Slakov & Leslie, 2003; Youll & Meekosha, 

2013). However, a reliance upon positive thinking is no more helpful than using avoidance 

strategies if people are ignoring or denying their suffering (Vianna et al., 2013). By validating 

participants’ feelings, both positive and negative, pets reinforced participants’ efforts to make 

meaning through acceptance and connection seeking.  



170 

 

 

When viewed in the context of literature on coping and social support, these meaning-

making strategies (disengagement/acceptance, distraction, and connection seeking) may not 

seem especially surprising or illuminating. What is of note is the lack of attention given to 

companion animals in research on psychosocial adjustment to cancer. Pets are seldom discussed 

(Costanzo et al., 2009; McCorkle et al., 2011) except for a brief mention in descriptions of 

pleasurable activities (Lockwood & O’Connor, 2017) or sources of social support (Molzahn et 

al., 2012). Moreover, the evidence base all but overlooks a significant form of psychological 

thriving that was demonstrated by most, if not all, of the participants in this study, namely, 

strengthened personal relationships (Carver, 1998). Participants’ relationships with pets and the 

deepening of these relationships through meaning-making is itself a form of thriving. Many 

participants felt closer to their pets following cancer while others experienced a temporary loss 

of intimacy only to be renewed again with the same or newly acquired pet. Over the span of their 

relationship with their pets, participants had dealt with various challenges from death and divorce 

to mental illness and substance use. Accordingly, cancer was not the only catalyst for instances 

of thriving.  

Another indicator of psychological thriving concerned participants’ knowledge of cancer. 

By researching information and interacting with health care professionals, participants displayed 

a wealth of knowledge about the types and outcomes of various cancer treatment options, in 

some cases, applying this same information to the care of their pets. For example, participants 

spoke about the importance of being physically active, avoiding certain medications or cleaning 

products, and choosing organic foods and supplements. A third example of thriving was 

participants’ orientation to life, and life beyond cancer. For participants, cancer was an ever-

present threat; it could still be there; it could always come back. The residue of cancer remained, 



171 

 

 

but with the touch of a cold wet nose, prickly tongues, and warm paws, participants were 

reminded that there were food bowls to be filled, litter boxes and fish bowls to be cleaned, and 

bellies to be scratched. As such, thriving did not manifest itself as a sustained or higher level of 

functioning (Carver, 1998). Thriving happened in the moments when participants were able to 

disconnect from cancer and re-connect with their pets (Halm, 2008). In the words of participants, 

pets helped them switch gears, navigate conflicting places, and control their thoughts. In this 

way, play and caretaking carried meaning well beyond distraction and stress-relief.  

5.3 Key Findings from the Eight Phenomenological Themes 

As noted in Chapter 3, themes are “creative shorthands” that enable us to look at cross-

cutting trends and patterns (van Manen, 1997). The eight phenomenological themes are intended 

to show the diversity and uniqueness of the participants’ experiences. In this section, I describe 

several key findings that bridge more than one of the eight themes. I give particular attention to 

findings that confirm, contradict, or extend results from the available literature.   

5.3.1 Kindred Play 

Through the medium of play, pets provided a wellspring of amusement. Some 

participants regarded their pets as being childlike in their fervor to explore their surroundings. 

Other participants viewed play as a counterbalance to the darkness and despair of their cancer 

experience. Importantly, pets were not simply the object of their amusement as participants were 

often engaged in play with their pets, hence the term kindred play. Pets were especially adept at 

eliciting playfulness in people and other animals. At times, it was the unabashed predictability of 

pets that turned a mild annoyance into a source of amusement, such as pets’ insistence on 

chasing the vacuum or fleeing at the sight of nail clippers. In other instances, the element of 

spontaneity appeared to heighten participants’ enjoyment of humorous play and unpredictable 



172 

 

 

play. Spontaneity helped to stem the tide of negative thoughts and fears running through their 

minds, allowing participants a momentary release in the form of laughter. Notably, research 

suggests that laughter promotes cardiovascular and immune health by increasing positive affect, 

reducing stress, and strengthening social bonds (Aron, Norman, Aron, McKenna, & Heyman, 

2000; Savage, Lujan, Thipparthi, & DiCarlo, 2017; Valeri, 2006).  

It is useful to clarify that play and playfulness are not one and the same. As noted in the 

work of Csikszentmihalyi, play is thought to involve “intense focus using skills to meet goals 

and losing a sense of time and self” whereas playfulness is seen as a personality trait or 

predilection for spontaneity and fun-seeking (Lockwood & O’Connor, 2017, p. 56). For 

example, professional sports and gambling involve play but not playfulness, as the primary focus 

is on competition rather than amusement (Lockwood & O’Connor, 2017; Sommerville, 

O’Connor, & Asher, 2017). Playfulness has a developmental component, reaching its peak 

among children and young animals and declining with age (Lockwood & O’Connor, 2017). 

Among people, playfulness is associated with greater use of adaptive coping strategies and less 

reliance upon avoidance strategies (Magnuson & Barnett, 2013). People who exhibit playfulness 

are more likely to view a stressful situation as a minor or temporary stressor (Drageset et al., 

2016; Lockwood & O’Connor, 2017; Magnuson & Barnett, 2013; Waldrop et al., 2011a; 

Wenninger et al., 2013).  

Although play seems so obvious to our sensibilities—we know it when we see it—there 

is a lack of consensus in the animal behaviour literature on how to define play (Byosiere, 

Espinosa, & Smuts, 2016). Some authors describe play as being intrinsically rewarding and 

involving behaviours that can be repeated in a flexible manner (Palagi et al., 2016; Sommerville 

et al., 2017). The seven types of play identified in this study can be classified as object play (i.e. 



173 

 

 

involving toys or objects) or social play (i.e. involving humans or animals) (Bradshaw, Pullen, & 

Rooney, 2015). Play also varied in frequency and intensity depending on the pet’s age, 

individual preferences, and breed-specific personality traits. For example, one participant 

remarked that her cat is a perfect match to the clownish traits that are characteristic of his breed 

while another said that his cat has the qualities (e.g. sharp reflexes) of a hunter. In the case of 

dogs, retrievers and collies were known to enjoy chasing toys or other dogs while terriers and 

pugs showed a preference for mutual game play, especially when their human caretakers were 

involved (Coren, 2008; Howse, Anderson, & Walsh, 2018). Interestingly, a preference for social 

play over object play, and play with people over conspecifics (i.e. animals of the same species) 

was also observed among some cats and fish.  

The results of observational studies suggest that cats are more inclined to play when they 

encounter prey-like (e.g. small, furry, moving rapidly, etc.) objects, and tend to engage in 

behaviours that are reminiscent of their predatory instincts to find, capture, and consume prey 

(Bradshaw et al., 2015; Hall, Bradshaw, & Robinson, 2002). In a similar vein, play seems to 

have been hardwired into the biology of dogs, with some authors suggesting that play was 

selected for during domestication to facilitate human-dog bonding (Bradshaw et al., 2015; Coren, 

2008; Sommerville et al., 2017). Findings from the present study challenge traditional views of 

play as being largely predatory-driven in cats, and socially-oriented in dogs (Bradshaw et al., 

2015; Howse et al., 2018). For example, cats not only engaged in instinctual play but also 

initiated rituals and games with their human caretakers. Moreover, dogs were not alone in being 

motivated by the social rewards of interacting with people (Bradshaw et al., 2015). Fish were 

also described as being playful and responsive towards people, thus, providing more than just 

ambient stimulation.  



174 

 

 

Whereas participants were generally more accepting of instinctual play in cats compared 

to dogs, the opposite seemed to be true in the case of rough-and-tumble play (abbreviated as RTP 

in this section). In human-animal or animal-animal RTP, one partner tries to gain an advantage 

over the other through roughhousing or play-fighting (Palagi et al., 2016). RTP relies upon 

improvisation, requiring partners to shift gears quickly and respond in a flexible manner (Eig, 

2017; Palagi et al., 2016). Given the competitive nature of RTP, verbal and nonverbal 

communication is important for negotiating play and curtailing aggression. In this study, 

participants used motherese when speaking to their pets, as well as, various play signals that 

were intended to mimic their pet’s gait, posture, facial expressions, or vocalizations (Eig, 2017; 

Palagi et al., 2016; Rooney, Bradshaw, & Robinson, 2001). Dogs, as evidenced by their tail 

wagging and barking, seemed to enjoy RTP with participants and other dogs (Howse et al., 2018) 

while few cats tolerated being teased or wrestled in this manner. Consistent with other 

investigations (Bradshaw et al., 2015; Eig, 2017), men were more likely than women to engage 

in RTP with both dogs and cats. One proposed reason for this gender difference is that RTP 

allows individuals to communicate their emotions indirectly, for example, teasing someone to 

express affection (StGeorge, Goodwin, & Fletcher, 2018).  

Play, and RTP in particular, requires skills in problem-solving and emotional regulation 

as individuals must be able to respond to novel and unexpected situations (Eig, 2017; Palagi et 

al., 2016; Sommerville et al., 2017). Implicated in stress and reward pathways, play activates 

hormones that help people and animals cope with stress (Sommerville et al., 2017). Research 

suggests that children who engage in RTP with their parents experience fewer social and 

emotional challenges later on in life (StGeorge et al., 2018). Therefore, RTP may be an 

indication of a strong and affectionate parent-child relationship, as well as, a means to develop 



175 

 

 

such a relationship. Human-animal RTP is also associated with enhanced bonding and affection 

(Eig, 2017). For instance, dogs show a reduction in stress hormones when playing wit h people 

(Bradshaw et al., 2015). In one experiment, dogs who were administered oxytocin tended to 

initiate play more frequently with other dogs, play for longer periods, and use more play signals 

compared to dogs in a control condition (Romero, Nagasawa, Mogi, Hasegawa, & Kikusui, 

2015). Aside from regulating stress, play fosters resilience by encouraging creativity and 

resourcefulness in both people and pets (Bradshaw et al., 2015).  

In the present study, play signals were not unique to pets as participants often adopted 

their pets’ vocalizations and body language to initiate or prolong play (Bradshaw et al., 2015; 

Sommerville et al., 2017). Accordingly, people and pets do in fact speak the same language 

when it comes to play. The use of play signals helped participants and pets negotiate when to 

engage in proximity and distance seeking. While it was easier for participants to interact with 

pets rather than people, play seemed to be one exception. Participants had recalled instances 

during cancer treatment when they were too exhausted to play. In another study, participants 

expressed concern about their cats having few opportunities for social interaction and physical 

activity (Strickler & Shull, 2014). Of the 277 people surveyed, 25 percent reported playing with 

their cat once a day for at least 5 min. Participants, who played with their cats regularly, reported 

fewer behavioural problems. Without assuming cause and effect (i.e. play reduces behavioural 

problems), play appears to be one such mechanism for building rewarding relationships between 

people and their pets.  

Although the frequency and duration of play was not measured in the present study, the 

general takeaway was that participants valued play in their relationship with their pets, as 

evidenced by their efforts to play even while being bed-ridden or suffering from pain and 



176 

 

 

exhaustion. For most participants, avoiding play was the exception rather than the norm. While 

other studies have emphasized the role of people in determining the length and frequency of play 

with pets (Palagi et al., 2016), this study is unique in highlighting the role of pets in establishing 

the rules and parameters for play (e.g. type, intensity, degree of physical contact). In reflecting 

upon the title of the theme, “It’s sort of silly, but,” it is critical that we attend to the word “but.” 

Play, in all its apparent silliness, is not a futile endeavour but rather a vibrant medium for 

exchanging positive affect and reinforcing social bonds between pets and people (Donoff & 

Bridgman, 2017).  

5.3.2 Mattering Presence 

Being in the presence of a pet was unlike any other interaction participants had 

experienced. There was a felt sense that something was different. Take an example involving 

sensory stimulation. If we blow on our fingertips, we feel a steady stream of air that can be warm 

or cool depending on our body temperature. The same stream of air now feels cold and tingly on 

our wrist, encircling the tiny hairs covering our skin. Physiological explanations would tell us 

that these sensations are due to the type of nerve endings and sensory receptors found on 

different parts of our body. For us, in our lived experience, something just feels different. For 

participants, having a pet was a daily reminder that their very being in the world mattered to 

someone. This mattering presence was apparent in their pets’ touch, proximity to participants, 

and their facial and bodily expressions. With pets, there was no obligation to speak, and yet 

words came rather easily, prompting participants to talk to their pets frequently and effusively. 

This running commentary helped to foster a sense of accompaniment, or as one participant put it, 

a feeling that pets were “metaphorically holding [their] hand” (Blazina, 2011; Winnicott, 1971). 



177 

 

 

Some of the more striking examples of this mattering presence tended to involve 

elements of movement and repetition. To illustrate, participants described feeling a sense of 

peacefulness while watching the rise and fall of their pets’ ribcage with each breath. The sight of 

water bubbling and rippling as fish swam around their bowls helped participants to feel relaxed, 

lulling them into a state of restful sleep. The purring of cats had a calming effect on participants 

with its rich vibrations pulsating through their chest and body. Daily walks allowed participants 

to focus on the sensation of walking and moving with their dogs. The experience of being 

absorbed in the repetitive sights and sounds of pets, shares an intriguing parallel with the 

therapeutic effects of arts-based practices. For instance, free-form colouring (i.e. colouring a 

blank page) requires people to structure their experience by making choices about what to draw. 

This type of colouring is less effective at reducing anxiety compared to colouring therapy which 

involves filling in ready-made geometric designs (Curry & Kasser, 2005). The use of 

symmetrical figures with repeating patterns is thought to disrupt negative thoughts and emotions, 

drawing people into an almost meditative state (Curry & Kasser, 2005; Vennet & Serice, 2012).  

For participants in this study, observing the repetitive movements of their pets induced a 

state of calm, perhaps, similar to that of colouring therapy. Repetition was also an inherent part 

of being a caretaker to a pet. The responsibilities of feeding, grooming, and exercising their pets 

provided participants with a sense of structure and direction (Brooks et al., 2013). Other 

instances of caretaking were motivated less by a sense of responsibility but by the mutual 

enjoyment of participants and pets. For example, participants relished the opportunity to cuddle 

with their pets, deriving comfort from its intimate and tactile nature. Some pets also enjoyed 

cuddling as evidenced by their efforts to initiate or prolong these encounters through proximity 

seeking, pawing, and making eye contact. In many instances, touch represented an important 



178 

 

 

means of exchanging positive affect between participants and pets. Considering that the human-

fish relationship is less amenable to touch, alternate strategies were necessary to facilitate 

communication. Participants and fish engaged in social mimicry by mirroring each other’s 

behaviour (Salazar Kämpf et al., 2018). Fish would look in the same direction, following the 

participant’s gaze and hand movements.  

Observed in both people and animals, social mimicry occurs spontaneously and 

unconsciously, and is thought to satisfy a basic need to affiliate and belong (Howse et al., 2018; 

Salazar Kämpf et al., 2018). In this study, cats and dogs not only imitated participants but also 

adjusted their activity level (e.g. slowing down or moving faster) or body language to match their 

human caretakers. Pets seemed to recognize when participants were feeling ill and would lean in, 

gently resting their body against the participants or curling up beside them. Moreover, when 

participants were smiling or talking in an animated tone of voice (i.e. motherese), pets would 

reciprocate or even amplify these affective cues through specific vocalizations such as barking, 

purring, or growling. Participants and dogs also communicated using referential gestures (e.g. 

pointing) which are used by an individual to draw another’s attention to a particular object or 

event (Worsley & O’Hara, 2018). Researchers have identified 19 referential gestures that dogs 

tend to use when interacting with their human caretakers (Worsley & O’Hara, 2018).  

Taken together, the use of social mimicry, gestures, and vocalizations highlights the 

essence of being in an attuned relationship such as that described by participants in the theme, 

It’s like each living thing has meaning. An attuned relationship is one in which relationship 

partners are able to recognize and respond to each other’s feelings (Blazina, 2011; Lasher, 1998). 

The sense of accompaniment that participants felt in the presence of their pets was a testament to 

the capacity of pets to be able to tune-in and understand the experiences of people. Through 



179 

 

 

repeated observation, pets and participants came to learn the meaning of subtle gestures and 

nuanced vocalizations (Worsley & O’Hara, 2018). Participants repeatedly emphasized instances 

during which pets seemed to know that something was wrong and adjusted their behaviour to 

reflect this knowing (Brooks et al., 2013). For example, pets avoided stepping on certain areas of 

their body or greeted participants by gently nuzzling against them rather than jumping or 

pouncing on them. Likewise, participants seemed to know when something was wrong with their 

pets, and to paraphrase one individual, part of them felt wounded as well.   

Compared to communication in the animal kingdom, interpersonal communication 

permits numerous combinations of words and symbols. Yet, people manage to converse with 

non-human animals whose communication patterns do not seem to share these generative and 

recursive features. For example, referential gestures are relatively rare among non-human 

animals, especially during inter-species communication (Worsley & O’Hara, 2018). The ability 

of dogs to use these gestures in their interactions with people, attests to the level of engagement 

that is required to accurately interpret and respond to another species’ nonverbal gestures 

(Worsley & O’Hara, 2018). If we were to prize interpersonal communication for its verbal 

intricacies, we would miss the truly boundless form of communication that characterizes the 

human-pet relationship. In the present study, pets often relied upon sensory (e.g. sounds, smells) 

cues to know when to approach participants, how close they could be, and when to disengage 

from them. Importantly, some pets were not receptive to being touched or picked up by people. 

Similar to examples concerning play, pets demonstrated agency in helping to shape the rules 

about human-pet intimacy. 

Also relevant in the discussion of agency is the role of silence in cultivating a mattering 

presence. Pets allowed for silence without the boredom and loneliness that looms over an empty 



180 

 

 

home or hospital room. This silence did not mean the absence of communication but rather the 

suspension of social pressures (e.g. judgment) that can accompany interpersonal relationships 

(Brooks et al., 2013). Moreover, this silence was intentional and communicative as opposed to an 

expression of awkwardness or hostility (Bartels et al., 2016; Knutson & Kristiansen, 2015). In 

interpersonal communication, silence can be met with confusion or disaffection on the part of the 

recipient (Knutson & Kristiansen, 2015). Alternatively, silence can engender closeness between 

communication partners such that a shared connection is felt but remains unspoken (Bartels et 

al., 2016; Knutson & Kristiansen, 2015). This “shared silence” has been described as a “gateway 

for healing” as communication partners can exercise agency in determining whether to speak or 

not (Knutson & Kristiansen, 2015, p. 1).  

