Reflections ~ A Life Assessment Program (How to Die with a Smile on your Face)


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These patients also shed new light on how wisdom involved a delicate balance between learning to simply be, while continually striving to change. On some days, patients may appear very accepting of their life circumstances, while on others they seem fraught with struggle. In its simplicity, this prayer highlights the dynamic and dualistic nature of wisdom as described by the hospice patients in this study. They too conveyed a pervasive battle that, when paradoxically embraced, could lead to contentment — even when the worst of life or death is placed before us.

Finally, the hospice patients in this study noted how their struggles related to conscious decisions about the attitudes and behaviors they wished to express in their final days. The patients understood that their final actions would impact their legacy. This finding speaks directly to the importance of not only providing dignity in care, but also ensuring that legacy-related needs of patients are addressed Chochinov, In sum, the hospice patients in this study highlighted how, after being diagnosed with a terminal illness, one's life perspective shifts.

One may learn to accept the illness, but may also wisely strive for growth at the same time. This tension can catalyze the need to live each day fully, and by doing so, can leave an even greater legacy. Although beneficial in understanding perspectives on wisdom among adults in hospice care, this study does have limitations.

Additionally, because this study required a minute interview, patients with serious cognitive or other psychiatric diagnoses e. As a result, the components of wisdom found in this study such as active coping and galvanized growth need to be further evaluated within other clinical populations. Finally, the one-time qualitative interview was conducted among patients who were receiving hospice care and, by definition, were in the last six months of life.

As a result, all the patients are now deceased, thereby barring any follow-up assessments. Overall, these study findings suggest that interviewing hospice patients might hold value for understanding not only the concept of wisdom, but other important concepts as well Morley, For example, hospice patients may help us refine other conceptualizations about aging, illness, love, loss, or even grace in the face of death Depp and Jeste, ; Montross-Thomas, Lori P. Montross-Thomas designed and implemented the study, analyzed results, and helped prepare the manuscript.

Jamie Joseph and Emily C. Edmonds analyzed data and helped prepare the manuscript. Lawrence A. Palinkas provided qualitative methodology supervision and support in data analysis. Dilip V. Jeste helped design the study, analyzed data, provided research supervision and support, and edited the manuscript.

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This study would not have been possible without the courage and commitment of the hospice patients who elected to share their thoughts and reflections as they approached the end of their lives. To them, we are inherently and respectfully grateful. We further wish to acknowledge all the dedicated individuals at Mission Hospice and the San Diego Hospice who were devoted to this study's purpose, design, and completion. Loading article Login Alert. Log in. Reflections on wisdom at the end of life: qualitative study of hospice patients aged 58—97 years.

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Aa Aa. Edmonds a2 , Lawrence A. Palinkas a4 and Dilip V. Emergent themes reported by 21 hospice patients regarding general descriptions and characteristics of wisdom Figure 1. Send article to Kindle. Volume 30, Issue 12 Lori P. Your Kindle email address Please provide your Kindle email. Available formats PDF Please select a format to send. By using this service, you agree that you will only keep articles for personal use, and will not openly distribute them via Dropbox, Google Drive or other file sharing services.

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Abstract Objective: Wisdom is a complex trait, and previous research has identified several components of wisdom. Design and Participants: Semi-structured qualitative interviews were conducted with 21 hospice patients aged 58—97 years who were in the last six months of their life. Methods: Hospice patients were asked to describe the core characteristics of wisdom, as well as how their terminal illness might have impacted their understanding of this concept.

Results: Broad concepts of wisdom described by the hospice patients align with the extant literature, thereby supporting those general conceptualizations.

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Conclusion: The end of life offers a unique perspective on wisdom by highlighting the modulation between actively accepting the current situation while continuing the desire to grow and change at this critical time. Introduction While wisdom is an ancient religious and philosophical concept Takahashi, ; Jeste and Vahia, , one of the first modern scientists to consider wisdom as a psychological construct was Erikson Results Participants Twenty-one patients diagnosed with a terminal illness, who had a prognosis of six months or less to live, were enrolled in the study between and Descriptions and characteristics of wisdom In response to open-ended questions regarding general characteristics of wisdom, patients spontaneously discussed each of the nine components of wisdom as previously identified in the meta-review by Bangen et al.

Influences of Illness on Wisdom Impact of illness and receiving hospice care In addition to the general conceptualizations of wisdom presented above, the hospice patients in this sample were able to provide additional unique insights into how wisdom may build or transform after being diagnosed with a terminal illness. Active acceptance Patients described their hope of finding a sense of acceptance or peace related to their illness, particularly in light of their ensuing physical changes and loss of functioning. Galvanized growth Patients also spoke of positive changes they encountered in response to their illness.

Wisdom involves persistent and dynamic balance Ultimately, patients described wisdom as a perpetual balance between actively accepting illness on one hand, while wanting to grow and change on the other see Figure 1 for a conceptual model. Discussion This study offers a unique perspective on wisdom from patients receiving hospice care at the end of their lives, thereby contributing to previous conceptualizations of wisdom's cognitive, reflective, and affective origins Clayton and Birren, ; Ardelt, ; Thomas et al.

Acknowledgments This study would not have been possible without the courage and commitment of the hospice patients who elected to share their thoughts and reflections as they approached the end of their lives. References Ardelt , M.

Wisdom as expert knowledge system: a critical review of a contemporary operationalization of an ancient concept. Human Development , 47 , — Baltes , P.

Introduction

The fascination of wisdom: its nature, ontogeny, and function. Perspectives on Psychological Science , 3 , 56 — Bangen , K. Defining and assessing wisdom: a review of the literature. American Journal of Geriatric Psychiatry , 21 , — Bellizzi , K. Expressions of generativity and posttraumatic growth in adult cancer survivors. Boyatzis , R. London; New Delhi : Sage Publications. Carstensen , L. Taking time seriously: a theory of socioemotional selectivity.

American Psychologist , 54 , — Chochinov , H. Dignity and the essence of medicine: the A, B, C, and D of dignity conserving care. BMJ , , — Clayton , V. Erikson's theory of human development as it applies to the aged: wisdom as contradictive cognition. Human Development , 18 , — Damon , W.


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    Reflections ~ A Life Assessment Program (How to Die with a Smile on your Face) Reflections ~ A Life Assessment Program (How to Die with a Smile on your Face)
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