Hospice Buffalo, Inc.

Background: End-of-life dreams and visions (ELDVs) are common and meaningful experiences for individuals trending toward death. While research has shown the positive impact of ELDVs on some psychological processes, there is more to learn. Objective: This study aimed to explore the differences in perceived self-transcendence between hospice patients who experience ELDVs and hospice patients who do not have this experience. Design: This is a cross-sectional comparison study. Settings/Subjects: Seventy-two hospice patients (35 with ELDV experiences and 37 without ELDV experiences) were recruited after being admitted into hospice. Study procedures were completed at the participant's current place of residence, all within the United States. Measurements: Self-transcendence was assessed using the Self-Transcendence Scale. Demographic information and a measure of confusion were also collected. Results: No significant differences were discovered between groups in terms of self-transcendence based on the measure used (p = 0.310). Patients with ELDVs did not experience greater levels of self-transcendence compared with nondreaming patients. Further, no significant differences were found on any of the items within the survey. Conclusions: The presence of ELDVs did not impact the experience of self-transcendence for hospice patients. Findings may be, in part, explained by (1) the consideration of self-transcendence as a natural stage of development, (2) the intrinsic relationship between self-transcendence, religiosity, and end of life, or (3) the holistic nature of hospice care and its impact on self-transcendence. Future research may explore if and how the presence of ELDVs impacts spiritual wellness for the dying.

The current study examined qualitative data from hospice clinicians’ perspectives on language, surrounding end-of-life (EOL), to understand challenges and opportunities for constructing a trajectory of communication leading towards a good death experience. Findings from two focus groups with nine clinicians’ and 12 individual interviews, four of which were follow up interviews after the focus groups, were guided by framework analysis and revealed three themes, constructing language choices, roles and responsibilities, and socio-cultural considerations. We used the Opportunity Model for Presence during the End-of-Life Process (OMP-EOLP) to make sense of the findings and discuss implications for language use throughout the EOL process. We argue additional efforts should be made in recognizing the value of presence checks, re-constructing advance care planning, and utilizing different forms of media as an educational tool and connection mechanism for clinicians with patients and families to achieve a timely engagement of EOL conversations for all healthcare participants.

Background: Family caregivers (FCGs) encounter several physical, psychosocial, and financial struggles while caring for a dying loved one. After their loved one has passed, FCGs face new difficulties as they transition out of the caregiving role and into bereavement. Recent research has focused on the positive adaptive outcomes of bereavement. Objective: This study examined the relationship between core bereavement experiences and post-traumatic growth (PTG) for bereaved hospice FCGs. Design: This is a quantitative cross-sectional mail-in survey. Settings/Subjects: A total of 395 bereaved FCGs of patients who died while under the care of a comprehensive hospice program were surveyed. Measurements: Demographics were collected. Bereavement experiences were assessed using the core bereavement items, and PTG was assessed using the Posttraumatic Growth Inventory (PTGI). Both surveys are validated measures. Results: Two-tailed bivariate correlations were used to analyze the relationships between bereavement experiences and PTG. Significant positive relationships were found between all bereavement experiences and PTG variables (p = <0.01-0.011, r = 0.134-0.290), except for one variable pairing (grief × new possibilities). Participants who reported more intense bereavement experiences also reported greater PTG, especially in the areas relating to others and appreciation of life. Conclusion: FCGs who undergo more intense bereavement experiences tend to experience greater PTG. This information can be used in the future to develop a more comprehensive understanding of the multifaceted nature of grief and loss.