In the cancer context, by choosing to remain silent, a person can retain a sense of 

autonomy in situations over which he/she feels little control (Bartels et al., 2016). Silence has 

also been found to be an effective tool for facilitating communication between patients and 

physicians. For example, oncologists use silence to demonstrate attentiveness and develop 

rapport with their patients (Bartels et al., 2016). The present study is unique in highlighting the 

communicative importance of silence for the human-pet relationship. With pets, participants felt 

relieved of any obligation to speak, prompting them to reflect upon these experiences and 

redefine their meaning (Knutson & Kristiansen, 2015). Such encounters provided an opportunity 

for participants to exercise agency and control, as well as, honor their pets’ agency in creating a 

mattering presence. 

5.3.3 Impetus to Hope 

The familiar excerpt, “Hope springs eternal,” from a poem by Alexander Pope, hardly 

seems to capture the lived experience of participants in this study (Pope, n.d.). As with meaning-



181 

 

 

making, hope did not materialize out of thin air. Hope was not some inexhaustible resource, 

limitless in its abundance (Folkman, 2010). Instead, hope represented the participants’ continual 

striving towards healing and recovery. To illustrate, one participant referred to her dog as the 

motivation for “reaching for a better space in [her] health.” Another described her cats as being 

the reason she has fought so hard, and continues to fight back against cancer. While hope 

appeared to have an element of choice, loss was deemed inevitable in the case of both people and 

pets. The pragmatic approach (e.g. funeral planning) taken by some participants, in anticipation 

of their own demise, seemed untenable when they spoke about their pets dying. The loss of a pet 

was inevitable, and yet inconceivable, even among participants who had lost a pet previously.  

Some pets experienced a forced separation as they were relinquished to the care of 

another person while other pets departed from their human caretakers in death. In the latter case, 

losing a pet did not happen all at once. The effects of illness and aging slowly eroded the vitality 

of pets, bringing new caretaking responsibilities and ways of relating to pets. Some pets 

seemingly “hung on” for participants, seeing them through cancer treatment or awaiting their 

return from the hospital. Similarly, participants described not wanting to let go of their pets. To 

illustrate, the example concerning euthanasia offers a poignant description of the complex nature 

of loss when an animal’s life is in our hands. Euthanasia is defined as “a humane method of 

terminating the life of an animal who is dearly loved, but has little or no hope for recovery” 

(Lagoni, 2011, p. 181). It is no coincidence that the noun hope comes up in this definition of 

euthanasia. Hope is also a verb that refers to something we do quite naturally when confronted 

with loss or some other threat to our well-being (Butt, 2011; Folkman, 2010; Herth, 2000). In 

turn, the experience of loss can erode our sense of hope, resulting in hopelessness and despair 

(O’Shaughnessy, Laws, & Esterman, 2015).  



182 

 

 

Formal theories of hope point to an individual’s capacity to find a path towards particular 

goals, as well as, his/her agency in achieving those goals (Snyder, 2002). For example, Snyder, 

Irving, and Anderson (as cited in Snyder, 2002) define hope as “a positive motivational state that 

is based on an interactively derived sense of successful (a) agency (goal-directed energy), and (b) 

pathways (planning to meet goals)” (p. 250). Consistent with phenomenology (van Manen, 

2014), scholarly definitions and theories can be brought into a discussion to show where they 

might be lacking in experiential meaning. Rather than attempting to substantiate a particular 

theory, I regard the participants’ accounts as providing valuable insights into the experiential 

meaning of hope and how it shows up in lived experience. Snyder’s (2002) description of hope 

as a “rainbow of the mind” may in fact come closer to the meanings I gleaned from the 

participants’ experiences (p. 269). For Snyder, the rainbow symbolizes hope. It shows the 

“spectrum of human strength” and “makes us think of what is possible.” Likewise, hope 

manifested in the participants’ ongoing efforts to heal and recover from cancer. 

As a psychological construct, hope can be thought of as a stable trait, as well as, a 

characteristic that becomes relevant in the context of specific goals (Folkman, 2010; Scioli, 

Scioli-Salter, Sykes, Anderson, & Fedele, 2016; Snyder, 1994). The recognition that hope has 

positive and negative aspects is central to theories of health promotion (Scioli et al., 2016). Hope 

has been linked to a lower risk of morbidity and greater use of adaptive coping strategies (Butt, 

2011; Folkman, 2010; Herth, 2000; Snyder, 1994). According to one theory, hope is constituted 

by four underlying motive systems: attachment, mastery, survival, and spiritualty (Scioli et al., 

2016). People then draw upon various resources to fulfill their need for attachment (e.g. trust in 

family and friends), mastery (e.g. understanding of one’s priorities), survival (e.g. ability to 

regulate one’s emotions), and spiritualty (e.g. connection with God or a higher power). In one 



183 

 

 

study, researchers examined the role of hope in restoring health among 20 breast cancer 

survivors (Scioli et al., 2016). The participants tended to rely upon attachment and spiritual 

resources, especially among those who were at a later stage of disease. Other reports suggest that 

hope is context-dependent such that different needs become relevant depending on the stage or 

severity of a person’s illness (Herth, 2000; Pattison & Lee, 2011).  

In line with Scioli’s findings regarding the importance of attachment resources, 

researchers in a similar investigation cited spousal or family support as being a “catalyst” for 

restoring hope (O’Shaughnessy et al., 2015). In this qualitative study, men (n=21) with prostate 

cancer and their female partners (n=9) were interviewed about their experiences during cancer as 

they pertained to the themes of love, hope, and faith. The results of focus groups and couple 

interviews suggest that from the time of diagnosis, participants must continually re-examine the 

meaning of hope with each new challenge that they encounter during their cancer journey. These 

findings support those of the present study regarding the fluid and dynamic nature of hope, and 

the importance of relationships for sustaining hope (Butt, 2011; O’Shaughnessy et al., 2015). 

When hope reached a low point, participants in the prostate cancer study reported feeling 

isolated and misunderstood (O’Shaughnessy et al., 2015). Despite the potential for pets to 

alleviate stress and loneliness, there was no explicit mention of pets in the either the prostate 

cancer or breast cancer study described above—a finding that reflects a general neglect of pets in 

the cancer care context, with the possible exception of therapy animals. 

Another theory of hope posits the existence of a reciprocal and interdependent 

relationship according to which, coping promotes hope and hope promotes coping (Folkman, 

2010). In this view, hope is regarded as an essential factor that enables people to manage 

significant and persistent forms of stress such as chronic illness (Folkman, 2010; Herth, 2000; 



184 

 

 

Snyder, 1994). The experience of illness profoundly disrupts the everyday tasks that bring 

structure and coherence to a person’s life (Folkman, 2010; Herth, 2000; Sidenius, Stigsdotter, 

Poulsen, & Bondas, 2017). For participants in the present study, the topic of hope came up 

explicitly during discussions about loss, mortality, and declining health with respect to their own 

and their pets’ health. Similar to using emotion-focused coping, participants sought relief from 

negative emotions by concentrating on the reasons they had to be hopeful (Folkman, 2010). They 

tried to focus on positive test results and reports of their cancer being in remission or slowed in 

its progression. For instance, a participant with an inoperable tumor described his treatment as a 

“long shot” but quickly added “the cancer has stopped growing so that’s a good thing.” In the 

case of pets, participants reminded themselves that their pets still had years of good health ahead 

of them.  

In addition to supporting participants’ efforts to engage in emotion-focused coping, hope 

also provided an occasion for participants to draw upon meaning-focused coping. Through 

careful consideration of their own and their pets’ well-being, participants sought to redefine their 

priorities in life (Folkman et al., 1986; Herth, 2000). The desire to be a good guardian to their 

pets impacted participants’ choices about diet, exercise, and substance use. Participants described 

dog walking, for example, as a “feeling of pride” and a “part of the recovery.” In many cases, 

participants viewed pets an extension or reflection of their own health. As in the case of hope, 

caretaking had a restorative function, allowing participants to act in ways that were consistent 

with their values and beliefs. To illustrate, some participants spoke about having a lifelong 

affinity towards animals which led them to adopt pets themselves or become involved in animal 

rescue (Mosteller, 2008). Aside from their sense of duty towards animals, the mutual 



185 

 

 

engagement of participants and pets in various consumption experiences (e.g. sleeping, eating) 

helped to guard against the stresses of daily life (Scioli et al., 2016).  

The intimate contexts (e.g. family home, bedroom) in which consumption experiences 

took place, revealed not only the intensity of the human-pet relationship but also its moral 

implications. To repeat a quote from Chapter 1: pets “keep their silence, yet they bear witness” to 

a person’s life (Gavriele-Gold, 2011, p.105). Perhaps it is not entirely accurate to characterize 

pets as being silent observers in relation to people. As discussed in the section, Mattering 

Presence, pets are far from silent given their vast repertoire of gestures and vocalizations, along 

with their facility in using these communication tools. Nevertheless, pets are silent in the sense 

that they can’t speak for themselves, and as such, their silence carries a moral imperative fo r 

those who are entrusted to care for them (Knutson & Kristiansen, 2015; Mosteller, 2008). This 

moral imperative was evident in the language participants used to describe their caretaking 

responsibilities (e.g. “they are bred as pets, so we are responsible,” “he didn’t ask to come into 

our family”). 

Furthermore, caretaking was imbued with a perpetual sense of wonderment, or as one 

participant remarked, “that constant mystery of how [pets] think.” Participants came to learn 

what their pets needed through trial-and-error, practice, and repetition. Similar to the examples of 

play and intimacy, pets also influenced rules about when they should be fed, walked, groomed, 

or cuddled. Just as pets couldn’t provide verbal reassurance that their needs were being met, 

participants couldn’t tell pets that they were trying to “rebuild” their health following cancer. 

They had to show their pets. For participants, cancer had taken much from them in the way of 

past (e.g. memories) and future experiences (e.g. the ability to conceive a child), and still cancer 



186 

 

 

did not deplete them of hope (O’Shaughnessy et al., 2015). In many cases, pets served as the 

impetus to hope, helping to restore hope as participants strived to heal and recover.  

5.3.4 Animal-Human Divide 

The subject of this study is the human-companion animal relationship, but what separates 

pets from people, literally and figuratively? The bond between pets and participants seemed to 

imply a certain amount of distance and separation. Pets sought refuge from loud noises or angry 

outbursts from people; participants retreated to their bedroom to convalesce after a round of 

chemo or radiation. While pets were generally welcome in these spaces, there were occasions 

when participants wished to be left alone. Likewise, pets’ desire to be in close proximity with 

people, appeared to wax and wane with the vicissitudes in participants’ emotions and energy 

level (Kerepesi, Dóka, & Miklósi, 2015; Mosteller, 2008). The interchange of proximity and 

distance seeking was also evident in how pets responded to changes in participants’ body odour 

during cancer treatment. One participant recalled how her dog became preoccupied with sniffing 

her infected toe. Another described how the chemo-smell on her skin acted as a deterrent to her 

ordinarily affectionate cat. As her cat declined to lick her hands, she remembered feeling “wrong 

and dirty.”  

The above findings raise some intriguing questions about the olfactory capabilities of cats 

and dogs. Despite a growing number of studies concerning the potential for dogs to aid in cancer 

detection (Marcus, 2012a; Wells, 2012), little is known about olfaction among cats, and even less 

is known about how chemical signals (e.g. pheromones) play a role in human-pet bonding 

(Vitale Shreve & Udell, 2017). Some preliminary research suggests that eye contact and gazing 

behaviour stimulates the release of oxytocin in both people and dogs (Nagasawa et al., 2015). 

Similar to behaviours such as social mimicry, body odours along with their associated hormones 



187 

 

 

have social and communicative functions (Bradshaw et al., 2015; Vitale Shreve & Udell, 2017), 

and these have yet to be explored for their capacity to strengthen or, perhaps, weaken the human-

pet bond.   

Yet, another consequence of cancer treatment was its impact on participants’ ability to 

fulfil their caretaking responsibilities towards pets. For participants, caring for a pet helped to 

reinforce positive identities as pet guardians and caretakers (e.g. walking a dog is a “badge of 

honour”) (Brooks et al., 2013; Wisdom et al., 2009). In one study, researchers examined 

participants’ (n=300) adjustment to illness using the concepts of social support and the “work” of 

managing a long-term condition (Brooks et al., 2013). Participants were randomly selected from 

diabetes and heart disease registers. Of those surveyed, 56 reported having a pet currently. 

According to the results, pets assisted participants with practical work by motivating them to 

exercise and eat regularly (Brooks et al., 2013; Siegel, 2011). Pets also contributed to emotional 

work and biographical work by offering comfort and providing a sense of continuity, 

respectively. Having a pet enabled participants to derive a sense of purpose without the negative 

aspects (e.g. fear of being a burden to others) that can accompany interpersonal relationships 

(Brooks et al., 2013).  

The conclusions reached by Brooks et al. regarding pet owner identities are consistent 

with the results of a concept analysis of North American print media between 1999 and 2008 

(Zimolag, 2011). Newspapers and bestselling books often depicted pet ownership as an everyday 

occupation in which people felt engaged and invested. Caretaking responsibilities were carried 

out in both solitary (e.g. feeding their pet at home) and shared contexts (e.g. taking their pet for 

grooming). Together, these two conceptualizations—Zimolag’s notion of pet ownership as an 

everyday occupation and Brooks et al.’s discussion of pets in relation to managing a long-term 



188 

 

 

condition—provide a useful way to think about people’s social and professional occupations, and 

how these are impacted by critical life events such as cancer. In the current study, caretaking 

responsibilities were little comfort to participants when they had to tend to an ailing pet or deal 

with their own health challenges. Some pets required treatments or procedures that stirred up 

painful memories of participants’ experiences during cancer treatment. In addition, participants 

expressed regret about not being a better parent or guardian to their pets with one remarking “I 

couldn’t even do it for myself.”  

Researchers in another study found that there were few pet-related concerns in a sample 

of 309 cancer patients (Larson et al., 2010). As in the 2010 survey, most participants in the 

present study reported being able to call upon friends or family for help with pet care. Although 

participants were grateful for their loved ones’ support, this kind of help did not ease the sense of 

duty that participants felt towards their pets. Other caretakers simply did not possess that “level 

of relationship” or “one-on-one love.” Just as a therapy dog was not the “same as having [their] 

own dog,” another caretaker was no substitute for the love and concern they had for their pets. 

Participants described having an uncanny awareness of their pets’ needs. As well, the time they 

had spent with their pets during cancer treatment only seemed to deepen this one-on-one love.  

This last point regarding being on-leave from professional work is significant, 

considering that career issues have been identified as an important indicator of quality of life 

following cancer treatment (Raque-Bogdan et al., 2015; Tighe et al., 2011). For some people, 

their work identity is central to their self-concept (Raque-Bogdan et al., 2015). Work itself offers 

a distraction, and provides opportunities for people to network and socialize with others. In a 

qualitative study, breast cancer patients (n=13) reported experiencing a loss of control over their 

career success, work choices, and financial security (Raque-Bogdan et al., 2015). Some 



189 

 

 

participants indicated that their cancer experience had strengthened their desire to find meaning 

and purpose in their work. In the current study, half of the participants were retired, and five 

were on-leave from work. Accordingly, having a pet may bring about a sense of routine and 

normalcy in the absence of professional work.  

The examples outlined above reflect normal and expected processes of proximity and 

distance seeking between participants and their pets. In contrast, some instances of human-pet 

separation were the result of unforeseen circumstances (e.g. allergies, illness, needs of current 

pets) that led to a complete and often permanent separation. Participants described needing to re-

home their pet with another family or having to return their pet to a shelter. Although some 

participants identified behavioural problems (e.g. unwanted chewing, inappropriate elimination) 

as a significant challenge in bonding with their pets, none reported relinquishing their pet for 

these reasons (Vitale Shreve & Udell, 2017). Despite the loss of income among participants who 

were on-leave from work or had taken early retirement, personal finances were not cited as the 

primary reason for giving up a pet (Sharkin & Ruff, 2011). Regardless of the reason, the decision 

to relinquish a pet can undermine the well-being of both pets and people (DeGue, 2011; Sharkin 

& Ruff, 2011). Highlighted in the example regarding the dog who ended up on Craigslist, pets 

are at risk for abuse, neglect, or being euthanized in the event that they cannot be adopted. As 

with participants in this study, guilt and remorse are common reactions, and can lead to further 

distress among people if a pet’s fate remains uncertain (Sharkin & Ruff, 2011).  

The foregoing discussion offers a literal interpretation of what I referred to as the animal-

human divide, or more specifically, the circumstances that undermine the establishment of a 

bond or threaten to break existing bonds. The animal-human divide also speaks to what 

differentiates pets from people. To echo a participant, “pets never come out and say I love you,” 



190 

 

 

and by the same token they never come out and say hurtful or unhelpful things (Gavriele-Gold, 

2011). For some participants, questionable bedside manners figured prominently in their 

interactions with health care providers. These providers were described as being blunt, 

prejudiced, negative, and unwilling to accept responsibility for their actions. In the case of 

friends and family, repeated queries about how participants were feeling or reminders to “think 

positive” became a source of frustration. As people rallied around participants or avoided them 

altogether, one “constant” that remained for many participants was their relationship with their 

pets. This is not to say that pets were always helpful and people were always unhelpful. Most 

participants emphasized the value of having support from friends and family members. Even 

still, these informal supports were not without their complications.   

The results of the study described above by Brooks et al. (2013) shed light on some key 

differences between the human-pet relationship and interpersonal relationships. Although friends 

and family members were regarded as being supportive, at times, their actions could be seen as 

“nagging” and unhelpful. In contrast, participants often described their pets using terms such as 

soothing and calming. Another difference concerned the role of reciprocity (i.e. responding in a 

similar manner to an offer of help or kindness) in participants’ relationships. The experience of 

being ill and having to rely upon people for help, tipped the scales of reciprocity, leading some 

participants to see themselves as a “burden” to others. In contrast, reciprocity remained intact in 

their relationships with pets. Pets gave their love and companionship, and participants could 

reciprocate by feeding, grooming, and exercising their pets (Brooks et al., 2013; Wisdom et al., 

2009). Similar to findings from the present study, participants in Brook et al.’s study were able to 

reclaim a sense of independence and autonomy through their role as a caretaker to their pets.  



191 

 

 

Consistent with a post-humanist approach (E. Power, 2008), rather than emphasizing 

perceived deficiencies in the human-pet relationship, Brooks et al. (2013) highlighted aspects of 

interpersonal relationships that were problematic, and had contributed to interpersonal 

difficulties. Importantly, despite participants’ tendency to use anthropomorphic descriptions (e.g. 

my pet is my baby), they did not consider their pets to be the same or a substitute for a human 

relationship (Brooks et al., 2013). Such findings confirm those of the present study concerning 

participants’ attempts to reconcile what made pets similar to people and what made them “living 

beings” who were unlike anyone else. Participants were careful to avoid humanizing pets, 

recognizing pets as having their own “dignity and space” in the world. Furthermore, this 

discussion of the animal-human divide makes clear that this seemingly inextricable bond can be 

broken or disturbed by both ordinary and extraordinary circumstances (Sharkin & Ruff, 2011).  

