Facing off-time mortality: Leaving a legacy.

Considering one's legacy is usual in later life but may be accentuated after receiving a serious and terminal cancer diagnosis. This may be particularly true when timing of the diagnosis is nonnormatively early, evoking the sense of losing future years of life. Acknowledging the severity of one's illness may also promote focus on legacy. We investigated the extent to which older individuals diagnosed with cancer narrated communion (i.e., loving, caring themes) when telling their legacy, including narration of aftermath concerns (i.e., concern for how others will fare after one's death). Communion was assessed in relation to individuals' potential years of life to lose and illness acknowledgment. Participants were a national sample of adults (N = 203; M = 65.80 years; 66% women; 77.94% White; 48.53% college-educated) with serious and terminal cancer receiving outpatient palliative care. They narrated legacies in semistructured interviews and completed measures of illness acknowledgment. We developed a novel construct, potential years of life to lose, calculated as the difference between chronological age and national life expectancy at birth. Coders, trained to high reliability, content-analyzed legacy narratives for communion with follow-up coding for aftermath concerns. Hierarchical regression indicated that for those with more potential years of life to lose, acknowledging the severity of their illness was critical to narrating communion-rich legacies. Similarly, aftermath concerns were common in those with the most years of life to lose who were able to acknowledge the severity of their illness. Findings affirm the psychological richness of individuals' legacies in the second half of life and highlight one way they adaptively respond to the nonnormative timing of serious and terminal cancer. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Nursing students' empathic communication: Role in recognizing and treating chronic pain patients.

OBJECTIVE: A substantial body of research supports what many nurses know from experience: empathy is at the heart of providing quality care. The major objective of this study was to identify unique mechanisms through which higher empathy translates into greater intentions to treat patients in pain employing novel methodology. METHODS: Using an ecologically-valid scenario methodology, student nurses (N = 156) reviewed the narrative of a patient in chronic pain. They completed standard, valid measures of empathy toward the patient, perception of the patient's pain, and intention to provide pain-relieving treatment. Nursing student's personality traits were assessed and perception of patients' age and sex were experimentally manipulated. RESULTS: Empathy was associated with higher intention to treat the patient in chronic pain irrespective of patients' age or sex. A moderated-mediation analysis confirmed that nursing students with higher empathy perceived the patient in the scenario as being in greater pain. This was correspondingly associated with higher intention to provide treatment. Nursing students' trait Extraversion was a moderator. CONCLUSION: Empathy not only improves rapport between patients and providers but is related to intentions to provide pain-relieving treatment. PRACTICE IMPLICATIONS: The clinical and educational importance of empathy in patient-provider relationships are discussed.

Reflecting on death: Priorities for living well.

The positive death movement has popularized considering one's mortality. Stemming from this, Before I Die Walls erected globally prompt individual reflection on life goals, considering life's finitude. The aims of the study: (i) examined relative extent of three categories of responses to a Before I Die task, moderated by age, and (ii) tested whether purpose in life is associated with categories of Before I Die responses, moderated by age. Young, middle aged and older adults (N = 195) completed a Before I Die task (BID) and several measures including a purpose in life scale. BID task responses were reliably card-sorted into theoretically derived categories. Findings show responses most frequently represent living an Accomplished and Productive Life. Having higher purpose was related to focus on an Accomplished and Productive Life for younger adults. Before I Die walls may be a useful activity allowing adults to generate goals aligned with living well.

Narrating Final Memories From Spousal Loss: The Role of Place and Quality of Death.

Objective: Personal memories of the death of a spouse can guide bereavement adjustment. Place of death and quality of death are end-of-life factors that are likely to influence death experiences and formation of subsequent personal memories. The current study employs narrative content-analysis to examine how place and quality of death relate to affective sequences present in older adults' final memories from the death of their spouse. Method: Based on power analyses, 53 older adults were recruited and completed a Final Memory Interview. They also reported place of spouse's death (ie, in hospital, out of hospital) and quality of death across four subscales. Final memory narratives were reliably content-analyzed (interrater agreements >.70), revealing positive and negative affective sequences, including: redemption, contamination, positive stability, and negative stability. Findings: Experiencing the death of a spouse in hospital was related to narrating final memories with contamination. In terms of quality of death, reporting a less comforting social environment at time of death was related to the presence of redemption in final memories. Reporting that one's spouse received appropriate medical care related to narrating memories that showed positive stability. Conclusions: Final memories are carried with the bereaved long after their loss. Positive final memories appear to stem from witnessing a comfortable, medically appropriate death outside of a hospital setting. End-of-life 'that is' between care and aligned with patients' values for place and treatment may be critical for spouses' formation of constructive final memories and bereavement adjustment.

