Confronting the prospect of dying: Reports of terminally ill patients

To identify dominant themes characterizing patients' perspectives on death during their last months of life, an ethnographic technique of interviewing and an inductive qualitative approach to analysis were employed. Serial, i n-depth, semi-structured interviews were conducted With 30 Patients (mean = 4.2 interviews/patient) followed as close to the time Of death as possible . The interviews were audiotaped, transcribed, and subjected to independent analysis bi, both authors using standard qualitative techniques. Patients were referred to the Study by Beth Israel Medical Center clinicians if they had a diagnosis of a life-threatening condition of which they were aware, were likely to die within one year according to their physician; had experi enced symptoms of the illness; were sufficiently alert to discuss the topic s addressed in the study; conversed easily in English; and consented to par ticipate. Outlooks on dying were thoroughly grounded in patients' frames of reference for giving meaning and consistency to other major events in thei r lives. Seven motifs characterizing these perspectives on death were disti lled: struggle (living and dying are difficult), dissonance (dying is not l iving), endurance (triumph of inner strength), coping (finding a new balanc e), incorporation (belief system accommodates death), quest (seeking meanin g in death), and volatile (unresolved and unresigned). Patients demonstrate d a striking capacity for coherence, integrating their responses to dying w ith broader motifs in their life stories. Health care providers would be we ll advised to become aware of such motifs so as to better understand patien t preferences for cam and responses to treatment recommendations. (C) US. C ancer Pain Relief Committee, 2001.