5.3.5 Transcendent Relationships 

As noted in the section, Mattering Presence, the experience of being in-tune with 

another’s feelings and experiences (i.e. attunement) is the foundation upon which the human-pet 

relationship develops and evolves. Findings from the current study suggest that attunement not 

only operates at the level of the individual participant and his/her pet but also transcends this 

relationship, allowing participants to experience meaning and connection in their interactions 

with nature and the people around them (A. J. Lopez et al., 2009; Pargament & Mahoney, 2002; 

Senreich, 2013). Accordingly, the human-pet relationship can be thought of as a transcendent 

relationship or a form of spiritual kinship (Girardin, 2000; Meezenbroek et al., 2010). 

Participants in this study described their pets as embodying particular ways of being in the world 

that compelled them to show greater care and compassion towards others and themselves; these 



192 

 

 

ways of being served as guideposts, helping to foster participants’ spiritual development (Faver, 

2009).   

Many participants described the importance of getting outside with their pets and 

enjoying the natural elements of the sun, rain, trees, water, and sand. Nature seemed to have a 

rejuvenating effect on pets and people, often creating an occasion for transcendent play. As noted 

in ethological studies (Howse et al., 2018; Salazar Kämpf et al., 2018), pets seemed to come 

alive, revelling in the feeling of being untethered by the dreaded leash or free to venture beyond 

the confines of their backyard. Likewise, participants readily immersed themselves in nature, 

their sensory capacities heightened and engaged. Recent studies suggest that engagement with 

nature offers psychological and physical benefits such as reduced stress, depression, and anxiety 

(Oh et al., 2017). Eco-therapy is an umbrella term for activities that encourage “sensory contact” 

with the natural world (Kamitsis & Simmonds, 2017; Phelps, Butler, Cousins, & Hughes, 2015). 

Nature encompasses both human-made (e.g. parks, gardens, trails, campgrounds, etc.) and 

naturally occurring landscapes, as well as, weather patterns, vegetation, wildlife, and 

domesticated animals (Blaschke, 2017; Kamitsis & Simmonds, 2017; Merrick, 2009).  

In a systematic review and qualitative meta-synthesis of research on the experiences of 

people with cancer, researchers identified three ways that participants engaged with nature: 

indirect (e.g. viewing natural landscapes), incidental (e.g. going for a walk), and intentional (e.g. 

participating in outdoor adventures) (Blaschke, 2017). Participants tended to view nature as an 

“unburdened and uninterrupted space” (p. 10). Among the benefits derived from engaging with 

nature were aesthetic enrichment, increased physical activity, distraction from cancer, greater 

reflection upon life changes, and alleviation of stress. Such benefits mirror those discussed by 

participants in the present study regarding the experience of interacting with a pet. Pets were not 



193 

 

 

only appreciated for their aesthetic appeal but also their capacity to help participants shift their 

attention to the present moment (Kamitsis & Simmonds, 2017). Through their physical presence 

and tactile comfort, pets reminded participants of their relationship with the natural world.  

The health benefits of nature, long recognized in non-Western countries, have been 

applied more recently to models of disease prevention and health promotion (Oh et al., 2017). In 

one study, researchers conducted semi-structured interviews with participants (n=14) who had 

been diagnosed with a stress-related illness, and were currently participating in a 10 week nature-

based therapy (NBT) program (Sidenius et al., 2017). The NBT program took place in an 

outdoor garden and involved a combination of gardening, mindfulness, and self-awareness 

exercises. Participants described this outdoor space as being safe, familiar, and relaxing. The 

freedom with which participants could explore and experiment in the garden helped them to 

develop coping strategies that were aligned with their current needs and abilities. The researchers 

speculated that because NBT is experienced through cognitive and bodily engagement, the 

strategies that participants had developed in this setting were more likely to be activated in 

another setting. Similar to the experience of being with a pet, nature-based activities are 

grounded in memories and physical sensations that become embodied through repeated 

engagement (Sidenius et al., 2017).  

In the present study, participants’ engagement with nature was not limited to being in the 

outdoors. To illustrate, one participant described filling her fish bowls with live plants to 

encourage her fish to swim and play. As well, cats had artificial trees that allowed them to jump 

and climb. The findings from a previous study point to the value of bringing the natural world 

indoors, as an accessible and cost-effective intervention (Phelps et al., 2015). In this 2015 study, 

participants (n=7) with breast cancer were asked to create and maintain a small indoor garden for 



194 

 

 

a period of three months. The results of focus groups showed an increase in participants’ mood, 

confidence, and self-esteem following the intervention. Similar to the experience of caring for a 

pet, tending to a garden gave participants a feeling of pride and responsibility.  

 In spite of the parallels between nature-based activities and pet care responsibilities, few 

studies have examined how pets influence people’s engagement with nature. Pets are often 

subsumed under the broad heading of nature, along with plants, rocks, and trees (Blaschke, 

2017). These natural elements, despite being amenable to manipulation by humans and animals, 

are far less intuitive and responsive compared to pets. In the present study, participants were not 

alone in their enjoyment of nature. Pets took great delight in digging holes, hunting wildlife, 

barking at waves on the beach, and even engaging in untold adventures, or as one participant 

remarked “whatever cats do outside.” In addition, findings from this study suggest that pets also 

helped to enrich these natural spaces. To illustrate, one participant described how being 

accompanied by a dog can make walking in the forest “so much more profound” as the dog 

brings “a whole different set of eyes” to the experience. According to Merrick (2009), spending 

time in nature with pets deepens our spiritual kinship with them. Merrick explains that people 

experience an “environmental epiphany” when their relationship with nature shifts in a 

meaningful way.  

In the present study, such environmental epiphanies were evident in participants’ 

descriptions of the complexities and inconsistencies regarding their relationships with pets. For 

instance, participants described their reluctance to consume meat. In addition, participants talked 

about how some pets are abused by people, and others help to “elevate” people as human beings. 

With the exception of a participant who referred to cats as being “autistic,” participants felt that 

their cats were especially loving and attentive. Participants in multi-pet households appreciated 



195 

 

 

their pets’ affection towards their pet siblings and even unfamiliar animals. One notable 

exception is the Betta fish. As a participant explained, these fish can’t live together because they 

fight. In the film Rumble Fish, the main character Rusty James asks why the Betta fish are kept 

in separate tanks to which his brother, the Motorcycle Boy, responds: “They belong in the river. I 

don’t think that they would fight if they were in the river, if they had the room to live” (Coppola, 

1983). Similarly, it was clear from the participants’ accounts that the spaces, both natural and 

human-made, in which they endured the effects of cancer and its treatment, had a profound 

impact on their capacity to heal and recover. Through their physical presence, pets helped to 

transform these indoor and outdoor settings into spaces of healing (Faver, 2009; Halm, 2008).  

Along with enriching the human-nature relationship, the experience of being in-tune with 

a pet seemed to spill over into participants’ interactions with other people. Pets acted as a 

“conduit” for communication between family members and friends (Walsh, 2009b), helping to 

ease the tension surrounding discussions of cancer (Tannen, 2004). For many participants, cancer 

had left them feeling vulnerable and exposed. Pets then became an extension of their body, 

shifting the focus away from participants, bringing levity into their interactions with others, and 

providing comfort when interacting with strangers (Brooks et al., 2013). Pets helped to 

ameliorate loneliness by providing an opportunity for participants to meet new people or develop 

more lasting social connections (Brooks et al., 2013). One participant described connecting with 

a stranger over their mutual love for cats. Two others recalled how their dogs alerted neighbours 

or passersby that they were in distress.  

The results of a multinational survey also lend support to the notion of pets as a conduit 

or “social bridge” between people (Wood et al., 2015). For participants in this study, having a 

dog increased the likelihood of participants receiving support from friends and neighbours whom 



196 

 

 

they had met because of their dog. Even in the case of cats, participants reported receiving offers 

of pet care when they were ill or away on holiday (Wood et al., 2015). One participant addressed 

the social facilitation effect of pets while also describing pets as a “bridge” between being a 

patient and being a “person again.” This participant remarked that having her dog Hazel 

accompany her on daily walks helped to lift the shame of “not feeling okay in [her] body.” Just 

by being themselves, Hazel and other pets created a space in which they could coexist 

meaningfully with their human caretakers and help them “escape” from the stresses of cancer 

and everyday life. From the reassuring jingle of their pets’ collar or the pitter-patter of their paws 

racing towards them, participants knew that they were not “suffering alone.” 

Aside from being a conduit for social interaction, pets’ role as a bridge also appeared to 

provide a touchstone to participants’ sense of being a person, and being a person outside of 

cancer. These two aspects are related to the concepts of loneliness and authenticity. Loneliness 

results when there is a mismatch between an individual’s actual and expected social connections 

(Bryan, Baker, & Tou, 2017). According to humanistic theories, well-being is enhanced when 

people are more aware of and accepting of their experience, in other words, more authentic in 

their relationships (Pisarik & Larson, 2011). Empirical research suggests that authenticity can 

buffer individuals from the effects of loneliness by helping them to be in the moment rather than 

fixating upon negative thoughts and feelings which can lead to anxiety and depression (Bryan et 

al., 2017). Also discussed by participants in the present study, people with cancer are at risk for 

loneliness and isolation, particularly, when they are further along in their cancer journey (van der 

Spek et al., 2013; Yalom & Josselson, 2011). Accordingly, not only do pets ameliorate loneliness 

by providing companionship, but have the potential to ease this burden by encouraging 

authenticity. 



197 

 

 

5.4 Implications 

5.4.1 Play and Social Connection 

The scientific study of play has evolved from early theories concerning the evolutionary 

benefits (e.g. working in groups) of play for human culture and development. Humanistic 

theorists increasingly regard play as an important means for facilitating self-expression, 

authenticity, and meaning-making (Bryan et al., 2017; Lockwood & O’Connor, 2017). Play also 

benefits pets by reducing stress and promoting motor skills (Palagi et al., 2016; Sommerville et 

al., 2017). Much of the research on play and playfulness among adult humans has been 

conducted in the field of leisure studies (Lockwood & O’Connor, 2017). Given the importance of 

play for reducing stress and strengthening social bonds, play should be encouraged in everyday 

life and, particularly, in the cancer context (Lockwood & O’Connor, 2017). To restate Carver’s 

(1998) framework, if we acknowledge people’s efforts to play and reframe play as a health 

intervention, people are more likely to benefit from play.  

In the cancer context, health care professionals could suggest simple exercises that 

patients can do with their pets to promote play (Marcus, 2012b). Hospitals and cancer clinics 

could allow pets to visit their human caretakers in the cancer ward. Pet visits could be beneficial 

for other patients, as well as, health care workers in terms of enhancing morale and improving 

patient-provider relationships (Lockwood & O’Connor, 2017). For people who are returning to 

work following cancer treatment, employers could allow and even encourage their employees to 

bring their pets to work or make accommodations for them to work from home. Such practices 

could go a long way to supporting the human-pet bond and easing a person’s transition back to 

regular routines.   



198 

 

 

Current efforts to promote the human-animal bond prioritize animal-assisted 

interventions (AAIs) in their models of care (Marcus, 2012a, 2012b). With varying effectiveness, 

cats, dogs, rabbits, horses, and even dolphins have been incorporated into therapeutic programs 

for people with cancer, depression, trauma, autism, and AIDS (Burgon, 2003; Keaveney, 2008; 

Williamson, 2008). AAI has been endorsed by the National Institutes of Health (NIH) as an 

important contributor to the health and well-being of people (Vitztum, 2013). During therapy 

animal visits, patients can expect to sit calmly and pet an animal who is trained to provide 

comfort and stress relief (Horowitz, 2008; Johnson et al., 2008; Wells, 2009b). Handlers who are 

often the animal’s primary caretaker could, perhaps, introduce an intervention to encourage 

gentle play between the therapy animal and the patient. Certification programs require therapy 

dogs to be able to stay calm and avoid barking in novel situations (Walsh, 2009b). Playfulness 

could also be an important quality for matching therapy animals with patients who are able to 

engage in more vigorous forms of physical activity including walking, playing a game of fetch, 

or engaging in rough-and-tumble play.  

It should be noted that people who report having a pet of their own may not be ideal 

candidates for animal-assisted interventions. As noted by participants in the present study, 

offering these kinds of interventions may stir up negative thoughts and feelings about being away 

from their pets during cancer treatment. Moreover, research suggests that dogs show a preference 

(i.e. tail wagging) for playing with a familiar person over a stranger. Therapy animals, although 

adept at providing support, may not be equally suitable for providing connection, meaning the 

kind of intimate and enduring relationship that can develop when people and pets share their 

lives together. As noted in the literature on coping behaviour, connection seeking is important for 



199 

 

 

meaning-making. Accordingly, the findings of the present study extend previous research by 

emphasizing the value of play for promoting health and well-being in both pets and people. 

5.4.2 Enrichment and Engagement  

As discussed in the section on transcendent relationships, natural and human-made spaces 

can have a profound impact on a person’s ability to heal and recover from illness. Likewise, 

research suggests that environments in which pets are encouraged to be active and engaged, are 

effective at promoting rewarding relationships between pets and people (Sommerville et al., 

2017; Strickler & Shull, 2014). The practice of modifying a pet’s environment for the sake of 

stimulating play and exercise is referred to as enrichment (Strickler & Shull, 2014). Enriched 

environments contain interactive features that prompt pets to explore their surroundings. With 

regards to indoor spaces, examples from the present study were fish bowls containing plants for 

playing peek-a-boo, cat trees for climbing, and toys for chewing and playing tug-of-war. Pets 

also adapted objects in their environment, transforming ordinary household items into objects of 

play. For instance, one participant described how her cat created a “perpetual game” of pulling 

up the carpet every night while another shared how his dog turns mundane chores into a spirited 

round of chasing the vacuum or broom.  

Enrichment also refers to opportunities for pets to socialize with people and other 

animals. For instance, puppies who are allowed to interact with their conspecifics from an early 

age show less anxiety when separated from their human caretakers, experience better welfare as 

adult dogs, and are more likely to be perceived as playful rather than aggressive (Sommerville et 

al., 2017). In the present study, participants in multi-pet households felt that it was important for 

their pets to have siblings to play with, keep each other company, and model appropriate 

behaviours (e.g. staying off furniture). While most dogs seemed to enjoy both social play (i.e. 



200 

 

 

involving people or animals) and object play (e.g. toys), some cats played with toys or other 

objects, only when their human caretakers were involved (Bradshaw et al., 2015). Among 

participants with indoor cats and those who were unable to walk their dogs regularly during 

cancer treatment, social play entailed tossing a ball around or using treats to entice their pets to 

play. These instances promoted bonding and mutual affection between participants and their 

pets.  

In contrast with findings from this study, other reports suggest that people’s beliefs about 

the importance of play for human-pet bonding do not always align with their behaviour. In spite 

of the almost $ 2 billion that are spent on cat toys yearly (American Pet Products Association, 

2016), consumers are not necessarily engaging in social play with their cats, instead leaving cats 

to their own devices. Keeping toys out all the time is problematic as cats often lose interest in 

objects the longer they are exposed to them (Strickler & Shull, 2014). Considering that pets, 

particularly indoor cats, are vulnerable to inactivity and a lack of social interaction, human 

caretakers can attend to enrichment by introducing novel toys, rotating toys, allowing spaces for 

pets to hide and climb, and increasing the frequency and duration of social play (Strickler & 

Shull, 2014).  

The importance of enrichment for human-pet bonding should not be underestimated. In 

one study, researchers surveyed participants (n=277) about their interactions with their indoor 

cats. Those who reported playing with their cat for at least five minutes at a time reported 

significantly fewer behavioural problems compared to participants who played with cats for 

sessions that lasted a minute (Strickler & Shull, 2014). Given the cross-sectional design, we 

cannot assume that play necessarily leads to a reduction in behavioural issues among cats. 

However, it stands to reason that people who value play would be more likely to promote 



201 

 

 

enrichment by engaging their pets in social play, providing pets with adequate stimulation, and 

investing time and energy to resolve behavioural challenges (Donoff & Bridgman, 2017).  

Cats, more often than dogs, are relinquished to rescue shelters, often due to behavioural 

problems such as aggression or excessive urination (Strickler & Shull, 2014). A few participants 

in this study reported being repeatedly bitten or clawed by their cats, but did not see these 

problems as being serious enough to warrant giving up their cat. These participants attributed 

their cats’ aggressive behaviour to a history of abuse or abandonment by a previous caretaker. 

Although people may have little choice with respect to relinquishing a pet, such as participants 

who were dealing with allergies or illness, this decision can evoke feelings of grief and remorse 

(Sharkin & Ruff, 2011). When inquiring about pets, health care professionals could ask whether 

people have given up a pet or contemplated doing so because of illness or other challenges, and 

connect them with counsellors or social workers who are trained to provide grief counselling.  

Health care professionals could also draw upon the human-pet relationship to create 

enriched spaces for people undergoing cancer treatment and follow-up care. In line with the aims 

of eco-therapy, professionals could incorporate nature-based techniques in their practice. In 

addition to encouraging people to spend time outdoors, professionals could incorporate natural 

elements into the workplace such as plants, or windows that bring in sunlight and look out onto 

natural landscapes (Kamitsis & Simmonds, 2017). Professionals could also integrate nature 

scenes into breathing exercises or use guided meditation as part of an outdoor walking tour. 

Some people consider pets to be their primary social relationships, and view them as a “safe 

haven” during difficult times (Kamitsis & Simmonds, 2017). Professionals could integrate pets 

into medical consultations or therapy sessions by allowing people to bring their pets to health 



202 

 

 

care centres, visiting people in their homes, or using video conferencing technology such as 

Skype to engage with people and their pets.  

5.4.3 Empathy and Imaginal Coping 

The experience of being in-tune with another individual’s thoughts and feelings (i.e. 

empathy), and reflecting these back to him/her can be understood as the “spiritual dimension of 

the helping process” (Faver, 2009, p. 367). Empathy is at the core of all helping professions 

including occupations in education, medicine, nursing, counselling, and social work (Carroll, 

2001; Faver, 2009). Research suggests that empathy can be enhanced by providing opportunities 

for people to learn and practise skills such as listening and responding to emotional cues, and 

engaging in perspective-taking or role-playing (S.-E. Brown, 2011; Y.-F. (Lily) Tsai & 

Kaufman, 2014). Similar to the scientific study of play, child development research has been at 

the forefront of addressing the importance of pets for cultivating empathy in people (S.-E. 

Brown, 2011; Pachana et al., 2011). Adopting a pet’s perspective encourages humility and 

respect for others (Faver, 2009; Mosteller, 2008). In one study, researchers examined the impact 

of playing with a computer-simulated virtual pet in a sample of 51 children who did not have a 

pet previously (Y.-F. (Lily) Tsai & Kaufman, 2014). According to the results, children who spent 

more time playing with their virtual pet tended to score higher on measures of empathy and 

humane attitudes towards animals. Children developed an emotional bond with their virtual pets 

whom they saw as having their own feelings, needs, and interests (E. Power, 2008; Y.-F. (Lily) 

Tsai & Kaufman, 2014).  