Recalling self-disruptive events and maintaining self-continuity in adulthood.

Older adults exhibit a stronger sense of self-continuity than the young. How do they accomplish that? The present study examines that issue using a life story lens. We investigated (a) whether older adults differ from the young when narrating self-disruptive (i.e., compared to nondisruptive) personal life events in the extent to which they focus on stability, change, and event-event connections and (b) if these ways of narrating self-disruptive events mediate relations between a person's age and sense of self-continuity. Participants (N = 185; 53% women) completed a sense of self-continuity measure and orally shared two nondisruptive and two self-disruptive life events. Event narratives were transcribed, and best practices were used for reliable content analysis. Mixed analysis of variances showed that, regardless of age, individuals narrated greater stability when recalling self-disruptive than nondisruptive life events. Older adults described less change and made more event-event connections than younger adults when recalling self-disruptive events. In mediation analyses, older adults' stronger sense of self-continuity (i.e., compared to younger adults) was partially explained by their narrating more event-event connections in recalling self-disruptive life events. Narrating more stability was not a mediator but was directly related to having a greater sense of self-continuity, regardless of age. Post hoc analyses indicated that greater narration of change was related to a lower sense of self-continuity for older, not younger, adults. We draw on lifespan and life story theories to suggest that older adults' narratives may situate self-disruptive events in larger biographical context, fostering a greater experience of self-continuity. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Adaptive and harmful autobiographical remembering after the loss of a loved one.

Objectives: Remembering one's personal past serves psychosocial functions. Adaptive use of autobiographical memory is related to well-being but little research has focused on grief. We address this in two studies theoretically grounded in the model of reminiscence and health.Method: Participants were adults who were actively grieving, and in both studies, completed the Reminiscence Functions Scale and grief-related measures (i.e. feelings of grief, positive changes in life perspective). Study 1 focused on uses for generally recalling one's past and Study 2 on uses of memories of the deceased.Results: Across studies, self-negative ways of remembering were associated with stronger feelings of grief and also mediated relations between social ways of remembering and grief. Self-positive ways of remembering the deceased (Study 2) were associated with having experienced positive changes in life perspective since the loss.Conclusion: The discussion focuses on how memories of one's personal past are linked to the experience of loss, even years into bereavement.

Older adults recall memories of life challenges: the role of sense of purpose in the life story.

Late life is still often characterized as a time of loss and decline. The current study moved beyond this view, using both the resilience framework and the life story approach to highlight the rich life experiences of older adults. Doing so created an opportunity to explore perspectives on sense of purpose in life, from the vantage point of old age. The study had two central questions. That is, how have older adults drawn on their sense of purpose across their lives, and what factors led to the development of a sense of purpose? Following guidelines for the consensual qualitative research method (CQR; Hill et al., The Counseling Psychologist, 25(4), 517-572, 1997; Hill & Knox, 2021), in-depth, semi-structured interviews were conducted with 18 older women and men (aged 60 - 100 years) and transcribed for analysis. The CQR method revealed seven domains in the interviews. Three domains were relevant to the first research question, including: overcoming life challenges to pursue purpose, perspective-taking to maintain purpose, and purpose as part of one's religion. Four domains provided insights on the second research question: life background influencing purpose, shifts in purpose across life, fulfilling purpose across life, and obstacles to pursuing purpose in life. Findings highlighted how older people use sense of purpose as a guide in the face of life's inevitable challenges. They also revealed the unique life story paths that lead to the development of purpose across individuals' lifetimes. The implications of maintaining a sense of purpose in life, across the later years, are discussed.

Empathic communication in dignity therapy: Feasibility of measurement and descriptive findings.

