Awareness of dying: an experience of Chinese patients with terminal cancer

Despite the effort to provide an alternate way to dying, there seems to be little effort to examine the real situation of hospice care. For example, the patients' desired outcomes are seldom addressed. It is recently that studies began to investigate the features of "good death." However, work in eastern cultures, such as Chinese, remains scarce. The purpose of this study is to gain an understanding of what it means to die a "good death" from the perspective of Chinese patients. Thirty-three Chinese hospice patients with terminal cancer were interviewed. Grounded in the analysis of qualitative data, seven elements that contribute to dying a good death emerged. Awareness of dying was identified as the foremost essential element of a good death. From the findings of this study, most respondents considered receiving a diagnosis of cancer as one of the significant points of psychological distress in the course of their illness. Half of the patients openly talked about their cancers and more than half of them discussed various issues related to death. That means, about one-third of the respondents talked about death and cancer with openness. These preliminary findings may reflect the progress of hospice work in Hong Kong. Meanwhile, 13 respondents did not mention the word "death" and 16 of them did not mention that they had cancer. They talked about their illness and future using the expressions that they preferred. It is important that health care professionals also respect people who show awareness of dying as much as those who do not present clear evidence of this awareness. Both groups of people can have a positive experience when they die.     

Deathbed visions from India: a study of family observations in northern Kerala

This is an interview-based study of 104 families and their observations of the last weeks and days of a dying family member. Forty families reported "unusual experiences and behaviors" from the dying person in their last period of life. Thirty of these dying persons displayed behavior consistent with deathbed visions-interacting or speaking with deceased relatives, mostly their dead parents. There were six cases of reported premonitions of death and five possible confusional states with one patient reported to have had both a deathbed vision and confusional experiences. Socio-demographic factors such as gender, age, occupation, or cause and place of death were not found to be significant. Hindu patients appeared to be more likely than Muslim patients to report these experiences. Use of opiates (or not) did not appear to influence reports. The findings are discussed with reference to past studies of deathbed visions as well as their implications for the future pastoral care of dying people and their families.     

Death: the ultimate social construction of reality

Using Berger and Luckmann's thesis (1966) on the social construction of reality as rationale, this research analyzes the death drawings of 946 university students enrolled in a Death and Dying course between 1985 and 2004 to investigate the basic constructs elicited by the word "death": dying, moment of death, after death, after life, and bereavement. Consistent with earlier research, gender, race, religion, and religiosity proved to be significant factors. As expected, personal experience with grief was strongly correlated with drawings focused on bereavement. In contrast to earlier studies, fear of death was not significantly related to a particular construct. Implications for research, education, and counseling are discussed.     

The development of the physicians' end-of-life care attitude scale

The Physicians' End-of-Life Care Attitude Scale (PEAS) was developed as an outcome measure for palliative care education. PEAS assesses the willingness of medical trainees to care for dying patients. Sixty-four Likert-type questions were created on the basis of discussions with focus groups of medical trainees, then administered to sixty-two medical students and residents. Total PEAS scores as well as personal preparation and professional role subscales (where higher scores indicated greater concern) possessed excellent internal consistency and reliability. In addition, there were substantial correlations between PEAS scores and the CA-Dying scale, a measurement of laypersons' fears about interacting with dying persons. Thus, PEAS adequately assesses the unique communication concerns of physicians in training regarding working with dying persons and their families. Correlations between PEAS scores and age were negative, while those who had experienced the death of a loved one had higher PEAS scores than those who did not. This suggests that for some persons, life experiences may lessen difficulties in dealing with dying persons, while for others, personal losses may exacerbate such concerns. The utility of PEAS in evaluating the efficacy of palliative care education as well as its potential to measure medical trainee's willingness to care for the terminally ill is discussed.     