The findings from the present study suggest that pets can promote empathic learning well 

beyond childhood and adolescence, fostering greater compassion towards others and oneself. For 

many participants, the “harsh reality” of having cancer was that some people simply can’t handle 



203 

 

 

being around someone who is ill. People struggle to find the right words to say. They ask you 

how you are but they don’t necessarily want to hear the answer. They try to put a positive spin on 

things. They offer words that they assume will bring comfort. Or worse yet, they avoid the 

person who is ill, pulling away when they are needed most. Especially among individuals who 

were several years post-diagnosis, participants described feeling “forgotten” with respect to 

psychosocial support (Phelps et al., 2015). People simply assumed that they are fine now. 

Similar to the way in which pets act as a “social bridge” between people (Wood et al., 

2015), pets could model supportive strategies that friends and family members can emulate such 

as: allowing silence, encouraging play and silliness, doing activities that provide a distraction 

from cancer, granting people space to grieve and face their mortality, and simply being there. 

Among health care professionals, the provision of psychosocial support could benefit from 

routine assessment about the presence of pets in a person’s life and the meaning of these 

relationships. Such an assessment would ideally include questions about their pets (e.g. name, 

activities they enjoy together) and an invitation to share photos of their pets. Professionals could 

also record the names of pets in a person’s medical file or clinical notes to encourage follow up 

conversations (Horowitz, 2008).  

Stories about pets and the photos and memories attached to them, are far from idle chatter 

or casual pleasantries. These stories represent something that, again has been addressed in child 

development research, but is all too often overlooked among adults, namely, the use of imaginal 

coping. Imaginal coping involves drawing upon one’s imagination to deal with stressful 

situations, for example, by engaging in play, role-play, storytelling, or funny rituals (Rindstedt, 

2014). Participants in this study often anthropomorphized their pets when sharing stories about 

them. Participants talked more, laughed more, and discussed taboo topics like poop. Some 



204 

 

 

participants spoke about pets who had passed away, perhaps, in an effort to keep their memory 

alive. Importantly, imaginal coping does not happen in a vacuum as another individual must be 

present to animate these stories and bring them to life (Rindstedt, 2014). Whether pets are the 

key players in a story, or the social bridge that draws people together, empathic learning and 

imaginal coping should not be discounted as mere child’s play. 

5.5 Limitations 

Apart from the issues of trustworthiness discussed in Chapter 3, the study has a number 

of limitations that warrant further consideration. These limitations concern three aspects of the 

research design: sampling and data collection, analytic methods, and interpretations of the 

findings. Firstly, the sample was heterogeneous with respect to the participants’ age, gender, 

occupational status, stage and type of cancer, and the breed of their pets, thus, offering a diverse 

range of lived experience descriptions. Nevertheless, the inclusion of a self-selected and non-

probabilistic sample rules out the possibility of concluding that the study findings will hold true 

for other patient groups or the general public. Aside from the participant with fish, the study did 

not take into consideration other types of pets kept in the home such as rabbits, birds, and 

reptiles. Readers should also keep in mind the sample’s limited ethno-cultural diversity when 

interpreting the results. Moreover, roughly half of the interviews were conducted in a coffee shop 

or campus location where pets are not permitted, thus, providing fewer opportunities to observe 

the participants interacting with their pets. Although the use of pet photos and videos helped to 

elicit detailed stories and examples, participants may have been less willing to discuss personal 

topics in a public setting. 

Secondly, aside from challenges with participant recall and social desirability, member 

checking was not a required technique among the methods employed to conduct the study. 



205 

 

 

However, one potential strength of using member-checking is the ability to capture the 

participants’ reflections on the accuracy of the interview transcripts and the researcher’s 

interpretations of their experiences (Lincoln & Guba, 2016). Although I sought to address these 

limitations by using verbatim transcripts and peer debriefing with researchers and practitioners, 

there exists the possibility that participants would have elected to make changes to the transcripts 

or researcher interpretations had I allowed them an opportunity to provide additional feedback on 

their participation in the study. Moreover, member-checking would have been useful for 

gathering input from participants during the process of anonymizing their accounts and selecting 

pseudonyms for their pets (Lincoln & Guba, 2016).  

A third limitation applies to my interpretations of the findings, as well as, efforts to 

embed them in the broader research landscape. It was necessary to venture outside of the 

literature typically discussed (e.g. nursing, supportive care, counselling, etc.) and turn to 

innovative methodologies (e.g. ethological, nature-based) and research topics (e.g. play, pediatric 

populations) in order to explain the relevance of the findings. With this in mind, one notable 

caveat of the study is the emphasis upon silence as a tool for facilitating both human-pet and 

interpersonal communication. Depending on the cultural background and relational dynamics of 

the individuals involved, silence can have different meanings and interpretations, signalling 

acquiescence in one setting and discord in another (Bartels et al., 2016; Knutson & Kristiansen, 

2015). A second caveat concerns the meaning of play for people and animals. Based upon a close 

reading of the participants’ accounts, one might believe that play is a central and ubiquitous 

feature of the human-companion animal bond. However, this finding may not be applicable to 

people from cultures in which pets are viewed as status symbols to indicate wealth or prestige 

(Blazina, Boyraz, & Shen-Miller, 2011; Hirschman, 1994). Considering the potential risks 



206 

 

 

presented by animals (e.g. allergies, zoonoses, physical injuries, etc.), pets may engender fear or 

indifference from people rather than playfulness (Chur-Hansen, McArthur, Winefield, Hanieh, & 

Hazel, 2014).  

Furthermore, play may not be feasible or desirable among people with more advanced 

stages of cancer or other types of illness that compromise their immunity, energy level, dexterity, 

or mobility. Participants in the present study who were on-leave from work presumably had 

more time to play with their pets, and, perhaps, tended to see these activities as being important 

to their relationship. In a similar vein, the responsibilities of caring for a pet would not 

necessarily have the same kind of restorative impact for people who are unable to provide 

adequate care to their pets for physical, emotional, and/or financial reasons (Bozcuk et al., 2017). 

With some exceptions, gender appeared to have an impact on the type and intensity of play with 

men more often engaging in rough-and-tumble play and women opting for cuddling and playing 

games with their pets. Beyond these apparent differences, the current research design does not 

allow for gender-based analyses of factors involved in human-pet bonding.  

5.6 Future Directions 

The present study raises a several intriguing findings that would be useful to address in 

future investigations. Firstly, the study confirms previous reports that hope is not only relevant to 

a person at the end-of-life but also to people who are contemplating their own death or the death 

of someone close to them (Butt, 2011; Folkman, 2010). For people with pets, the prospect of an 

early death becomes all the more pressing given the relatively short lifespan of many pets and the 

potential for life-threatening injuries (e.g. falls) or illness (e.g. cancer, ingesting toxic 

substances). Some pets will undergo euthanasia (translated literally as “good death”) as a way to 

end their suffering, or, for reasons such as public safety, convenience, or population control 



207 

 

 

(Lagoni, 2011). Less research has been directed towards understanding how best to support 

people as they prepare for their pet’s euthanasia than helping people cope with the aftermath of a 

pet’s demise (Lagoni, 2011).  

Findings from the present study demonstrate the importance of allowing pet siblings and 

human family members to be in attendance during the procedure. Moreover, as pets cannot speak 

for themselves, it is critical that both health care and veterinary care professionals recognize and 

validate people for the “unspoken bond” that they share with their pets. Euthanasia may be a 

person’s final act of caretaking for a pet who is gravely ill and suffering. Among people who 

observe their pets “hanging on” for their sake, these individuals may benefit from veterinary 

grief counselling to work through their grief and bereavement. Whether a pet dies from natural 

causes or euthanasia, preparing for this kind of loss can help people think about what having a 

good death might mean for them (Pattison & Lee, 2011). 

Secondly, previous research suggests that women more often than men tend to discuss the 

topic of hope and the internal (e.g. self-esteem) and external (e.g. interpersonal relationships) 

resources that help them to remain hopeful (O’Shaughnessy et al., 2015). Although no such 

gender differences were identified in the present study, the lower uptake of the study among men 

and the resulting sample composition (nine women, five men) attest to the value of 

understanding how both men and women utilize hope as a strategy for coping with illness 

(Folkman, 2010; O’Shaughnessy et al., 2015). Consistent with the negativity bias discussed in 

Chapter 2, more research has been focused on studying the absence of hope and its relationship 

to depression and ill health (Folkman, 2010). It would be useful in future investigations to 

explore how constructs such as hopefulness and playfulness differ according to age, gender, 

culture, stage of illness, and access to health care and social support (Bozcuk et al., 2017). Such 



208 

 

 

investigations would also benefit from including the experiences of childhood survivors of 

cancer and young adults with cancer as these individuals are likely to have their own unique 

developmental needs and concerns (Hopman & Rijken, 2015; Raque-Bogdan et al., 2015).  

Another area little explored concerns how people’s interactions with nature impact their 

lived experience (Blaschke, 2017). People recovering from cancer can engage with nature 

through various means including plants, gardens, hospital courtyards, outdoor adventures, and 

nature-based therapeutic interventions. The existing research on nature-based activities is built 

upon an assumption that human-nature interactions can be assessed quantitatively through the 

use of systematic observation or self-report questionnaires (Blaschke, 2017; Sidenius et al., 

2017). Research suggests that people’s motives for engaging with nature, and its subsequent 

impact on their health and well-being, is highly personal and idiosyncratic (Blaschke, 2017). 

Such findings call into question the assumptions that underlie current models of research, 

specifically, whether nature can be administered or prescribed as a therapeutic intervention.  

Currently, there are no clinical practice guidelines to support the use of nature-based 

activities for the prevention or treatment of illness (Oh et al., 2017). Methodological limitations 

of existing studies include small sample sizes and a lack of control for participant expectations. 

Perhaps, qualitative studies might provide empirical evidence that encourages researchers and 

practitioners to dispense with prescriptive interventions and, instead, move toward an approach 

that validates people’ own resources and ways of coping with their illness. Such an approach 

might also encourage policy makers to incorporate nature and natural elements into the design of 

health care settings that serve both adults and children. 

Lastly, it is well established that social connection and social support are protective for 

the health and well-being of individuals (Wood et al., 2015). Less clear are the ways in which 



209 

 

 

play helps to promote social connection, sense of community, adaptive coping strategies, and 

creativity (Donoff & Bridgman, 2017). The WHO recognizes play as being important for 

physical, mental, and cardiovascular health, as well as, overall fitness (Donoff & Bridgman, 

2017). A burgeoning topic in the study of human play concerns the potential uses of urban 

design to foster spontaneous play. Alongside this body of work are animal behaviour and animal 

welfare studies that are focused on the adaptive functions of play, primarily, in cats, monkeys 

and rats (Donoff & Bridgman, 2017). Far less research exists on how and why people and pets 

play. Considering that play helps to strengthen social bonds, in future studies, researchers could 

develop measures to assess the type, nature, and frequency of play as a potential indicator of the 

quality of the human-pet relationship (Bradshaw et al., 2015; Sommerville et al., 2017). In 

addition, there is a need for comparative studies of human play and animal play, as well as, 

greater alignment between these two related bodies of research (Burghardt, 2016).  

5.7 Conclusion 

Cancer, once considered an immediate death sentence, is increasingly regarded as a 

condition that requires long-term care and management (Hopman & Rijken, 2015; Raque-

Bogdan et al., 2015). Cancer survivorship refers to a continuum that encompasses different 

phases during which people encounter various challenges including changes in their health, 

physical appearance, relationships, and occupational status (Kazanjian et al., 2012). Emotional 

distress is prevalent among people with cancer, and is less amenable to relief using traditional 

medical interventions (Baun & Mccabe, 2003; Marcus, 2012b). The increased popularity of 

animal-assisted interventions in cancer care must be met by greater attention to the bond between 

people and their pets. More than half (57%) of Canadians share their homes with at least one pet 

(Cherniack & Cherniack, 2015; Perrin, 2009). Cats (7.9 million) are the most common type of 



210 

 

 

pet, followed by dogs (5.9 million), birds, rabbits, and fish (Alberta Ministry of Agriculture and 

Rural Development, 2014; Perrin, 2009).  

A common concern raised in the human-animal bond literature is that people are drawn to 

pets primarily because of a lack of human social support that comes with increased urbanization 

and modernization (Blazina et al., 2011; Gavriele-Gold, 2011). Such claims not only marginalize 

the experiences of people who consider pets to be one of their primary social relationships but 

they also overlook the possibility that pets can fulfill relational needs that no human being can. 

In adopting a phenomenological approach, this study aims to show the uniqueness of the 

participants’ experiences with their pets while also speaking to what is essential about the 

experience of bonding and living with a pet (van Manen, 1997). Phenomenology compels us to 

think about the relationship between who we are and how we act, thus, promoting greater 

thoughtfulness, tact, and ethical sensitivity in our professional activities and personal experience 

(van Manen, 2014). 

In view of the foregoing discussion, the present study extends previous research by 

highlighting the importance of attunement for the human-companion animal bond. As a 

cornerstone of attachment theory, attunement refers to a transactional process whereby 

individuals become in-tune with and are able to reflect back one another’s feelings and 

experiences (Blazina, 2011; Lasher, 1998). Similar to the attachment behaviours observed 

between infants and their caregivers, pets and participants often displayed proximity seeking 

(Bowlby, 1982). At times, participants functioned as parents or guardians to their pets while, in 

other instances, pets provided a secure base for participants, offering them comfort and 

reassurance (Kurdek, 2008). Accordingly, pets not only served as attachment figures (e.g. 

children, secure base) for participants, but also fulfilled a variety of relational needs beyond 



211 

 

 

attachment. Such relational needs included friendship, companionship in play, leisure and rest, 

companionship while recuperating from illness, emotional support, spiritual kinship, connection 

to nature and natural elements, and unspoken connection through their mattering presence. By 

emphasizing attunement, this study illuminates a diverse range of bonding experiences that are 

relevant to the human-pet relationship, and draws attention to the importance of silence, an often 

underappreciated form of communication (Knutson & Kristiansen, 2015). 

Finally, the study brings home the idea that hope is not a self-sustaining resource. It ebbs 

and flows, and, for some people, pets may serve as an impetus to hope. Snyder (1994) regards 

hope as having a “natural relationship” with meaning in that meaning tells us what is important 

in life, and hope helps us move closer to what is meaningful to us. Consistent with participants’ 

experiences in this study, other investigations suggest that the way in which doctors and nurses 

communicate about survival rates and disease prognosis has an impact on how patients 

experience hope (O’Shaughnessy et al., 2015). Professionals may attempt to dissuade people 

from relying upon false hope, or, in other words, unrealistic expectations about their future 

(Folkman, 2010; O’Shaughnessy et al., 2015). Whether they be unrealistic or “the faintest hope,” 

as one participant described it, these seeds of hope may provide the necessary foundation for 

helping people find benefit in even the most traumatic of situations (Folkman, 2010; Snyder, 

1994). Moreover, people tend to redefine hope at different points in time, for example, 

transitioning from hopes of being cured or free of cancer to having their symptoms under control 

or maintaining a good quality of life (Folkman, 2010; O’Shaughnessy et al., 2015). By 

supporting people’s relationships with their companion animals, professionals can provide timely 

and meaningful care that is responsive to each individual’s unique experience of hope. 

  



212 

 

 

‘Night sweet Prince 



213 

 

 

References 

Alberta Ministry of Agriculture and Rural Development. (2014). Consumer corner: Canadian  

pet market outlook. Retrieved December 14, 2015, from 

http://www1.agric.gov.ab.ca/$department/deptdocs.nsf/all/sis14914 

Alcalar, N., Ozkan, S., Kucucuk, S., Aslay, I., & Ozkan, M. (2012). Association of coping style, 

cognitive errors and cancer-related variables with depression in women treated for breast 

cancer. Japanese Journal of Clinical Oncology, 42(10), 940–947. 

https://doi.org/10.1093/jjco/hys119 

Allen, K., Blascovich, J., & Mendes, W. B. (2002). Cardiovascular reactivity and the presence of 

pets, friends, and spouses: The truth about cats and dogs. Psychosomatic Medicine, 64(5), 

727–739. 

American Pet Products Association. (2016). Pet industry market size & ownership statistics. 

Retrieved March 11, 2016, from 

http://www.americanpetproducts.org/press_industrytrends.asp 

American Psychological Association. (2010). Publication manual of the American Psychological 

Association (6th ed.). Washington, DC: American Psychological Association. 

Anderson, A., & Anderson, L. (2003). God’s messengers: What animals teach us about the  

divine. Novato, CA: New World Library. 

Aron, A., Norman, A. A., Aron, E. N., McKenna, C., & Heyman, R. E. (2000). Couples’ shared 

participation in novel and arousing activities and experienced relationship quality. 

Journal of Personality and Social Psychology, 78(2), 273–284. 



214 

 

 

Ashing-Giwa, K., & Ganz, P. A. (1997). Understanding the breast cancer experience of African-

American women. Journal of Psychosocial Oncology, 15(2), 19–35. 

https://doi.org/10.1300/J077v15n02_02 

Ashing-Giwa, K. T., Padilla, G., Tejero, J., Kraemer, J., Wright, K., Coscarelli, A., … Hills, D. 

(2004). Understanding the breast cancer experience of women: A qualitative study of 

African American, Asian American, Latina and Caucasian cancer survivors. Psycho-

Oncology, 13(6), 408–428. https://doi.org/10.1002/pon.750 

Balcombe, J. (2009). Animal pleasure and its moral significance. Applied Animal Behaviour 

Science, 118(3–4), 208–216. https://doi.org/10.1016/j.applanim.2009.02.012 

Baldacchino, D. R., Borg, J., Muscat, C., & Sturgeon, C. (2012). Psychology and theology meet: 

Illness appraisal and spiritual coping. Western Journal of Nursing Research, 34(6), 818–

847. https://doi.org/10.1177/0193945912441265 

Bartels, J., Rodenbach, R., Ciesinski, K., Gramling, R., Fiscella, K., & Epstein, R. (2016). 

Eloquent silences: A musical and lexical analysis of conversation between oncologists 

and their patients. Patient Education and Counseling, 99(10), 1584–1594. 

https://doi.org/10.1016/j.pec.2016.04.009 

Baun, M. M., & Mccabe, B. W. (2003). Companion animals and persons with dementia of the 

Alzheimer’s type: Therapeutic possibilities. American Behavioral Scientist, 47(1), 42–51. 

https://doi.org/10.1177/0002764203255211 

Beck, L., & Madresh, E. A. (2008). Romantic partners and four-legged friends: An extension of 

attachment theory to relationships with pets. Anthrozoös, 21(1), 43–56. 

https://doi.org/10.2752/089279308X274056 

Becker, M., & Morton, D. (2002). The healing power of pets. New York, NY: Hyperion. 



