Content area
Abstract
The purpose of this study was to examine how people with a life-threatening illness prepare for death and to understand and describe the dying process. In-depth interviews were conducted with 15 hospice clients over the course of 3 months. From the texts of the recorded conversations, the data were analyzed using thematic analysis. Twelve themes emerged and were developed from the data that describe the participant's experience of dying and how he or she prepared for death. The themes that emerged from listening to the participants are: (a) Living with a life threatening illness requires both learning and loss of skills; (b) Thanatologic realization creates a heightened sense of awareness and appreciation of life; (c) Knowing you are going to die and not wanting to die vacillates throughout the dying process; (d) Making decisions helps maintain a sense of control; (e) Preparation for death involves previous life experiences; (f) Preparing oneself for death is necessary in order to prepare others; (g) Spiritual preparation is a high priority near the end of the dying trajectory; (h) Goals at the end-of-life are related to short time frames; (i) Supportive care is essential; (j) living with a life threatening illness is not something people are prepared for; and (k) A life threatening illness becomes a major life focus for the dying and their families. These findings highlighted the end of life as a unique life phase with growth and development opportunities. These themes were compared to Ira Byock's end-of-life landmarks; and the participants as a whole achieved Byock's landmarks. The data revealed the presence of 2 additional landmarks that I believe could reshape models of care for people living with a life-threatening illness. These landmarks are a sense of completion with curative treatments and a sense of knowing life after death. The participants, as a whole, spoke of their belief in afterlife. This belief elevated spiritual development as a priority and also brought solace to them as they experienced the pain and suffering associated with a life threatening illness. I found that the end of life is an ending and a beginning. This finding is very important because if the topic of death, due to denial, has created obstacles for dialogue and practice, then shifting the conversation to living will enhance the interactions with dying people. Though the end of life tasks spoken of by the participants are congruent with the literature, the difference in this study reveals a concentration on tasks for living at the end of life far more important than death preparation. These living at the end of life tasks are both the physical limitations associated with a terminal illness and tasks associated with living after death or leaving a legacy. Although the dying experience for these participants was individually unique they all communicated the need for supportive care as essential. In addition, the participants embraced the chance to contribute to this research and to tell their story. Listening to these people was a powerful experience and a life-changing opportunity.