OBJECTIVE: Dignity therapy (DT) is a guided process conducted by a health professional for reviewing one's life to promote dignity through the illness process. Empathic communication has been shown to be important in clinical interactions but has yet to be examined in the DT interview session. The Empathic Communication Coding System (ECCS) is a validated, reliable coding system used in clinical interactions. The aims of this study were (1) to assess the feasibility of the ECCS in DT sessions and (2) to describe the process of empathic communication during DT sessions. METHODS: We conducted a secondary analysis of 25 transcripts of DT sessions with older cancer patients. These DT sessions were collected as part of larger randomized controlled trial. We revised the ECCS and then coded the transcripts using the new ECCS-DT. Two coders achieved inter-rater reliability (κ = 0.84) on 20% of the transcripts and then independently coded the remaining transcripts. RESULTS: Participants were individuals with cancer between the ages of 55 and 75. We developed the ECCS-DT with four empathic response categories: acknowledgment, reflection, validation, and shared experience. We found that of the 235 idea units, 198 had at least one of the four empathic responses present. Of the total 25 DT sessions, 17 had at least one empathic response present in all idea units. SIGNIFICANCE OF RESULTS: This feasibility study is an essential first step in our larger program of research to understand how empathic communication may play a role in DT outcomes. We aim to replicate findings in a larger sample and also investigate the linkage empathic communication may have in the DT session to positive patient outcomes. These findings, in turn, may lead to further refinement of training for dignity therapists, development of research into empathy as a mediator of outcomes, and generation of new interventions.

Dignity therapy intervention fidelity: a cross-sectional descriptive study with older adult outpatients with cancer.

OBJECTIVES: Intervention fidelity is imperative to ensure confidence in study results and intervention replication in research and clinical settings. Like many brief protocol psychotherapies, Dignity Therapy lacks sufficient evidence of intervention fidelity. To overcome this gap, our study purpose was to examine intervention fidelity among therapists trained with a systematized training protocol. METHODS: For preliminary fidelity evaluation in a large multi-site stepped wedge randomized controlled trial, we analyzed 46 early transcripts of interviews from 10 therapists (7 female; 7 White, 3 Black). Each transcript was evaluated with the Revised Dignity Therapy Adherence Checklist for consistency with the Dignity Therapy protocol in terms of its Process (15 dichotomous items) and Core Principles (6 Likert-type items). A second rater independently coded 26% of the transcripts to assess interrater reliability. RESULTS: Each therapist conducted 2 to 10 interviews. For the 46 scored transcripts, the mean Process score was 12.4/15 (SD = 1.2), and the mean Core Principles score was 9.9/12 (SD = 1.8) with 70% of the transcripts at or above the 80% fidelity criterion. Interrater reliability (Cohen's kappa and weighted kappa) for all Adherence Checklist items ranged between .75 and 1.0. For the Core Principles items, Cronbach's alpha was .92. CONCLUSIONS: Preliminary findings indicate that fidelity to Dignity Therapy delivery was acceptable for most transcripts and provide insights for improving consistency of intervention delivery. The systematized training protocol and ongoing monitoring with the fidelity audit tool will facilitate consistent intervention delivery and add to the literature about fidelity monitoring for brief protocol psychotherapeutic interventions.

Young adults' perspectives on advance care planning: Evaluating the Death over Dinner initiative.

We investigated how death attitudes and experience relate to perspectives on advance care planning (ACP) in young adulthood, and whether attending a Death over Dinner event affects perspectives on ACP. Participants (N = 109) were assigned to a Death over Dinner or waitlist control condition, completing pretest and post-test measures. Higher Death Rejection and having more Experience with Death predicted Reservations about ACP. Participation in a Death over Dinner decreased Reservations toward ACP compared to the control group. Death over Dinner appears to be useful in ameliorating reservations toward ACP without shortening individuals' sense of their time left to live.

Description of a training protocol to improve research reproducibility for dignity therapy: an interview-based intervention.

BACKGROUND: Dignity Therapy (DT) has been implemented over the past 20 years, but a detailed training protocol is not available to facilitate consistency of its implementation. Consistent training positively impacts intervention reproducibility. OBJECTIVE: The objective of this article is to describe a detailed method for DT therapist training. METHOD: Chochinov's DT training seminars included preparatory reading of the DT textbook, in-person training, and practice interview sessions. Building on this training plan, we added feedback on practice and actual interview sessions, a tracking form to guide the process, a written training manual with an annotated model DT transcript, and quarterly support sessions. Using this training method, 18 DT therapists were trained across 6 sites. RESULTS: The DT experts' verbal and written feedback on the practice and actual sessions encouraged the trainees to provide additional attention to eight components: (1) initial framing (i.e., clarifying and organizing of the patient's own goals for creating the legacy document), (2) verifying the patient's understanding of DT, (3) gathering the patient's biographical information, (4) using probing questions, (5) exploring the patient's story thread, (6) refocusing toward the legacy document creation, (7) inviting the patient's expression of meaningful messages, and (8) general DT processes. Evident from the ongoing individual trainee mentoring was achievement and maintenance of adherence to the DT protocol. DISCUSSION: The DT training protocol is a process to enable consistency in the training process, across waves of trainees, toward the goal of maintaining DT implementation consistency. This training protocol will enable future DT researchers and clinicians to consistently train therapists across various disciplines and locales. Furthermore, we anticipate that this training protocol could be generalizable as a roadmap for implementers of other life review and palliative care interview-based interventions.