215 

 

 

Berscheid, E., & Regan, P. (2016). The psychology of interpersonal relationships. New York, 

NY: Routledge. 

Bibbo, J. (2013). Staff members’ perceptions of an animal-assisted activity. Oncology Nursing 

Forum, 40(4), E320-326. https://doi.org/10.1188/13.ONF.E320-E326 

Bigatti, S. M., Steiner, J. L., & Miller, K. D. (2012). Cognitive appraisals, coping and depressive 

symptoms in breast cancer patients. Stress and Health: Journal of the International 

Society for the Investigation of Stress, 28(5), 355–361. https://doi.org/10.1002/smi.2444 

Blaschke, S. (2017). The role of nature in cancer patients’ lives: A systematic review and 

qualitative meta-synthesis. BMC Cancer, 17(1), 370. https://doi.org/10.1186/s12885-017-

3366-6 

Blazina, C. (2011). Life after loss: Psychodynamic perspectives on a continuing bonds approach 

with “pet companion.” In C. Blazina, G. Boyraz, & D. Shen-Miller (Eds.), The 

psychology of the human-animal bond: A resource for clinicians and researchers (pp. 

203–224). New York, NY: Springer. 

Blazina, C., Boyraz, G., & Shen-Miller, D. (2011). Introduction: Using context to inform clinical 

practice and research. In C. Blazina, G. Boyraz, & D. Shen-Miller (Eds.), The psychology 

of the human-animal bond: A resource for clinicians and researchers (pp. 3–24). New 

York, NY: Springer. 

Boehmer, S., Luszczynska, A., & Schwarzer, R. (2007). Coping and quality of life after tumor 

surgery: Personal and social resources promote different domains of quality of life. 

Anxiety, Stress, and Coping, 20(1), 61–75. https://doi.org/10.1080/10615800701195439 

Bowlby, J. (1982). Attachment and loss: Vol. 1. Attachment. New York, NY: Basic Books. 



216 

 

 

Bozcuk, H., Ozcan, K., Erdogan, C., Mutlu, H., Demir, M., & Coskun, S. (2017). A comparative 

study of art therapy in cancer patients receiving chemotherapy and improvement in 

quality of life by watercolor painting. Complementary Therapies in Medicine, 30, 67–72. 

https://doi.org/10.1016/j.ctim.2016.11.006 

Bradshaw, J. W. S., Pullen, A. J., & Rooney, N. J. (2015). Why do adult dogs ‘play’? 

Behavioural Processes, 110, 82–87. https://doi.org/10.1016/j.beproc.2014.09.023 

Brandes, S. (2010). The meaning of American pet cemetery gravestones. Ethnology: An 

International Journal of Cultural and Social Anthropology, 48(2), 99–118. 

Bratzke, L. C., Muehrer, R. J., Kehl, K. A., Lee, K. S., Ward, E. C., & Kwekkeboom, K. L. 

(2015). Self-management priority setting and decision-making in adults with 

multimorbidity: A narrative review of literature. International Journal of Nursing 

Studies, 52(3), 744–755. https://doi.org/10.1016/j.ijnurstu.2014.10.010 

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in 

Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa 

Brooks, H. L., Rogers, A., Kapadia, D., Pilgrim, J., Reeves, D., & Vassilev, I. (2013). Creature 

comforts: Personal communities, pets and the work of managing a long-term condition. 

Chronic Illness, 9(2), 87–102. https://doi.org/10.1177/1742395312452620 

Brown, R. D. K. (2006). Pastoral concern in relation to the psychological stress caused by the 

death of an animal companion. Mental Health, Religion & Culture, 9(5), 411–422. 

https://doi.org/10.1080/13694670500212208 

Brown, S.-E. (2011). Theoretical concepts from self psychology applied to animal hoarding. 

Society & Animals, 19(2), 175–193. https://doi.org/10.1163/156853011X563006 



217 

 

 

Bryan, J. L., Baker, Z. G., & Tou, R. Y. (2017). Prevent the blue, be true to you: Authenticity 

buffers the negative impact of loneliness on alcohol-related problems, physical 

symptoms, and depressive and anxiety symptoms. Journal of Health Psychology, 22(5), 

605–616. https://doi.org/10.1177/1359105315609090 

Bultz, B. D., & Carlson, L. E. (2006). Emotional distress: The sixth vital sign--future directions 

in cancer care. Psycho-Oncology, 15(2), 93–95. https://doi.org/10.1002/pon.1022 

Burghardt, G. M. (2016). What is the state of play? International Journal of Play, 5(2), 212–214. 

https://doi.org/10.1080/21594937.2016.1203922 

Burgon, H. (2003). Case studies of adults receiving horse-riding therapy. Anthrozoös, 16(3), 

263–276. 

Butt, C., M. (2011). Hope in adults with cancer: State of the science. Oncology Nursing Forum, 

38(5), 341–350. 

Byosiere, S.-E., Espinosa, J., & Smuts, B. (2016). Investigating the function of play bows in 

adult pet dogs (Canis lupus familiaris). Behavioural Processes, 125, 106–113. 

https://doi.org/10.1016/j.beproc.2016.02.007 

Campo, R., & Uchino, B. (2013). Humans’ bonding with their companion dogs: Cardiovascular 

benefits during and after stress. The Journal of Sociology & Social Welfare, 40(4). 

Retrieved from http://scholarworks.wmich.edu/jssw/vol40/iss4/13 

Canadian Cancer Society’s Advisory Committee on Cancer Statistics. (2015). Canadian Cancer 

Statistics 2015. Retrieved from Canadian Cancer Society website: cancer.ca/Canadian-

Cancer-Statistics-2015-EN 



218 

 

 

Canadian Cancer Statistics Advisory Committee. (2018). Canadian Cancer Statistics 2018. 

Retrieved from Canadian Cancer Society website: cancer.ca/Canadian-Cancer-Statistics-

2018-EN 

Carroll, B. (2001). A phenomenological exploration of the nature of spirituality and spiritual 

care. Mortality, 6(1), 81–98. https://doi.org/10.1080/13576270020028656 

Carter, S. M., & Little, M. (2007). Justifying knowledge, justifying method, taking action: 

Epistemologies, methodologies, and methods in qualitative research. Qualitative Health 

Research, 17(10), 1316–1328. https://doi.org/10.1177/1049732307306927 

Carver, C. S. (1998). Resilience and thriving: Issues, models, and linkages. Journal of Social  

Issues, 54(2), 245–266. 

Cavanaugh, L. A., Leonard, H. A., & Scammon, D. L. (2008). A tail of two personalities: How 

canine companions shape relationships and well-being. Journal of Business Research, 

61(5), 469–479. https://doi.org/10.1016/j.jbusres.2007.07.024 

Chang, H.-J., Chen, W.-X., Lin, E. C.-L., Tung, Y.-Y., Fetzer, S., & Lin, M.-F. (2014). Delay in 

seeking medical evaluations and predictors of self-efficacy among women with newly 

diagnosed breast cancer: A longitudinal study. International Journal of Nursing Studies, 

51(7), 1036–1047. https://doi.org/10.1016/j.ijnurstu.2013.10.024 

Cherniack, E. P., & Cherniack, A. R. (2015). Assessing the benefits and risks of owning a pet. 

CMAJ : Canadian Medical Association Journal, 187(10), 715–716. 

https://doi.org/10.1503/cmaj.150274 

Chur-Hansen, A., McArthur, M., Winefield, H., Hanieh, E., & Hazel, S. (2014). Animal-assisted 

interventions in children’s hospitals: A critical review of the literature. Anthrozoös, 27(1), 

5–18. https://doi.org/10.2752/175303714X13837396326251 



219 

 

 

Cohen, S. P. (2002). Can pets function as family members? Western Journal of Nursing 

Research, 24(6), 621–638. 

Coppola, F. F. (1983). Rumble fish [Motion Picture]. United States: Universal Pictures. 

Coren, S. (2008). The modern dog. New York, NY: Free Press. 

Coren, S. (2011, November 21). Retrieved May 20, 2016, from Is Anthropomorphism a sin? 

Comparing dogs to people is sometimes useful and sensible website: 

https://www.psychologytoday.com/blog/canine-corner/201111/is-anthropomorphism-sin 

Costanzo, E. S., Ryff, C. D., & Singer, B. H. (2009). Psychosocial adjustment among cancer 

survivors: Findings from a national survey of health and well-being. Health Psychology, 

28(2), 147–156. https://doi.org/10.1037/a0013221 

Creswell, J. W., & Miller, D. L. (2000). Determining validity in qualitative inquiry. Theory Into 

Practice, 39(3), 124–130. https://doi.org/10.1207/s15430421tip3903_2 

Curry, N. A., & Kasser, T. (2005). Can coloring mandalas reduce anxiety? Art Therapy, 22(2), 

81–85. https://doi.org/10.1080/07421656.2005.10129441 

Davis, H. L. (2011). Death of a companion animal: Understanding human responses to 

bereavement. In C. Blazina, G. Boyraz, & D. Shen-Miller (Eds.), The psychology of the 

human-animal bond: A resource for clinicians and researchers (pp. 225–244). New 

York, NY: Springer. 

DeGue, S. (2011). A triad of family violence: Examining overlap in the abuse of children, 

partners, and pets. In C. Blazina, G. Boyraz, & D. Shen-Miller (Eds.), The psychology of 

the human-animal bond: A resource for clinicians and researchers (pp. 245–262). New 

York, NY: Springer. 

Dilthey, W. (1987). Introduction to the human sciences. Toronto, ON: Scholarly Book Services. 



220 

 

 

Doll, R., Kazanjian, A., Smillie, K., Ward, A., & Chasen, M. (2012). A call for action in 

survivorship research and care. Current Oncology, 19(1), 16–20. 

Donoff, G., & Bridgman, R. (2017). The playful city: Constructing a typology for urban design 

interventions. International Journal of Play, 6(3), 294–307. 

https://doi.org/10.1080/21594937.2017.1382995 

Dotson, M. J., & Hyatt, E. M. (2008). Understanding dog–human companionship. Journal of 

Business Research, 61(5), 457–466. https://doi.org/10.1016/j.jbusres.2007.07.019 

Dowling, M. (2007). From Husserl to van Manen. A review of different phenomenological 

approaches. International Journal of Nursing Studies, 44(1), 131–142. 

https://doi.org/10.1016/j.ijnurstu.2005.11.026 

Drageset, S., Lindstrøm, T. C., & Underlid, K. (2016). “I just have to move on”: Women’s 

coping experiences and reflections following their first year after primary breast cancer 

surgery. European Journal of Oncology Nursing, 21, 205–211. 

https://doi.org/10.1016/j.ejon.2015.10.005 

Dunkel-Schetter, C., Feinstein, L. G., Taylor, S. E., & Falke, R. L. (1992). Patterns of coping 

with cancer. Health Psychology, 11(2), 79–87. 

Dunkel-Schetter, C., Folkman, S., & Lazarus, R. S. (1987). Correlates of social support receipt. 

Journal of Personality and Social Psychology, 53(1), 71–80. 

Eig, A. M. (2017). Rough and tumble play in the adult group. International Journal of Group 

Psychotherapy, 67(3), 410–432. https://doi.org/10.1080/00207284.2017.1307077 

Faver, C. A. (2009). Seeking our place in the web of life: Animals and human spirituality. 

Journal of Religion & Spirituality in Social Work: Social Thought, 28(4), 362–378. 

https://doi.org/10.1080/15426430903263161 



221 

 

 

Fine, A. H. (2011). Understanding the AAT Rx: Applications of AAI in clinical practice. In C. 

Blazina, G. Boyraz, & D. Shen-Miller (Eds.), The psychology of the human-animal bond: 

A resource for clinicians and researchers (pp. 125–136). New York, NY: Springer. 

Fine, A. H., & Eisen, C. (2008). Afternoons with puppy: Inspirations from a therapist and his  

animals. West Lafayette, IN: Purdue University Press. 

Fleishman, S. B., Homel, P., Chen, M. R., Rosenwald, V., Abolencia, V., Gerber, J., & Nadesan, 

S. (2015). Beneficial effects of animal-assisted visits on quality of life during multimodal 

radiation-chemotherapy regimens. The Journal of Community and Supportive Oncology, 

13(1), 22–26. https://doi.org/10.12788/jcso.0102 

Flick, U. (2014). An introduction to qualitative research (5th ed.). Thousand Oaks, CA: Sage. 

Folkman, S. (2010). Stress, coping, and hope. Psycho-Oncology, 19(9), 901–908. 

https://doi.org/10.1002/pon.1836 

Folkman, S., & Lazarus, R. S. (1988). The relationship between coping and emotion: 

Implications for theory and research. Social Science & Medicine, 26(3), 309–317. 

https://doi.org/10.1016/0277-9536(88)90395-4 

Folkman, S., Lazarus, R. S., Gruen, R. J., & DeLongis, A. (1986). Appraisal, coping, health 

status, and psychological symptoms. Journal of Personality and Social Psychology, 

50(3), 571–579. 

Frankl, V. E. (2006). Man’s search for meaning. Boston: Beacon Press. 

Franklin, A., Emmison, M., Haraway, D., & Travers, M. (2007). Investigating the therapeutic 

benefits of companion animals: Problems and challenges. Qualitative Sociology Review, 

3(1), 42–58. 



222 

 

 

Fraser, D. (2009). Animal behaviour, animal welfare and the scientific study of affect. Applied 

Animal Behaviour Science, 118(3–4), 108–117. 

https://doi.org/10.1016/j.applanim.2009.02.020 

Frey, B. B., Daaleman, T. P., & Peyton, V. (2005). Measuring a dimension of spirituality for 

health research validity of the spirituality index of well-being. Research on Aging, 27(5), 

556–577. https://doi.org/10.1177/0164027505277847 

Friedmann, E., Katcher, A. H., Lynch, J. J., & Thomas, S. A. (1980). Animal companions and 

one-year survival of patients after discharge from a coronary care unit. Public Health 

Reports, 95(4), 307–312. 

Friedmann, E., & Thomas, S. A. (1995). Pet ownership, social support, and one-year survival 

after acute myocardial infarction in the Cardiac Arrhythmia Suppression Trial (CAST). 

The American Journal of Cardiology, 76(17), 1213–1217. 

Friedmann, E., Thomas, S. A., Stein, P. K., & Kleiger, R. E. (2003). Relation between pet 

ownership and heart rate variability in patients with healed myocardial infarcts. The 

American Journal of Cardiology, 91(6), 718–721. 

Friedmann, E., & Tsai, C. C. (2006). The animal-human bond: Health and wellness. In A. H. 

Fine (Ed.), Animal-assisted therapy: Theoretical foundations and practice guidelines (pp. 

95–117). San Diego, CA: Academic Press. 

Gadamer, H.-G. (1998). Truth and method (2nd rev. ed.). New York, NY: Continuum. 

García-Jimenez, M., Santoyo-Olsson, J., Ortiz, C., Lahiff, M., Sokal-Gutierrez, K., & Nápoles, 

A. M. (2014). Acculturation, inner peace, cancer self-efficacy, and self-rated health 

among Latina breast cancer survivors. Journal of Health Care for the Poor and 

Underserved, 25(4), 1586–1602. https://doi.org/10.1353/hpu.2014.0158 



223 

 

 

Gavriele-Gold, J. R. (2011). The human-canine bond: New learnings and a changing rationality 

from a psychoanalytic perspective. Psychoanalytic Review, 98(1), 91–105. 

https://doi.org/10.1521/prev.2011.98.1.91 

Giddens, A. (1991). Modernity and self-identity: Self and society in the late modern age. 

Stanford, California: Stanford University Press. 

Giorgi, A. (2000). The status of Husserlian phenomenology in caring research. Scandinavian 

Journal of Caring Sciences, 14(1), 3–10. https://doi.org/10.1111/j.1471-

6712.2000.tb00554.x 

Girardin, D. W. (2000). Part VI. Implications of spirituality with oncology patients. Current 

Problems in Cancer, 24(5), 269–280. https://doi.org/10.1016/S0147-0272(00)90003-5 

Goodall, J. (1999). Reason for hope: A spiritual journey. New York, NY: Warner Books. 

Grandin, T. (2005). Animals in translation: Using the mysteries of autism to decode animal 

behavior. New York, NY: Scribner. 

Grandin, T., & Johnson, C. (2009). Animals make us human. New York, NY: Mariner Books. 

Grier, K. (2006). Pets in America: A history. New York, NY: Harvest Book, Harcourt. 

Guba, E. G., & Lincoln, Y. S. (1994). Competing paradigms in qualitative research. In N. K. 

Denzin & Y. S. Lincoln (Eds.), Handbook of qualitative research (pp. 105–117). 

Thousand Oaks, CA: Sage Publications, Inc. 

Hall, S. L., Bradshaw, J. W. S., & Robinson, I. H. (2002). Object play in adult domestic cats: 

The roles of habituation and disinhibition. Applied Animal Behaviour Science, 79(3), 

263–271. https://doi.org/10.1016/S0168-1591(02)00153-3 

Halm, M. A. (2008). The healing power of the human-animal connection. American Journal of 

Critical Care, 17(4), 373–376. 



224 

 

 

Hanrahan, C. (2011). Challenging anthropocentricism in social work through ethics and 

spirituality: Lessons from studies in human-animal bonds. Journal of Religion & 

Spirituality in Social Work: Social Thought, 30(3), 272–293. 

https://doi.org/10.1080/15426432.2011.587387 

Harper, D. (2002). Talking about pictures: A case for photo elicitation. Visual Studies, 17(1), 13–

26. https://doi.org/10.1080/14725860220137345 

Hazan, C., & Shaver, P. (1987). Romantic love conceptualized as an attachment process. Journal 

of Personality and Social Psychology, 52(3), 511–524. 

Heidegger, M. (2010). Being and time (J. Stambaugh, Trans.). Albany, NY: State University of 

New York Press. 

Henry, M., Cohen, S. R., Lee, V., Sauthier, P., Provencher, D., Drouin, P., … Mayo, N. (2010). 

The Meaning-Making intervention (MMi) appears to increase meaning in life in 

advanced ovarian cancer: A randomized controlled pilot study. Psycho-Oncology, 19(12), 

1340–1347. https://doi.org/10.1002/pon.1764 

Herth, K. (2000). Enhancing hope in people with a first recurrence of cancer. Journal of 

Advanced Nursing, 32(6), 1431–1441. https://doi.org/10.1046/j.1365-2648.2000.01619.x 

Hill, R., Gaines, J., & Wilson, R. M. (2007). Consumer behavior, extended self, and sacred 

consumption: An alternative perspective from our animal companions. ACR European 

Advances, E-08. Retrieved from http://acrwebsite.org/volumes/13867/eacr/vol8/E-08 

Hines, L. M. (2003). Historical perspectives on the human-animal bond. American Behavioral 

Scientist, 47(1), 7–15. https://doi.org/10.1177/0002764203255206 

Hirschman, E. C. (1994). Consumers and their animal companions. Journal of Consumer 

Research, 20(4), 616–632. 