Exploring death anxiety among elderly people: a literature review and empirical investigation

Given the growing number of elderly persons in society and concerns about their health and well-being, the aim was to review the available literature on their death anxiety, and to explore features of this experience among a small sample of older men and women in care facilities. In both the review and empirical parts of this study, components and correlates of death anxiety were investigated. The review revealed limited research focus on death anxiety among the elderly, particularly among those in institutions, but suggested both components and correlates for inclusion in our empirical study. Results showed that, among our elderly participants in an assisted living facility (N = 49; age range: 60-96 years), there were higher levels of fear for others and of the dying process than for fear of the unknown. Notably, among the correlates identified, fear for significant others was associated with poor physical health; fear of the dying process was related to low self-esteem, little purpose in life, and poor mental well-being. Gender differences in death anxiety were found: women showed greater fear for the death of loved ones and for the consequences of their own death on these loved ones, than did men. These patterns are discussed in the light of concerns about the welfare of elderly persons; scientific implications are also considered.     

Deathbed visions from the Republic of Moldova: a content analysis of family observations

This is an interview-based study of 102 families and their observations of the last weeks and days of a dying family member. Forty-one families reported hearing about "visions," "hallucinations," or "dreams" from their dying loved one before their death. Of these 41 mixed cases, 37 cases demonstrated classic features of deathbed visions-reports of seeing dead relatives or friends communicating to the dying person. This article reports a content analysis of these 37 cases in order to identify the major psychosocial themes that seem to be conveyed by these kinds of experiences. Six major themes are identified. These themes are: support, comfort, companionship, reunion, prognosis, and choice and control. Implications of these themes are discussed in relation to their role in providing significant support for the psychological morale and social well being of dying people.     

Personifications of personal and typical death as related to death attitudes

The present article examined differences in personifications of personal and typical death as a function of attitudes about death. Ninety-eight students enrolled in psychology classes were randomly assigned to personify death as a character in a movie depicting either their own deathbed scene or the deathbed scene of the typical person prior to completing the Death Attitude Profile-Revised. The results supported the conceptual distinction between attitudes about personal death and death in general. Participants in the personal death condition personified death more frequently as a gentle-comforting image and less frequently as a cold-remote image than did participants in the typical death condition. The results also further validated the relation between personifications of death and death attitudes. Across both conditions, participants who selected the grim-terrifying image reported more fear of death and death avoidance; whereas, participants who selected the cold-remote or robot-like images reported more neutral acceptance.     

Living beyond the unanticipated sudden death of a partner: a phenomenological study

This research project explored grief and its impact upon men and women who have experienced the sudden and unanticipated death of his or her partner. It included what grief meant to them, how it was manifested in his or her everyday lives and how his or her partner's death had impacted upon his or her relationship with themselves, with others and the world. A Husserlian phenomenological approach was used to explore the experiences of the ten women and five men whose partner had died up to five years prior to being interviewed. The need for the surviving partner to continue to participate in everyday life placed great strain upon the internal resources of the surviving partner. The surviving partner needed to reinvent him or herself, in an attempt to become independent and regain functionality, whilst dealing with the sadness and loss that they had experienced. The surviving partner discovered that a new life order emerged that included hope, optimism, planning for the future and perhaps the prospect of a new relationship. The death of a partner left the surviving partner with a loss that would always be a part of them, with the memories of his or her relationship being maintained within them that will never be replaced by somebody else. The results of this research project reinforce the need for ongoing education of the community in grief and bereavement issues in order to increase the awareness of the support needs of the bereaved person. The length of time and amount of energy required to incorporate the experience into the survivor's life, is greatly underestimated by the community, and perhaps by some of the health and caring professionals. Colonial and hospital based bereavement support services need to be established and be proactive using outreach programs, actively offering the suddenly bereaved partner and family support and information.     

The "moment of death"

The "moment of death," once a dominant concept in preparing for a "good death", has been eclipsed by a focus on the wider concept of the "dying trajectory". However, findings from interviews with 25 bereaved individuals suggest that dying loved ones' final moments may still be experienced as highly significant in their own right. In some accounts the dying individual's final moments did not feature or made little impression, either because the survivor was not present, or there was no obviously definable moment, or because other, usually medical factors, such as whether to resuscitate the person, took precedence. However, in six cases such moments were constructed as profound, special, and memorable occasions. These constructions are explored in relation to achieving a good death, the dying trajectory as a whole, and making sense of the bereavement experience. Their implications for sociological theories of identity and embodiment are also considered.     