Quality of Life for Older Cancer Patients: Relation of Psychospiritual Distress to Meaning-Making During Dignity Therapy.

BACKGROUND: Nearly 500,000 older Americans die a cancer-related death annually. Best practices for seriously ill patients include palliative care that aids in promoting personal dignity. Dignity Therapy is an internationally recognized therapeutic intervention designed to enhance dignity for the seriously ill. Theoretically, Dignity Therapy provides opportunity for patients to make meaning by contextualizing their illness within their larger life story. The extent to which Dignity Therapy actually elicits meaning-making from patients, however, has not been tested. AIM: The current study examines (i) extent of patient meaning-making during Dignity Therapy, and (ii) whether baseline psychospiritual distress relates to subsequent meaning-making during Dignity Therapy. DESIGN: Participants completed baseline self-report measures of psychospiritual distress (i.e., dignity-related distress, spiritual distress, quality of life), before participating in Dignity Therapy. Narrative analysis identified the extent of meaning-making during Dignity Therapy sessions. PARTICIPANTS: Twenty-five outpatients (M age = 63, SD = 5.72) with late-stage cancer and moderate cancer-related symptoms were recruited. RESULTS: Narrative analysis revealed all patients made meaning during Dignity Therapy but there was wide variation (i.e., 1-12 occurrences). Patients who made greater meaning were those who, at baseline, reported significantly higher psychospiritual distress, including greater dignity-related distress (r = .46), greater spiritual distress (r = .44), and lower quality of life (r = -.56). CONCLUSION: Meaning-making was found to be a central component of Dignity Therapy. Particularly, patients experiencing greater distress in facing their illness use the Dignity Therapy session to express how they have made meaning in their lives.

Recalling youth: Control over reminiscence bump events predicts life satisfaction in midlife.

The reminiscence bump phenomenon is well established: adults in the second half of life remember more events from their youth than from other periods. Almost no research has focused, however, on the adaptive value of the reminiscence bump for adult well-being. Grounded in a life story approach, this research examined whether perceiving that one had control over events from the bump period (compared with other past periods and also one's present life) was related to current life satisfaction. We also investigated whether chronological age moderated these associations. Participants (N = 470; 49-90 years; 59% women) were part of the European Study on Adult Well-being. They briefly reported up to 15 personally significant events from across their entire life. They indicated age at occurrence and rated their perceived control for each reported event. Well-being was assessed with a standard measure of current life satisfaction. Perceived control over the present and covariates including memory valence and current circumstances (i.e., financial security, social living arrangement, number of medications, and mental health) were also measured. Findings indicate that greater perceived control over reminiscence bump events, but not other past events, predicted current life satisfaction in adults in late midlife (i.e., ages 49-60). In contrast, greater present-focused perceived control was associated with life satisfaction in those 62 years and older. The findings are discussed in the context of the life story account of the reminiscence bump. Understanding the adaptive value of recalling one's personal past may require attention to individuals' current life phase. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Life challenges and resilience: the role of perceived personality continuity.

OBJECTIVES: Self-functioning, one aspect of mental health, is positive in later life. Although experiencing challenges may disrupt mental health, internal resources can foster resilience. This study examines how the frequency of recent challenges relates to current self-functioning. Perceived personality continuity, one's sense of maintaining their trait personality, is investigated as an internal resource. METHOD: Participants (N = 99 young adults, 88 older adults) reported all challenging events experienced in the last six years. Perceived personality continuity over the same time was assessed. Multi-measurement of current self-functioning included self-concept clarity, self-esteem, and self-acceptance. RESULTS: Older adults reported higher self-concept clarity and self-esteem; young adults reported higher self-acceptance. Experiencing more challenges related to lower self-concept clarity and self-esteem across age groups, with a stronger negative link to self-esteem for young adults. Perceived personality continuity partially mediated relations between: (i) challenges and self-concept clarity, and (ii) challenges and self-esteem. Perceived personality continuity mediated positive self-functioning for older adults only. CONCLUSION: A late life strength, older adults report higher self-functioning overall. Challenges negatively relate to self-functioning across age groups, but younger adults' self-esteem is more vulnerable. When having faced challenges, older adults' perceived personality continuity is critical to positive current self-functioning.