225 

 

 

Hoffer, L. N. (2011). Lapdogs and moral shepherd’s dogs: Canine and paid female companions  

in nineteenth-century English literature. In C. Blazina, G. Boyraz, & D. Shen-Miller 

(Eds.), The psychology of the human-animal bond: A resource for clinicians and 

researchers (pp. 107–122). New York, NY: Springer. 

Holak, S. L. (2008). Ritual blessings with companion animals. Journal of Business Research, 61, 

534–541. 

Holbrook, M. B. (2008). Pets and people: Companions in commerce? Journal of Business 

Research, 61(5), 546–552. https://doi.org/10.1016/j.jbusres.2007.07.010 

Holbrook, M. B., Stephens, D. L., Day, E., Holbrook, S. M., & Strazar, G. (2001). A collective 

stereographic photo essay on key aspects of animal companionship: The truth about dogs 

and cats. Academy of Marketing Science Review, 1, 1–20. 

Holt, D. (2001). Praying with Katie: God, my cat, and me. Kansas City, MO: Andrews  McMeel 

Publishing. 

Hopman, P., & Rijken, M. (2015). Illness perceptions of cancer patients: Relationships with 

illness characteristics and coping. Psycho-Oncology, 24(1), 11–18. 

https://doi.org/10.1002/pon.3591 

Horowitz, S. (2008). The human-animal bond: Health implications across the lifespan. 

Alternative and Complementary Therapies, 14(5), 251–256. 

https://doi.org/10.1089/act.2008.14505 

Howse, M. S., Anderson, R. E., & Walsh, C. J. (2018). Social behaviour of domestic dogs (Canis 

familiaris) in a public off-leash dog park. Behavioural Processes, 157, 691–701. 

https://doi.org/10.1016/j.beproc.2018.03.016 



226 

 

 

Husserl, E. (1970). The crisis of the European sciences and transcendental phenomenology: An 

introduction to phenomenological philosophy. Evanston: Northwestern University Press. 

Jim, H. S., Richardson, S. A., Golden-Kreutz, D. M., & Andersen, B. L. (2006). Strategies used 

in coping with a cancer diagnosis predict meaning in life for survivors. Health 

Psychology, 25(6), 753–761. https://doi.org/10.1037/0278-6133.25.6.753 

Johnson, R. A., Meadows, R. L., Haubner, J. S., & Sevedge, K. (2003). Human-animal 

interaction: A complementary/alternative medical (CAM) intervention for cancer 

patients. American Behavioral Scientist, 47(1), 55–69. 

https://doi.org/10.1177/0002764203255213 

Johnson, R. A., Meadows, R. L., Haubner, J. S., & Sevedge, K. (2008). Animal-assisted activity 

among patients with cancer: Effects on mood, fatigue, self-perceived health, and sense of 

coherence. Oncology Nursing Forum, 35(2), 225–232. 

https://doi.org/10.1188/08.ONF.225-232 

Kamitsis, I., & Simmonds, J. G. (2017). Using resources of nature in the counselling room: 

Qualitative research into ecotherapy practice. International Journal for the Advancement 

of Counselling, 39(3), 229–248. https://doi.org/10.1007/s10447-017-9294-y 

Kazanjian, A., Smillie, K., Howard, A. F., Ward, A., & Doll, R. (2012). A structured approach to 

knowledge exchange: Understanding the implementation of a cancer survivor program. 

European Journal of Oncology Nursing: The Official Journal of European Oncology 

Nursing Society, 16(4), 399–405. https://doi.org/10.1016/j.ejon.2011.09.002 

Keaveney, S. M. (2008). Equines and their human companions. Journal of Business Research, 

61(5), 444–454. 



227 

 

 

Kerepesi, A., Dóka, A., & Miklósi, Á. (2015). Dogs and their human companions: The effect of 

familiarity on dog–human interactions. Behavioural Processes, 110, 27–36. 

https://doi.org/10.1016/j.beproc.2014.02.005 

Knight, S., & Edwards, V. (2008). In the company of wolves: The physical, social, and 

psychological benefits of dog ownership. Journal of Aging and Health, 20(4), 437–455. 

https://doi.org/10.1177/0898264308315875 

Knutson, H. V., & Kristiansen, A. (2015). Varieties of silence: Understanding different forms 

and functions of silence in a psychotherapeutic setting. Contemporary Psychoanalysis, 

51(1), 1–30. https://doi.org/10.1080/00107530.2015.954218 

Kobak, R. (2009). Defining and measuring of attachment bonds: Comment on Kurdek (2009). 

23(4), 447–449. https://doi.org/10.1037/a0015213 

Krueger, R. A., & Casey, M. A. (2009). Focus groups: A practical guide for applied research 

(4th ed.). Thousand Oaks, California: Sage Publications, Inc. 

Kurdek, L. A. (2008). Pet dogs as attachment figures. Journal of Social and Personal 

Relationships, 25(2), 247–266. https://doi.org/10.1177/0265407507087958 

Kvillemo, P., & Bränström, R. (2014). Coping with breast cancer: A meta-analysis. PLoS ONE, 

9(11). https://doi.org/10.1371/journal.pone.0112733 

Lagoni, L. (2011). Family-present euthanasia: Protocols for planning and preparing clients for 

the death of a pet. In C. Blazina, G. Boyraz, & D. Shen-Miller (Eds.), The psychology of 

the human-animal bond: A resource for clinicians and researchers (pp. 181–202). New 

York, NY: Springer. 

Langdridge, D. (2007). Phenomenological psychology: Theory, research and method. Harlow, 

UK: Pearson Education. 



228 

 

 

Laranjeira, C., Ponce Leão, P., & Leal, I. (2013). Meaning of life after cancer: An existential-

phenomenological approach to female cancer survival. Women’s Studies International 

Forum, 40, 132–143. https://doi.org/doi:10.1016/j.wsif.2013.05.015 

Larson, B. R., Looker, S., Herrera, D. M., Creagan, E. T., Hayman, S. R., Kaur, J. S., & Jatoi, A. 

(2010). Cancer patients and their companion animals: Results from a 309-patient survey 

on pet-related concerns and anxieties during chemotherapy. Journal of Cancer 

Education, 25(3), 396–400. https://doi.org/10.1007/s13187-010-0062-5 

Lasher, M. (1998). A relational approach to the human-animal bond. Anthrozoös, 11(3), 130–

133. https://doi.org/10.2752/089279398787000670 

Latham, A. (2003). Research, performance, and doing human geography: Some reflections on 

the diary-photograph, diary-interview method. Environment and Planning A: Economy 

and Space, 35(11), 1993–2017. https://doi.org/10.1068/a3587 

Lee, V., Robin Cohen, S., Edgar, L., Laizner, A. M., & Gagnon, A. J. (2006). Meaning-making 

intervention during breast or colorectal cancer treatment improves self-esteem, optimism, 

and self-efficacy. Social Science & Medicine (1982), 62(12), 3133–3145. 

https://doi.org/10.1016/j.socscimed.2005.11.041 

Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. Beverly Hills: Sage. 

Lincoln, Y. S., & Guba, E. G. (2016). The constructivist credo. New York, NY: Routledge. 

Linden, W., MacKenzie, R., Rnic, K., Marshall, C., & Vodermaier, A. (2015). Emotional 

adjustment over 1 year post-diagnosis in patients with cancer: Understanding and 

predicting adjustment trajectories. Supportive Care in Cancer, 23(5), 1391–1399. 

https://doi.org/10.1007/s00520-014-2492-9 



229 

 

 

Lockwood, R., & O’Connor, S. (2017). Playfulness in adults: An examination of play and 

playfulness and their implications for coaching. Coaching: An International Journal of 

Theory, Research and Practice, 10(1), 54–65. 

https://doi.org/10.1080/17521882.2016.1268636 

Lopez, A. J., McCaffrey, R., Quinn Griffin, M. T., & Fitzpatrick, J. J. (2009). Spiritual well-

being and practices among women with gynecologic cancer. Oncology Nursing Forum, 

36(3), 300–305. https://doi.org/10.1188/09.ONF.300-305 

Lopez, K. A., & Willis, D. G. (2004). Descriptive versus interpretive phenomenology: Their 

contributions to nursing knowledge. Qualitative Health Research, 14(5), 726–735. 

https://doi.org/10.1177/1049732304263638 

Magnuson, C. D., & Barnett, L. A. (2013). The playful advantage: How playfulness enhances 

coping with stress. Leisure Sciences, 35(2), 129–144. 

https://doi.org/10.1080/01490400.2013.761905 

Maharaj, N. (2013). The significance of companion dogs in the everyday lives of their human 

caregivers (Unpublished master’s thesis). University of British Columbia, Vancouver, 

BC. 

Maharaj, N., & Haney, C. J. (2015). A qualitative investigation of the significance of companion 

dogs. Western Journal of Nursing Research, 37(9), 1175–1193. 

https://doi.org/10.1177/0193945914545176 

Maharaj, N., Kazanjian, A., & Haney, C. J. (2016). The human–canine bond: A sacred 

relationship. Journal of Spirituality in Mental Health, 18(1), 76–89. 

https://doi.org/10.1080/19349637.2015.1047922 



230 

 

 

Maller, C., Townsend, M., Pryor, A., Brown, P., & St Leger, L. (2006). Healthy nature healthy 

people: ‘Contact with nature’ as an upstream health promotion intervention for 

populations. Health Promotion International, 21(1), 45–54. 

https://doi.org/10.1093/heapro/dai032 

Manes, C. (1997). Other creations: Rediscovering the spirituality of animals. New York, NY: 

Doubleday. 

Marcus, D. A. (2012a). Complementary medicine in cancer care: Adding a therapy dog to the 

team. Current Pain and Headache Reports, 16(4), 289–291. 

https://doi.org/10.1007/s11916-012-0264-0 

Marcus, D. A. (2012b). Therapy dogs in cancer care: A valuable complementary treatment. New 

York, NY: Springer. 

Marcus, D. A. (2013a). The role of volunteer services at cancer centers. Current Pain and 

Headache Reports, 17(11), 376. https://doi.org/10.1007/s11916-013-0376-1 

Marcus, D. A. (2013b). The science behind animal-assisted therapy. Current Pain and Headache 

Reports, 17(4), 322. https://doi.org/10.1007/s11916-013-0322-2 

Marcus, D. A., Blazek-O’Neill, B., & Kopar, J. L. (2014). Symptom reduction identified after 

offering animal-assisted activity at a cancer infusion center. The American Journal of 

Hospice & Palliative Care, 31(4), 420–421. https://doi.org/10.1177/1049909113492373 

Mays, N., Pope, C., & Popay, J. (2005). Details of approaches to synthesis a methodological 

appendix to the paper: Systematically reviewing qualitative and quantitative evidence to 

inform management and policy making in the health field. [Technical Report]. Ottawa, 

Canada: Canadian Health Services Research Foundation/NHS Service Delivery and 

Organisation R&D Programme. 



231 

 

 

McConnell-Henry, T., Chapman, Y., & Francis, K. (2011). Member checking and Heideggerian 

phenomenology: A redundant component. Nurse Researcher, 18(2), 28–37. 

https://doi.org/10.7748/nr2011.01.18.2.28.c8282 

McCorkle, R., Ercolano, E., Lazenby, M., Schulman-Green, D., Schilling, L. S., Lorig, K., & 

Wagner, E. H. (2011). Self-management: Enabling and empowering patients living with 

cancer as a chronic illness. CA: A Cancer Journal for Clinicians, 61(1), 50–62. 

https://doi.org/10.3322/caac.20093 

McElroy, S. C. (1998). Animals as guides for the soul. New York, NY: Ballantine. 

McNicholas, J., Gilbey, A., Rennie, A., Ahmedzai, S., Dono, J.-A., & Ormerod, E. (2005). Pet 

ownership and human health: A brief review of evidence and issues. BMJ (Clinical 

Research Ed.), 331(7527), 1252–1254. https://doi.org/10.1136/bmj.331.7527.1252 

McPhedran, S. (2011). Urbanization and animal cruelty: What role does utilitarianism play? In 

C. Blazina, G. Boyraz, & D. Shen-Miller (Eds.), The psychology of the human-animal 

bond: A resource for clinicians and researchers (pp. 263–274). New York, NY: Springer. 

Meezenbroek, E. de J., Garssen, B., Berg, M. van den, Dierendonck, D. van, Visser, A., & 

Schaufeli, W. B. (2010). Measuring spirituality as a universal human experience: A 

review of spirituality questionnaires. Journal of Religion and Health, 51(2), 336–354. 

https://doi.org/10.1007/s10943-010-9376-1 

Mehnert, A., Koch, U., Schulz, H., Wegscheider, K., Weis, J., Faller, H., … Härter, M. (2012). 

Prevalence of mental disorders, psychosocial distress and need for psychosocial support 

in cancer patients—Study protocol of an epidemiological multi-center study. BMC 

Psychiatry, 12, 70. https://doi.org/10.1186/1471-244X-12-70 

Mensch, J. R. (2003). Ethics and selfhood. New York, NY: State University of New York Press. 



232 

 

 

Merleau-Ponty, M. (2012). Phenomenology of perception (D. A. Landes, Trans.). New York, 

NY: Routledge. 

Merrick, M. T. (2009). Environmental epiphanies: Exploring the shifts in human-nature 

interactions (Unpublished doctoral dissertation). University of Illinois at Urbana-

Champaign, Illinois. 

Migdal, L., & MacDonald, D. A. (2013). Clarifying the relation between spirituality and well-

being. The Journal of Nervous and Mental Disease, 201(4), 274–280. 

https://doi.org/10.1097/NMD.0b013e318288e26a 

Miles, M. B., Huberman, A. M., & Saldana, J. (2014). Qualitative data analysis: A methods 

sourcebook (3rd ed.). Thousand Oaks, CA: Sage Publications, Inc. 

Molassiotis, A., Panteli, V., Patiraki, E., Ozden, G., Platin, N., Madsen, E., … Margulies, A. 

(2006). Complementary and alternative medicine use in lung cancer patients in eight 

European countries. Complementary Therapies in Clinical Practice, 12(1), 34–39. 

https://doi.org/10.1016/j.ctcp.2005.09.007 

Molzahn, A., Sheilds, L., Bruce, A., Stajduhar, K., Makaroff, K. S., Beuthin, R., & Shermak, S. 

(2012). People living with serious illness: Stories of spirituality. Journal of Clinical 

Nursing, 21(15–16), 2347–2356. https://doi.org/10.1111/j.1365-2702.2012.04196.x 

Morey, D. F. (2006). Burying key evidence: The social bond between dogs and people. Journal 

of Archaeological Science, 33(2), 158–175. https://doi.org/10.1016/j.jas.2005.07.009 

Morley, C., & Fook, J. (2005). The importance of pet loss and some implications for services. 

Mortality, 10(2), 127–143. https://doi.org/10.1080/13576270412331329849 



233 

 

 

Morrow, S. L. (2007). Qualitative research in counseling psychology: Conceptual foundations. 

The Counseling Psychologist, 35(2), 209–235. 

https://doi.org/10.1177/0011000006286990 

Mosteller, J. (2008). Animal-companion extremes and underlying consumer themes. Journal of 

Business Research, 61(5), 512–521. https://doi.org/10.1016/j.jbusres.2007.07.004 

Murph, P. (2010). Psychosocial aspects of cancer care: What does it mean for our patients and 

families? Home Healthcare Nurse, 28(9), 533–540. 

https://doi.org/10.1097/NHH.0b013e3181f2f3b6 

Muschel, I. J. (1984). Pet therapy with terminal cancer patients. Social Casework, 65(8), 451–

458. 

Nagasawa, M., Mitsui, S., En, S., Ohtani, N., Ohta, M., Sakuma, Y., … Kikusui, T. (2015). 

Oxytocin-gaze positive loop and the coevolution of human-dog bonds. Science, 

348(6232), 333–336. https://doi.org/10.1126/science.1261022 

Neimeyer, R. A., Burke, L. A., Mackay, M. M., & van Dyke Stringer, J. G. (2010). Grief therapy 

and the reconstruction of meaning: From principles to practice. Journal of Contemporary 

Psychotherapy, 40(2), 73–83. https://doi.org/10.1007/s10879-009-9135-3 

Nitkin, P. (2014). Being there: Relationships between people with cancer and their pets—What 

helps and what hinders (Unpublished doctoral dissertation). University of British 

Columbia, Vancouver, BC. 

Odendaal, J. S. (2000). Animal-assisted therapy—Magic or medicine? Journal of Psychosomatic 

Research, 49(4), 275–280. 

Oh, B., Lee, K. J., Zaslawski, C., Yeung, A., Rosenthal, D., Larkey, L., & Back, M. (2017). 

Health and well-being benefits of spending time in forests: Systematic review. 



234 

 

 

Environmental Health and Preventive Medicine, 22(1), 71. 

https://doi.org/10.1186/s12199-017-0677-9 

O’Leary, V. E., & Ickovics, J. R. (1995). Resilience and thriving in response to challenge: An 

opportunity for a paradigm shift in women’s health. Women’s Health, 1(2), 121–142. 

O’Shaughnessy, P. K., Laws, T. A., & Esterman, A. J. (2015). Love, faith and hope – A 

secondary analysis of prostate cancer survivors and their partners. Contemporary Nurse, 

50(2–3), 149–168. https://doi.org/10.1080/10376178.2015.1101352 

Pachana, N. A., Massavelli, B. M., & Robleda-Gomez, S. (2011). A developmental 

psychological perspective on the human–animal bond. In C. Blazina, G. Boyraz, & D. 

Shen-Miller (Eds.), The psychology of the human-animal bond: A resource for clinicians 

and researchers (pp. 151–166). New York, NY: Springer. 

Pagani, C. (2011). Children and adolescents who are kind to animals. In C. Blazina, G. Boyraz, 

& D. Shen-Miller (Eds.), The psychology of the human-animal bond: A resource for 

clinicians and researchers (pp. 289–306). New York, NY: Springer. 

Pagani, C., Robustelli, F., & Ascione, F. R. (2008). Animal abuse experiences described by  

Italian school-aged children. In F. R. Ascione (Ed.), The international handbook of 

animal abuse and cruelty: Theory, research, and application (pp. 247–268). West 

Lafayette, IN: Purdue University Press. 

Palagi, E., Burghardt, G. M., Smuts, B., Cordoni, G., Dall’Olio, S., Fouts, H. N., … Pellis, S. M. 

(2016). Rough-and-tumble play as a window on animal communication. Biological 

Reviews, 91(2), 311–327. https://doi.org/10.1111/brv.12172 



235 

 

 

Pargament, K. I., & Mahoney, A. (2002). Spirituality: Discovering and conserving the sacred. In 

C. R. Snyder & S. J. Lopez (Eds.), The handbook of positive psychology (pp. 646–659). 

New York, NY: Oxford University Press. 