Physician anger--Part 1. Changing perception: an interview with Charles E. Dwyer, PhD. Interview by Richard L. Reece.

On January 21, Richard Reece, MD, interviewed Charles E. Dwyer, PhD, to talk about solutions for changing the perceptions of today's beleaguered physicians. He discusses the state of affairs of physician executives in this turbulent industry and how they need to move beyond their thinking about organizations and their current responses to change. The key, Dwyer emphasizes, is influencing people to do what you want them to do. "If you want somebody to do something other than what they are doing now, then you must bring them to perceive that what you want them to do is better than what they are doing now in terms of what is important to them." He also explores how physicians can change their responses to the health care environment: "You can actually decide how you are going to respond conceptually, emotionally, and behaviorally to anything that happens in your life." Part 2 of this interview will appear in the upcoming May/June issue and will provide hands-on strategies for dealing with physician anger, fear, and resentment.     

Images of heaven and the spiritual afterlife: Qualitative analysis of children's storybooks about death, dying, grief, and bereavement

Many parents turn to picture books and storybooks to help explain issues surrounding death and dying to their young children. In addition to dealing with topics such as death, funerals, memories, and grief, a number of the books also mention the concept of heaven and what our loved ones might experience after they die. This article uses qualitative research methods to analyze 49 children's storybooks that touch on the existence of heaven or a spiritual afterlife. Results show that heaven is portrayed in a simplistic fashion, as a place high in the sky with bright lights, angels, and clouds. Even as heaven is presented in a relatively simple way, there are also patterned differences in depictions of the spiritual afterlife depending upon whether the decedent in the book was a family pet, a child, a parent, or a grandparent. The article concludes with a discussion of how these depictions of heaven and the afterlife might help young children cope with death-related grief.     

Public Understanding of Ebola Risks: Mastering an Unfamiliar Threat

Ebola was the most widely followed news story in the United States in October 2014. Here, we ask what members of the U.S. public learned about the disease, given the often chaotic media environment. Early in 2015, we surveyed a representative sample of 3,447 U.S. residents about their Ebola‐related beliefs, attitudes, and behaviors. Where possible, we elicited judgments in terms sufficiently precise to allow comparing them to scientific estimates (e.g., the death toll to date and the probability of dying once ill). Respondents’ judgments were generally consistent with one another, with scientific knowledge, and with their self‐reported behavioral responses and policy preferences. Thus, by the time the threat appeared to have subsided in the United States, members of the public, as a whole, had seemingly mastered its basic contours. Moreover, they could express their beliefs in quantitative terms. Judgments of personal risk were weakly and inconsistently related to reported gender, age, education, income, or political ideology. Better educated and wealthier respondents saw population risks as lower; females saw them as higher. More politically conservative respondents saw Ebola as more transmissible and expressed less support for public health policies. In general, respondents supported providing “honest, accurate information, even if that information worried people.” These results suggest the value of proactive communications designed to inform the lay public's decisions, thoughts, and emotions, and informed by concurrent surveys of their responses and needs.     

The role of psychotherapy and humor for death anxiety, death wishes, and aging

This article is part of a series of humor on social attitudes (Richmen, 1977), humor by the elderly (Richman, 1989), assessment (Richman, 1996a), and psychotherapy (Richman, 1996b). The present study is based on the topics of humor related to death anxiety and wishes, and aging that emerged during psychotherapy with elderly patients. The healing qualities of laughter and humor have been observed since Biblical times to the present, however the applications of humor to professional psychotherapy is still in its infancy. The examples in this study spell out how humor in therapy can bring people together, and help them affirm life and laugh at anxiety, depression, and their problems in living.     