More Vulnerable? The Life Story Approach Highlights Older People's Potential for Strength During the Pandemic.

OBJECTIVES: Older adults have repeatedly been referred to as more physically vulnerable during the COVID-19 pandemic. The pandemic, however, is not only about becoming physically ill. It has many psychosocial aspects: people are exposed to myriad life challenges. The life story approach does not ignore physical status but also emphasizes psychosocial strengths. It highlights that older people are likely to have developed resilience through experiencing life challenges and living across history. METHOD: We used the narrative method to review research on three strengths: tendency toward life reflection, adaptive use of personal memory, and temporal focus encouraging generativity. RESULTS: For each, we (a) present evidence that this strength manifests in the second half of life, and (b) identify how it may specifically be applied in dealing with the challenges of the pandemic. In considering their life stories, the picture that emerges is one of older adults as having the potential to show considerable psychosocial strength despite the adversities of the pandemic. DISCUSSION: We conclude that during this period of sweeping change in the lives of individuals of all ages, our older citizens may act as valuable societal anchors.

More on the MORE Life Experience Model: What We Have Learned (So Far).

We have all had difficult times and challenges in our lives, and most of us feel that we learned something from those experiences. At the same time, few people actually become wise in the course of their lives - while most of us become (or remain) well-adapted and happy, generally satisfied, or even bitter or depressed. Why is it that some people, but not others, grow wise over time by learning from life's challenges (Linley & Joseph, 2004)? In the MORE Life Experience Model (Glück & Bluck, 2013), we argued that life challenges are catalysts for the development of wisdom, and that psychological resources crucially influence how people appraise life challenges, how they deal with them, and how they integrate them into their life story as time goes on. Based on the literature on wisdom and growth from challenging experiences, we proposed five resources as important for the development of wisdom: Mastery, Openness, Reflectivity, and Emotion Regulation including Empathy - in short, MORE. Since proposing the model, we have conducted a first empirical test of its predictions. This paper describes our expected and unexpected findings, which provide insights that we integrate to further refine and elaborate the MORE Life Experience Model. First, we describe the theoretical and empirical background of the original model.

Identifying distinct sets of predictors of specific functions of autobiographical memory.

Grounded in the ecological approach, research has charted several adaptive functions of autobiographical remembering. Each represents a rather different psychosocial domain (i.e., self, social, directive). The goal of this research was to determine the contributions of each of a set of variables, controlling for all others, in predicting use of autobiographical memory to serve each specific function. In two studies, participants (N = 100; N = 195) rated frequency of functional use of specific event memories and completed a brief battery of memory-related measures. Most Study One results were replicated in Study Two. Self-relevance of memories was related to their functional use regardless of domain. Each function was also, however, predicted by a unique set of variables consistent with its use in a given psychosocial domain. Findings emphasise how a combination of factors come into play to allow humans to use autobiographical memory to serve various different functions in navigating daily life.

Experiential Palliative Care Immersion: Student Nurse's Narratives Reflect Care Competencies.

Many nurses report a lack of confidence providing care for patients facing a life-threatening illness. Palliative care leaders have devised primary palliative nursing care competencies (CARES [Competencies And Recommendations for Educating undergraduate nursing Students]) that all students should achieve. In this study, nursing students participated in an innovative palliative care immersion experience, the Comfort Shawl Project. We performed a reliable content analysis of their narrative reflections. The goal was to evaluate whether reflections on their interactions with patients/families were consistent with CARES competencies. Nine female students wrote reflections after gifting each of the 234 comfort shawls to patients. Four CARES-related categories were analyzed: Individual Values and Diversity, Compassionate Communication, Fostering Quality of Life, and Self-Insight and Emotion. Reflections were highly representative (41%) of recognizing Individual Values and Diversity, representing sensitivity for patients' unique differences in values, an integral component of palliative care. The Comfort Shawl Project shows promise as an experiential immersion for introducing nursing students to CARES competencies.

In memory: Predicting preferences for memorializing lost loved ones.

People's preferences for memorializing loved ones vary and may depend on their personal attitudes and experiences with death. Participants (N = 145) completed the memorializing preferences checklist and measures of personal attitudes and life experiences with death. Factor analysis identified four memorializing preferences. In terms of predicting preferences, greater acknowledgment of death, and having experienced more losses, predicted preference for memorializing through societal tradition, community legacy, and continuing intimacy. Greater death resistance and less closeness to the deceased predicted preference for memorializing through confronting loss. Findings are discussed in terms of the range of preferences for and motivations behind memorializing.