Pascale, C.-M. (2011). Cartographies of knowledge: Exploring qualitative epistemologies. 

Thousand Oaks, CA: Sage Publications, Inc. 

Pattison, N. A., & Lee, C. (2011). Hope against hope in cancer at the end of life. Journal of 

Religion and Health, 50(3), 731–742. https://doi.org/10.1007/s10943-009-9265-7 

Perrin, T. (2009). The business of urban animals survey: The facts and statistics on companion 

animals in Canada. The Canadian Veterinary Journal, 50(1), 48–52. 

Phelps, C., Butler, C., Cousins, A., & Hughes, C. (2015). Sowing the seeds or failing to 

blossom? A feasibility study of a simple ecotherapy-based intervention in women 

affected by breast cancer. Ecancermedicalscience, 9. 

https://doi.org/10.3332/ecancer.2015.602 

Pisarik, C. T., & Larson, K. R. (2011). Facilitating college students’ authenticity and 

psychological well-being through the use of mandalas: An empirical study. The Journal 

of Humanistic Counseling, 50(1), 84–98. https://doi.org/10.1002/j.2161-

1939.2011.tb00108.x 

Podberscek, A. L., Paul, E. S., & Serpell, J. A. (2000). Companion animals and us. Cambridge: 

Cambridge University Press. 

Pope, A. (n.d.). An essay on man: Epistle I. Retrieved May 20, 2017, from Poetry foundation 

website: https://www.poetryfoundation.org/poems/44899/an-essay-on-man-epistle-i 

Power, E. (2008). Furry families: Making a human–dog family through home. Social & Cultural 

Geography, 9(5), 535–555. https://doi.org/10.1080/14649360802217790 



236 

 

 

Power, E. R. (2013). Dogs and practices of community and neighboring. Anthrozoös, 26(4), 579–

591. https://doi.org/10.2752/175303713X13795775536011 

Raque-Bogdan, T. L., Hoffman, M. A., Ginter, A. C., Piontkowski, S., Schexnayder, K., & 

White, R. (2015). The work life and career development of young breast cancer 

survivors. Journal of Counseling Psychology, 62(4), 655–669. 

https://doi.org/10.1037/cou0000068 

Reynolds, J. S., & Perrin, N. A. (2004). Mismatches in social support and psychosocial 

adjustment to breast cancer. Health Psychology, 23(4), 425–430. 

https://doi.org/10.1037/0278-6133.23.4.425 

Richardson, A. (2004). Creating a culture of compassion: Developing supportive care for people 

with cancer. European Journal of Oncology Nursing: The Official Journal of European 

Oncology Nursing Society, 8(4), 293–305. https://doi.org/10.1016/j.ejon.2004.07.004 

Riley, S. (2015). Listen to me Marlon [Documentary, Motion Picture]. United States: Universal 

Pictures. 

Rilke, R. M. (1992). The notebooks of Malte Laurids Brigge (M. D. Herter Norton, Trans.). New 

York, NY: W. W. Norton &  Company. 

Rindstedt, C. (2014). Children’s strategies to handle cancer: A video ethnography of imaginal 

coping. Child: Care, Health and Development, 40(4), 580–586. 

https://doi.org/10.1111/cch.12064 

Romero, T., Nagasawa, M., Mogi, K., Hasegawa, T., & Kikusui, T. (2015). Intranasal 

administration of oxytocin promotes social play in domestic dogs. Communicative & 

Integrative Biology, 8(3). https://doi.org/10.1080/19420889.2015.1017157 



237 

 

 

Rooney, N. J., Bradshaw, J. W. S., & Robinson, I. H. (2001). Do dogs respond to play signals 

given by humans? Animal Behaviour, 61(4), 715–722. 

https://doi.org/10.1006/anbe.2000.1661 

Rose, G. (2003). Family photographs and domestic spacings: A case study. Transactions of the 

Institute of British Geographers, 28(1), 5–18. https://doi.org/10.1111/1475-5661.00074 

Ryan, S., & Ziebland, S. (2015). On interviewing people with pets: Reflections from qualitative 

research on people with long-term conditions. Sociology of Health & Illness, 37(1), 67–

80. https://doi.org/10.1111/1467-9566.12176 

Sakson, S. (2009). Paws & effect: The healing power of dogs. New York, NY: Spiegel & Grau. 

Salazar Kämpf, M., Liebermann, H., Kerschreiter, R., Krause, S., Nestler, S., & Schmukle, S. C. 

(2018). Disentangling the sources of mimicry: Social relations analyses of the link 

between mimicry and liking. Psychological Science, 29(1), 131–138. 

https://doi.org/10.1177/0956797617727121 

Sanders, C. R. (1993). Understanding dogs: Caretakers’ attributions of mindedness in canine-

human relationships. Journal of Contemporary Ethnography, 22(2), 205–226. 

https://doi.org/10.1177/089124193022002003 

Sandoe, P., Corr, S., & Palmer, C. (2015). Companion animal ethics. West Sussex: Wiley- 

Blackwell. 

Sarason, B. R., Pierce, G. R., & Sarason, I. G. (1990). Social support: The sense of acceptance  

and the role of relationships. In B. R. Sarason, I. G. Sarason, & G. R. Pierce (Eds.), 

Social support: An interactional view (pp. 97–128). New York, NY: Wiley. 



238 

 

 

Savage, B. M., Lujan, H. L., Thipparthi, R. R., & DiCarlo, S. E. (2017). Humor, laughter, 

learning, and health! A brief review. Advances in Physiology Education, 41(3), 341–347. 

https://doi.org/10.1152/advan.00030.2017 

Schaepe, C., & Bergjan, M. (2015). Educational interventions in peritoneal dialysis: A narrative 

review of the literature. International Journal of Nursing Studies, 52(4), 882–898. 

https://doi.org/10.1016/j.ijnurstu.2014.12.009 

Scioli, A., Scioli-Salter, E. R., Sykes, K., Anderson, C., & Fedele, M. (2016). The positive 

contributions of hope to maintaining and restoring health: An integrative, mixed-method 

approach. The Journal of Positive Psychology, 11(2), 135–148. 

https://doi.org/10.1080/17439760.2015.1037858 

Senreich, E. (2013). An inclusive definition of spirituality for social work education and practice. 

Journal of Social Work Education, 49(4), 548–563. 

https://doi.org/10.1080/10437797.2013.812460 

Serpell, J. A. (2003). Anthropomorphism and anthropomorphic selection—Beyond the “cute 

response.” Society &amp; Animals, 11(1), 83–100. 

https://doi.org/10.1163/156853003321618864 

Sharkin, B., S., & Ruff, L. A. (2011). Broken bonds: Understanding the experience of pet 

relinquishment. In C. Blazina, G. Boyraz, & D. Shen-Miller (Eds.), The psychology of the 

human-animal bond: A resource for clinicians and researchers (pp. 275–288). New 

York, NY: Springer. 

Shen-Miller, D. (2011). Qualitative directions in human-animal companion research. In C. 

Blazina, G. Boyraz, & D. Shen-Miller (Eds.), The psychology of the human-animal bond: 

A resource for clinicians and researchers (pp. 361–382). New York, NY: Springer. 



239 

 

 

Sidenius, U., Stigsdotter, U. K., Poulsen, D. V., & Bondas, T. (2017). “I look at my own forest 

and fields in a different way”: The lived experience of nature-based therapy in a therapy 

garden when suffering from stress-related illness. International Journal of Qualitative 

Studies on Health and Well-Being, 12(1), 1–14. 

https://doi.org/10.1080/17482631.2017.1324700 

Siegel, J. (2011). Pet ownership and health. In C. Blazina, G. Boyraz, & D. Shen-Miller (Eds.), 

The psychology of the human-animal bond: A resource for clinicians and researchers 

(pp. 167–180). New York, NY: Springer. 

Skeen, J. (2011). What humans can learn from horses about being whole. In C. Blazina, G. 

Boyraz, & D. Shen-Miller (Eds.), The psychology of the human-animal bond: A resource 

for clinicians and researchers (pp. 81–106). New York, NY: Springer. 

Slakov, J., & Leslie, M. (2003). A creative model for a post-treatment group for women with 

cancer. Canadian Journal of Counselling/Revue Canadienne de Counseling, 37(1), 6–15. 

Smith, B. P., & Litchfield, C. A. (2009). A review of the relationship between Indigenous 

Australians, dingoes (canis dingo) and domestic dogs (canis familiaris). Anthrozoös, 

22(2), 111–128. https://doi.org/10.2752/175303709X434149 

Smith, J. A., Flowers, P., & Larkin, M. (2009). Interpretative phenomenological analysis: 

Theory, method and research. Thousand Oaks, CA: Sage. 

Smith, J. A., & Osborn, M. (2008). Interpretative phenomenological analysis. In J. A. Smith 

(Ed.), Qualitative psychology: A practical guide to research methods (2nd ed., pp. 53–

80). Los Angeles, CA: Sage Publications. 

Smith, S. K., Herndon, J. E., Lyerly, H. K., Coan, A., Wheeler, J. L., Staley, T., & Abernethy, A. 

P. (2011). Correlates of quality of life-related outcomes in breast cancer patients 



240 

 

 

participating in the Pathfinders pilot study. Psycho-Oncology, 20(5), 559–564. 

https://doi.org/10.1002/pon.1770 

Snyder, C. R. (1994). The psychology of hope: You can get there from here. New York, NY: 

Simon and Schuster. 

Snyder, C. R. (2002). Hope Theory: Rainbows in the Mind. Psychological Inquiry, 13(4), 249–

275. Retrieved from JSTOR. 

Sommerville, R., O’Connor, E. A., & Asher, L. (2017). Why do dogs play? Function and welfare 

implications of play in the domestic dog. Applied Animal Behaviour Science, 197, 1–8. 

https://doi.org/10.1016/j.applanim.2017.09.007 

Staats, S., Sears, K., & Pierfelice, L. (2006). Teachers’ pets and why they have them: An 

investigation of the human animal bond. Journal of Applied Social Psychology, 36(8), 

1881–1891. https://doi.org/10.1111/j.0021-9029.2006.00086.x 

StGeorge, J. M., Goodwin, J. C., & Fletcher, R. J. (2018). Parents’ views of father–child rough-

and-tumble play. Journal of Child and Family Studies, 27(5), 1502–1512. 

https://doi.org/10.1007/s10826-017-0993-0 

Streng, F. J. (1976). Understanding religious life. Encino, CA: Dickenson. 

Strickler, B. L., & Shull, E. A. (2014). An owner survey of toys, activities, and behavior 

problems in indoor cats. Journal of Veterinary Behavior, 9(5), 207–214. 

https://doi.org/10.1016/j.jveb.2014.06.005 

Stull, J. W., Brophy, J., & Weese, J. S. (2015). Reducing the risk of pet-associated zoonotic 

infections. CMAJ: Canadian Medical Association Journal, 187(10), 736–743. 

https://doi.org/10.1503/cmaj.141020 



241 

 

 

Tannen, D. (2004). Talking the dog: Framing pets as interactional resources in family discourse. 

Research on Language and Social Interaction, 37(4), 399–420. 

https://doi.org/10.1207/s15327973rlsi3704_1 

The RSA. (2013). Brene Brown on empathy [Video file]. Retrieved from 

https://www.youtube.com/watch?v=1Evwgu369Jw 

Thomas, D. W. (2015). Whole-pet healing: A heart-to-heart guide to connecting with and caring  

for your animal companion. Carlsbad, California: Hay House. 

Tighe, M., Molassiotis, A., Morris, J., & Richardson, J. (2011). Coping, meaning and symptom 

experience: A narrative approach to the overwhelming impacts of breast cancer in the 

first year following diagnosis. European Journal of Oncology Nursing: The Official 

Journal of European Oncology Nursing Society, 15(3), 226–232. 

https://doi.org/10.1016/j.ejon.2011.03.004 

Trevino, K. M., Balboni, M., Zollfrank, A., Balboni, T., & Prigerson, H. G. (2014). Negative 

religious coping as a correlate of suicidal ideation in patients with advanced cancer. 

Psycho-Oncology, 23(8), 936–945. https://doi.org/10.1002/pon.3505 

Tsai, J.-S., Chen, S.-C., Chiu, T.-Y., Leung, K.-K., Hu, W.-Y., Hung, S.-H., … Chen, C.-Y. 

(2012). Correlates of fatigue phenomenon in palliative care patients with advance cancers 

in Taiwan. Journal of Palliative Medicine, 15(7), 737–743. 

https://doi.org/10.1089/jpm.2011.0525 

Tsai, Y.-F. (Lily), & Kaufman, D. (2014). Interacting with a computer-simulated pet: Factors 

influencing children’s humane attitudes and empathy. Journal of Educational Computing 

Research, 51(2), 145–161. https://doi.org/10.2190/EC.51.2.a 



242 

 

 

Urbanski, B. L., & Lazenby, M. (2012). Distress among hospitalized pediatric cancer patients 

modified by pet-therapy intervention to improve quality of life. Journal of Pediatric 

Oncology Nursing, 29(5), 272–282. https://doi.org/10.1177/1043454212455697 

Vachon, M. L. S. (2008). Meaning, spirituality, and wellness in cancer survivors. Seminars in 

Oncology Nursing, 24(3), 218–225. https://doi.org/10.1016/j.soncn.2008.05.010 

Valeri, R. M. (2006). Tails of laughter: A pilot study examining the relationship between 

companion animal guardianship and laughter. Society & Animals, 14(3), 275–293. 

van der Spek, N., Vos, J., van Uden-Kraan, C. F., Breitbart, W., Tollenaar, R. A. E. M., Cuijpers, 

P., & Verdonck-de Leeuw, I. M. (2013). Meaning making in cancer survivors: A focus 

group study. PloS One, 8(9), e76089. https://doi.org/10.1371/journal.pone.0076089 

van Manen, M. (1997). Researching lived experience: Human science for an action sensitive 

pedagogy. Walnut Creek, California: Left Coast Press. 

van Manen, M. (2014). Phenomenology of practice: Meaning-giving methods in 

phenomenological research and writing. Walnut Creek, California: Left Coast Press. 

van Manen, M., & Adams, C. (2010). Phenomenological research. In C. Kridel (Ed.), 

Encyclopedia of curriculum studies (pp. 1–6). Thousand Oaks, CA: Sage Publications. 

Vennet, R. van der, & Serice, S. (2012). Can coloring mandalas reduce anxiety? A replication 

study. Art Therapy, 29(2), 87–92. https://doi.org/10.1080/07421656.2012.680047 

Vianna, D., Claro, L. L., Mendes, A. A., da Silva, A. N., Bucci, D. A., de Sá, P. T., … Silva, P. 

R. (2013). Infusion of life: Patient perceptions of expressive therapy during 

chemotherapy sessions. European Journal of Cancer Care, 22(3), 377–388. 

https://doi.org/10.1111/ecc.12041 



243 

 

 

Virués-Ortega, J., & Buela-Casal, G. (2006). Psychophysiological effects of human-animal 

interaction: Theoretical issues and long-term interaction effects. The Journal of Nervous 

and Mental Disease, 194(1), 52–57. 

https://doi.org/10.1097/01.nmd.0000195354.03653.63 

Visser, A., Garssen, B., & Vingerhoets, A. (2010). Spirituality and well-being in cancer patients: 

A review. Psycho-Oncology, 19(6), 565–572. https://doi.org/10.1002/pon.1626 

Vitale Shreve, K. R., & Udell, M. A. R. (2017). Stress, security, and scent: The influence of 

chemical signals on the social lives of domestic cats and implications for applied settings. 

Applied Animal Behaviour Science, 187, 69–76. 

https://doi.org/10.1016/j.applanim.2016.11.011 

Vitztum, C. (2013). Human-animal interaction: A concept analysis. International Journal of 

Nursing Knowledge, 24(1), 30–36. https://doi.org/10.1111/j.2047-3095.2012.01219.x 

Waldrop, D. P., O’Connor, T. L., & Trabold, N. (2011a). Waiting for the other shoe to drop: 

Distress and coping during and after treatment for breast cancer. Journal of Psychosocial 

Oncology, 29(4), 450–473. https://doi.org/10.1080/07347332.2011.582638 

Waldrop, D. P., O’Connor, T. L., & Trabold, N. (2011b). “Waiting for the other shoe to drop:” 

distress and coping during and after treatment for breast cancer. Journal of Psychosocial 

Oncology, 29(4), 450–473. 

Walsh, F. (2009a). Human-animal bonds I: The relational significance of companion animals. 

Family Process, 48(4), 462–480. https://doi.org/10.1111/j.1545-5300.2009.01296.x 

Walsh, F. (2009b). Human-animal bonds I: The relational significance of companion animals. 

Family Process, 48(4), 462–480. https://doi.org/10.1111/j.1545-5300.2009.01296.x 



244 

 

 

Walsh, F. (2009c). Human-animal bonds II: The role of pets in family systems and family 

therapy. Family Process, 48(4), 481–499. https://doi.org/10.1111/j.1545-

5300.2009.01297.x 

Webb, T. L., Miles, E., & Sheeran, P. (2012). Dealing with feeling: A meta-analysis of the 

effectiveness of strategies derived from the process model of emotion regulation. 

Psychological Bulletin, 138(4), 775–808. https://doi.org/10.1037/a0027600 

Wells, D. L. (2009a). The Effects of Animals on Human Health and Well-Being. Journal of 

Social Issues, 65(3), 523–543. https://doi.org/10.1111/j.1540-4560.2009.01612.x 

Wells, D. L. (2009b). The effects of animals on human health and well-being. Journal of Social 

Issues, 65(3), 523–543. https://doi.org/10.1111/j.1540-4560.2009.01612.x 

Wells, D. L. (2012). Dogs as a diagnostic tool for ill health in humans. Alternative Therapies in 

Health and Medicine, 18(2), 12–17. 

Wenninger, K., Helmes, A., Bengel, J., Lauten, M., Völkel, S., & Niemeyer, C. M. (2013). 

Coping in long-term survivors of childhood cancer: Relations to psychological distress. 

Psycho-Oncology, 22(4), 854–861. https://doi.org/10.1002/pon.3073 

Whittemore, R., Chase, S. K., & Mandle, C. L. (2001). Validity in qualitative research. 

Qualitative Health Research, 11(4), 522–537. 

https://doi.org/10.1177/104973201129119299 

Williamson, C. (2008). Dolphin assisted therapy: Can swimming with dolphins be a suitable 

treatment? Developmental Medicine & Child Neurology, 50(6), 477–477. 

https://doi.org/10.1111/j.1469-8749.2008.00477.x 



245 

 

 

Wills, T. A., & Ainette, M. C. (2012). Social networks and social support. In A. Baum, T. A. 