Ayudarum: an Austrian crowdsourcing company in the Startup Chile accelerator program

The founders of Ayudarum, an Austrian crowdsourcing company that is focused on connecting students with potential employers, joined the Chilean Startup accelerator ‘Startup Chile’ to help their young company expand outside its European roots. Startup Chile had provided Ayudarum with a mentor to help them understand how to grow Ayudarum’s number of users. Ayudarum’s initial business model, which had functioned well in Europe, involved partnering with universities. Universities made the Ayudarum site available to students who, in turn, logged in with their student email account. Once there was a large base of students onboard, firms were contacted to advertise jobs on the site. Now that the founders were trying to tap into the South American market, they discovered that students did not use their university email addresses and that there were distinct cultural differences in the way students worked, found jobs, and were paid. This difference may mean that Ayudarum would need to rethink the way its business model, how different markets should be targeted, and how the most value could be derived from its membership at Startup Chile.     

Von der Kunst, sich für den richtigen Beruf zu entscheiden

Students often make their decision of a course of studies without being aware of the consequences for their future career and life, without having been informed about alternatives and — even more important — without having thought about their personal talents and interests. During their studies itself, they often run into difficulties when they realise that they took the wrong decision. High rates of changes in studies or cancelling all studies are the consequence (25 % in total, more than 40 % in special studies like social sciences). The author works as a students’ advisor and students’ coach and, among others, offers analyses of talents and a comprehensive advisory training for professional orientation. The present essay describes the theoretical basis of her work, the concrete procedure and a practical example of her daily work.     

In learning mode? The role of mindsets in derailing and enabling experiential leadership development

In comparison to the vast literature on leadership theories, concepts, and behaviors, relatively less is known about why leaders often learn little from their leadership experiences, as well as how to support them in doing so. We propose that leaders learn more from their challenging leadership experiences when they are in learning mode, defined as intentionally framing and pursuing each element of the experiential learning process with more of a growth than a fixed mindset. We describe how the extent to which leaders are in learning mode stems from salient mindset cues and guides whether they work through the experiential learning process with a predominantly self-improvement or self-enhancement motive. We theorize about several other likely mediators and moderators of when being in learning mode will manifest in experiential leadership development. Practical implications at the micro, meso, and macro levels, as well as within management education are outlined.     

Characteristics of good mentors.

Physician executives who have advanced in their careers have had people who helped them. Six successful physician executives were interviewed about how mentors encouraged, taught, and helped them grow. Most agreed the term role model was more comfortable to them than the word mentor and that they only recognized these people as mentors when they looked back on their career paths--not at the time the interactions were happening. Sometimes they were role models and sometimes they were just the right person with the right information at the right time. Most were located in the person's city and organization and seen daily, but some were in another part of the country and seen on occasional visits but regularly talked to each other on the phone. Generally they were friends who created safe environments for learning, were protectors, gave specific feedback, viewed problems from a different angle, and stretched the thinking of those who sought their advice.     

What's your financial set point?

Motivation is an important career issue, especially in the shrinking health care market. What inspires people to work hard today is often not the same thing that encouraged our parents' industriousness. What motivates you? What motivates your direct reports? Research suggests that people can't be motivated beyond their "financial set point"--the amount of money they need or want which will motivate them to work harder or smarter. The following motivators are explored: (1) Upward mobility; (2) limited goals; (3) need only; (4) revenge; (5) ego nourishment; and (6) time.     

A sociocultural analysis of death anxiety among older Japanese urbanites in a citizens' movement

By examining the experiences of death anxiety and attitudes toward personal deaths among members of a citizens' movement, the Grave-Free Promotion Society (GFPS), this study considers the applicability of the view that culture and high self-esteem serve as defenses against death anxiety in Japan's changing society. The GFPS promotes the scattering of ashes over the conventional interment of cremated remains in a family grave. GFPS members often lack descendants to care for a family grave, the neglect of which is thought to endanger the deceased's peaceful rest. By returning the dead to nature through ash scattering, the GFPS provides an alternative strategy of managing its members' posthumous well-being. GFPS members often report that their choice of ash scattering has reduced their anxiety about their personal deaths and improved the quality of their lives. Based upon these findings, this study offers some suggestions for increasing cultural sensitivities of test instruments commonly used to examine death anxiety among older persons for use in a Japanese context.