Revenson, & J. Singer (Eds.), Handbook of health psychology (pp. 465–492). New York, 

NY: Psychology Press. 

Winnicott, D. W. (1971). Playing and reality. Middlesex: Penguin Books. 

Wisdom, J. P., Saedi, G. A., & Green, C. A. (2009). Another breed of service animals: STARS 

study findings about pet ownership and recovery from serious mental illness. The 

American Journal of Orthopsychiatry, 79(3), 430–436. https://doi.org/10.1037/a0016812 

Wood, L., Martin, K., Christian, H., Nathan, A., Lauritsen, C., Houghton, S., … McCune, S. 

(2015). The pet factor—Companion animals as a conduit for getting to know people, 

friendship formation and social support. PLoS ONE, 10(4). 

https://doi.org/10.1371/journal.pone.0122085 

Worsley, H. K., & O’Hara, S. J. (2018). Cross-species referential signalling events in domestic 

dogs (Canis familiaris). Animal Cognition, 21(4), 457–465. 

https://doi.org/10.1007/s10071-018-1181-3 

Wright, J. D., Kritz-Silverstein, D., Morton, D. J., Wingard, D. L., & Barrett-Connor, E. (2007). 

Pet ownership and blood pressure in old age. Epidemiology (Cambridge, Mass.), 18(5), 

613–618. https://doi.org/10.1097/EDE.0b013e3181271398 

Würbel, H. (2009a). Ethology applied to animal ethics. Applied Animal Behaviour Science, 

118(3), 118–127. https://doi.org/10.1016/j.applanim.2009.02.019 

Würbel, H. (2009b). The state of ethological approaches to the assessment of animal suffering 

and welfare. Applied Animal Behaviour Science, 118(3), 105–107. 

https://doi.org/10.1016/j.applanim.2009.02.021 

Yalom, I. D. (1980). Existential psychotherapy. New York, NY: Basic Books. 



246 

 

 

Yalom, I. D., & Josselson, R. (2011). Existential psychotherapy. In R. J. Corsini & D. Wedding 

(Eds.), Current psychotherapies (9th ed., pp. 310–341). Belmont, California: 

Brooks/Cole. 

Yeung, N. C. Y., Lu, Q., & Lin, W. (2014). Specificity may count: Not every aspect of coping 

self-efficacy is beneficial to quality of life among Chinese cancer survivors in China. 

International Journal of Behavioral Medicine, 21(4), 629–637. 

https://doi.org/10.1007/s12529-014-9394-6 

Yontef, G., & Jacobs, L. (2011). Gestalt therapy. In R. J. Corsini & D. Wedding (Eds.), Current 

psychotherapies (9th ed., pp. 342–382). Belmont, California: Brooks/Cole. 

Youll, J., & Meekosha, H. (2013). Always look on the bright side of life: Cancer and positive 

thinking. Journal of Sociology, 49(1), 22–40. https://doi.org/10.1177/1440783311417742 

Zimolag, U. U. (2011). An evolutionary concept analysis of caring for a pet as an everyday 

occupation. Journal of Occupational Science, 18(3), 237–253. 

https://doi.org/10.1080/14427591.2011.586325 

  

 

 



247 

 

 

Appendices 

Appendix A  Literature Review Search Strategy 

Sources: A search was conducted of PubMed, CINAHL, PsycINFO, and Academic Search 

Premier. The following search terms were used to identify peer-reviewed papers published in 

English from 2006 to 2016: “cancer,” “companion animal,” “spiritual,” “meaning,” and “self-

efficacy.” An updated search was carried out in 2018 to capture additional papers.  

 

Methods: After title screening, papers were selected for full review if the abstract contained the 

terms “pet” or “animal” AND “cancer” or “oncology.” Papers addressing the following subject 

areas were excluded: comparative oncology, veterinary oncology, and farm animal studies. 

Additional data sources came from books and reference lists of empirical studies and review 

papers. Papers were presented and discussed with the doctoral supervisory committee.  

 

Results: The initial search returned over 3000 results. After removing duplicate entries and 

refining the search strategy using MeSH terms (e.g. Human-Pet Bonding), 207 papers were 

retrieved. The final selection of papers (n=44) were screened and sorted based on their relevance 

to the topic. Of these, 10 papers were focused on cancer and companion animals (Figure 3). 

 

 

 

  

 

 

 

 

 

 

 

 

 

Figure 1 Title and abstract screening to identify primary and secondary literature   

Total N 

retrieved = 207  

Articles for screening = 57 

 

PubMed (4), CINAHL (23), 

PsycINFO (21), and Academic 

Search Premier (9) 

Cancer and companion animals (10), 

cancer and self-efficacy (6), cancer and 

spirituality (11), companion animals and 

self-efficacy (12), and companion animals 

and spirituality (5) 

44 articles accessed 

for full text and 

included in analysis 

Duplications = 13  



248 

 

 

 
 

Appendix B  Recruitment Poster 

                  a place of mind 

                  THE UNIVERSITY  OF  BRITISH COLUMBIA 

 

 

THE SIGNIFICANCE OF PETS FOR A 
PERSON’S CANCER JOURNEY 

 

We are conducting a study on how people experience their relationship 
with their pet as they are living with and recovering from cancer 
 
We are hoping to learn what makes the human-pet relationship, unique and 
meaningful to people who have had a cancer diagnosis for a period of at 
least 6 months 
 
We are interested in speaking with people who see their relationship with 
their cat or dog as important to their cancer journey 
 
The Principal Investigator for this study is Dr. Arminée Kazanjian, Professor in the 
School of Population and Public Health at the University of British Columbia, (604) 822-
4618 
 

 

You may be eligible to participate if you: 
 

 Were diagnosed with cancer at least 6 months ago and have had time to think 
about the importance of your pet since then 

 Currently have a cat or dog 
 Are at least 19 years old and fluent in written and spoken English 
 Are willing to talk about your experiences in a confidential interview lasting 

between 1 and 2 hours 

 

You will receive $25 to thank you for your participation 
 

If you would like to participate, or would like further information about this 
study, please contact Nandini Maharaj by email at n.maharaj@alumni.ubc.ca 
or by phone at 778-389-0823 

 

Thank you for your interest in the study!   
 



249 

 

 

Appendix C  Consent Form 

T H E  U N I V E R S I T Y  O F  B R I T I S H  C O L U M B I A 

School of Population and Public Health 

 

 

2206 East Mall 

Vancouver, B.C. Canada  V6T 1Z3 

 

Tel:  (604) 822-2772 

Fax:  (604) 822-4994 

Website: www.spph.ubc.ca 

 

Consent Form 

 

The Significance of Pets for a Person’s Cancer Journey 

 

 

Title of the Study: Exploring the Lived Experience of the Human-companion Animal 

Relationship for People with Cancer 

 

 

Who is conducting the study? 

 

Principal Investigator:    

Arminée Kazanjian, DrSoc, Professor, UBC School of Population and Public Health 

Phone: (604) 822-4618 

 

Co-Investigator(s):   

 

William Borgen, PhD, Professor, UBC Department of Educational & Counselling 

Psychology, and Special Education  

Phone: (604) 822-5261 

 

Nandini Maharaj, PhD Candidate, Graduate Student, UBC Interdisciplinary Studies 

Graduate Program  

Phone: (778) 389-0823 

 

This research is part of Ms. Maharaj’s dissertation (public document) in fulfillment of 

a Doctoral Degree in Interdisciplinary Studies at the University of British Columbia. 

The principal investigator and supervisor of this research is Dr. Arminée Kazanjian.  

 

 



250 

 

 

Who is funding this study? 

 

The study is being funded by the Social Sciences and Humanities Research Council 

(SSHRC), through a doctoral fellowship (Grant 752-2016-2368) to Nandini Maharaj.  

 

Why should you take part in this study? Why are we doing this study? 

 

The purpose of this study is to learn more about how people with cancer experience 

their relationship with their pets (cats, dogs). Research suggests that close, satisfying 

relationships are important for a person’s well-being. Some people see their pets as 

an important and meaningful connection. With the exception of research on cancer 

patients and therapy animals, few studies have explored the relationship between 

people with cancer and their own pets. Therefore, the aim of this study is to 

understand the meaning and significance of pets for people who are living with and 

recovering from cancer. 

 

 

What happens if you say “Yes, I want to be in the study”?  

 

If you say ‘Yes’, you will be interviewed in person for between 1 to 2 hours at a 

convenient place of your choice. We will be asking you to describe meaningful 

experiences that you have shared with your pet since you were diagnosed with 

cancer. We are particularly interested in collecting detailed stories that will help us to 

capture the meaning and significance of pets for people in their cancer journey. We 

will ask you to complete a short demographic survey (e.g. age, gender), the results 

of which will be used to describe, in general terms, the group of participants in the 

study. The interview will be audio-taped, transcribed, and analyzed for themes and 

patterns. 

Photos of pets: You are invited to bring in photos of your pets to discuss during the 

interview. The photos can be cell phone images, for example, of daily experiences or 

particular events that you would like to share and that are meaningful to you.    

 

To ensure confidentiality, any personal or identifying information will be removed and 

a study identification number will be assigned to keep track of individual stories. The 

data file containing participants’ names will be encrypted (i.e. the information is 

unreadable) and password protected in the Principal Investigator’s secure office. 

Only members of the research team will have access to the data. The data will be 

held for at least 5 years after the study is completed and will then be destroyed in 



251 

 

 

accordance with UBC policy. 

 

 

How will the results be used? 

 

The information that you provide in the interviews will be analyzed and reported in 

a doctoral dissertation. The study findings may also be published in journal articles 

or presented at academic conferences. Upon completion of the study, the 

dissertation will be a public document that can be viewed through the UBC 

library. Your name and your pets’ name(s) will not be included in any research 

reports or presentations. You have the option of receiving a brief summary of the 

findings.  

 

Is there any way being in this study could be bad for you? 

 

There are no known risks for participating in this study. If some of the questions seem 

sensitive or personal, you can choose not to answer.  

 

Will being in this study help you in any way? What are the benefits of participating? 

 

By taking part in this study, you will have the opportunity to share your experience 

with a group of researchers and inform research in this area. You may be helping 

future cancer patients and survivors by helping to communicate the importance of 

pets to health care professionals in research, academic, and cancer care 

communities.  

 

How will your identity be protected? How will your privacy be maintained? Measures 

to maintain confidentiality 

 

Your confidentiality will be strictly respected. The principal investigator, co-

investigators, and research assistants will have access to the audio recordings and 

raw data. All study data will be identified only by a code number and kept in either 

a locked filing cabinet or in password secured computers. The tapes and transcripts 

will be kept for at least five years after the study is completed and will then be 

destroyed in accordance with UBC policy. In any reports of the completed study, 

you and your pet(s) will not be identified by name.  

 



252 

 

 

 

Will you be paid for your time/ taking part in this research study? 

 

You will receive $25 for your participation in this study. Your participation is entirely 

voluntary.  

 

 

Whom can you contact if you have questions about the study? 

 

If you have questions about the project, you can contact the Principal investigator, 

Dr. Arminée Kazanjian (tel: 604-822-4618, arminee.kazanjian@ubc.ca). 

To participate: Please call Nandini (Nan) Maharaj at (778) 389-0823 or send an email 

to n.maharaj@alumni.ubc.ca  

 

 

Whom can you contact if you have complaints or concerns about the study? 

 

If you have any concerns or complaints about your rights as a research participant 

and/or your experiences while participating in this study, contact the Research 

Participant Complaint Line in the UBC Office of Research Ethics at 604-822-8598 or if 

long distance e-mail RSIL@ors.ubc.ca or call toll free 1-877-822-8598. 

 

 

Consent 

 

 Taking part in this study is entirely up to you. You have the right to refuse to 

participate in this study. If you decide to take part, you may choose to 

withdraw from the study at any time without giving a reason and without any 

repercussions or negative impact.  

 

 Your signature below indicates that you consent to participate in this study and 

that you have received a copy of this consent form for your own records. 

  

    

_________________________________________________________________________ 

Participant Signature     Date 

 

 

 



253 

 

 

____________________________________________________ 

Printed Name of the Participant signing above 

 

 

earch      

      findings. 

 

 

  



254 

 

 

Appendix D  Interview Guide 

Interview Guide 

Purpose of the interview: I’m interested in what your relationship with your pet(s) is like, how it 

is important to you, and what it has been like over time and during your cancer journey. I had 

asked you to bring in some photos today; at any point, if there’s one that fits with what we are 

discussing, we can talk about it. Does that sound okay? 

 

You responded to the poster, (and identified yourself as someone with cancer) can you tell me 

how long your diagnosis was? 

 

 

 

Pet information: Tell me a little bit about your pet (name, age, and breed). Is this your first pet? 

When did he/she come into your life? Did you have your pet before or after your diagnosis? 

 

 

 

Can you describe your relationship with your pet and what makes this relationship important to 

you?  

 

When we go back to when you got your pet(s), what was it like then? What has it been like since 

then? 

 

If they had their pet before their diagnosis, ask: Tell me about your relationship wit h your pet 

before your diagnosis. What has it been like since then?  

 

Eliciting specific stories: Think back and try to recall a specific time during your cancer journey 

when you and your pet were really connecting. The more detail you can give is really helpful. 

 

When and how did it occur, what were you doing, what was your pet doing, describe the 

place, what did you say, what happened next, how did you feel, what was the overall 

feeling of this interaction or event? 

 

What else do you remember about this experience? 

 

What made it meaningful? What made it memorable? 

 

What was it like the first time this happened, the most recent time? 

 

Note: When participants start coming up with explanations, opinions, or generalizations, I will 

try to bring them back to the level of concrete experience by asking: Can you give an example of 

this? Do you remember a specific instance when this happened? Please describe the experience 

in as much detail as you can. 



255 

 

 

Closing question: Is there anything else that you would like to say that we haven’t covered?  

 

 

Interview Questions for Photo Elicitation: 

 

I’m interested in what led you to bring in this photo. 

 

Tell me about your experience with taking this photo.  

 

Is taking photos of your pet something you would normally do? What was happening 

right before? What was it about this experience that you wanted to capture? 

 

Can you tell me what this photo means to you? How does this represent your relationship with 

your companion animal?  

 

What were you feeling when this photo was taken? How are you experiencing the photo 

right now as we are looking at it? 

 

 

 

  



256 

 

 

 
 

Appendix E  Demographic Questionnaire 

            a place of mind 

            THE UNIVERSITY  OF  BRITISH COLUMBIA 

 

 

Demographic Questionnaire 

Please answer the following questions by filling in the blank sections or checking 

the boxes where appropriate. If there are any questions that you feel 

uncomfortable answering, you can leave them blank. 

All information provided will be kept strictly confidential. 

 

Your information: 

1. Age:   □ 19-29    □ 30-39    □ 40-49    □ 50-59    □ 60-69    □ 70 or above  

2. Gender:    □ Male     □ Female     □ Other_______________ 

3. Ethnocultural background: ____________________________________ 

4. Relationship status:   □ Single    □ Married/domestic partnership     

□ Widowed    □ Separated     □ Divorced       

5. Highest level of education completed:   □ Less than high school     

□ High school    □ University/College    □ Graduate degree    □ Other ____________ 

6. Current employment status: ________________________ 

7. Other than your pet(s), who lives in your household? Please specify their 

relationship to you (e.g. son, spouse), but no names: 

______________________________________________________________________________

______________________________________________________________________________ 

 

Cancer-related information: 

7. Type or site of cancer:  ____________________________ 



257 

 

 

8. Type of cancer treatment(s) received: _____________________________ 

9. Month and year of cancer diagnosis:  ______________________________ 

10. Month and year of last treatment:  ___________________________ 

 

Pet information: 

I have a:  

□ Cat  □ Dog     or    □ Both cat(s) and dog(s) 

Please describe each of your pets:  

For example: Buddy, 8 y/o dog, male, mixed breed  

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________ 

Have you had any pets before your current cat and/or dog?   □ Yes    □ No 

Other types of pets currently in your household: 

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________ 

 

When did your pet come into your life:   □ Before diagnosis    □ After diagnosis 

 

Reason(s) for having a pet: 

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________ 
 



258 

 

 

Appendix F  Example of Exploratory Noting and Isolating Themes  

Descriptive comments (plain text): the content of what participants said  

 

Linguistic comments (italicized): participants’ use of language, both verbal and nonverbal 

 

Conceptual annotations (underlined): the researcher’s questions, interpretations, and use of 

psychological constructs (J. A. Smith et al., 2009) 

 

Original transcript Exploratory notes Emergent themes 

P: [Sighs] I think she’s been an 

integral part of my healing. And yeah 

I just think that she’s given me a lot of 

hope you know because the other 

thing I kept thinking when I thought 

oh my god I might actually just, I 

might die, like when you’re actually 

faced with that possibility, you’re told 

that is a possibility. My oncologist 

would sometimes say the most inane 

things without thinking you know 

which doesn’t actually help anybody. 

I don’t know there was this sense in 

me that oh I couldn’t, I’d never 

considered the possibility that I would 

leave her you know [sighs deeply] and 

she is my little baby you know and I 

feel like it’s my responsibility to, I’ve 

been lucky enough that she’s you 

know come into my life and she’s my 

little, my little pal in this life you 

know and I feel like it’s my 

responsibility. What would I, you 

know I mean I know she’d probably 

be fine without me. She’d live with 

my parents or something but at the 

same time like, I wasn’t prepared to 

let that happen so she gave me that 

will to fight and to just think “no 

that’s not going to be me, I’m going to 

be one of the 50 percent who do 

survive, I’m going to be one of the 50 

percent that survive and thrive 

[emphasis]” 

Pausing to reflect before continuing 

 

Pet provides healing and hope. 
Possibly related to previous comment 

that pet is a “beacon of light”; 

something to look forward to 
Thinking about dying 

Repetition, hesitation, switching from 

first to second person pronoun 
 

Communication with doctor. Words 

can hurt, harm; related to comments: 

attach to words, words hard to erase, 
create a story around those words 

Hesitation, uncertainty  

Awareness that I might leave my pet  
Sighing, slower pace of speech 

Pet is my baby, my pal, my 

responsibility. Having a pet being 
akin to parenting, friendship. There’s 

a sense of obligation but also 

gratitude and feeling fortunate. 

Repetition of the word little. Literal 
meaning—being small but also 

speaks to caring and nurturing 

Halting speech 
There is someone to care for pet if 

she dies 

 

Fighting the disease. Will to fight, 
will to survive and thrive. Pet makes 

a difference in how she positions 

herself in relation to cancer, being a 
fighter 

Emphatic 

Beating the odds, odds may be 
against her 

 
 
Integral to healing 
 
Giving me hope 
 
Confronting death 
 
 
 
Attaching to words 
 
 
 
 
 
 
 
My responsibility 
 
 
 
 
 
 
 
 
 
 
Will to fight 
 
Survive and thrive