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Reflections on wisdom at the end of life: qualitative study of hospice patients aged 58–97 years

Published online by Cambridge University Press:  24 January 2018

Lori P. Montross-Thomas
Affiliation:
Department of Family Medicine & Public Health, University of California San Diego, San Diego, California, USA Department of Psychiatry, University of California San Diego, San Diego, California, USA Sam and Rose Stein Institute for Research on Aging, University of California San Diego, San Diego, California, USA
Jamie Joseph
Affiliation:
Department of Psychiatry, University of California San Diego, San Diego, California, USA
Emily C. Edmonds
Affiliation:
Department of Psychiatry, University of California San Diego, San Diego, California, USA
Lawrence A. Palinkas
Affiliation:
Department of Children, Youth, and Families, University of Southern California School of Social Work, Los Angeles, CA, USA
Dilip V. Jeste*
Affiliation:
Department of Psychiatry, University of California San Diego, San Diego, California, USA Sam and Rose Stein Institute for Research on Aging, University of California San Diego, San Diego, California, USA Department of Neurosciences, University of California San Diego, San Diego, California, USA
*
Correspondence should be addressed to: Dilip V. Jeste, M.D., University of California San Diego, 9500 Gilman Drive, Mail Code #0664, La Jolla, California 92093-0664, USA. Phone: +1-858-534-4020. Email: djeste@ucsd.edu.

Abstract

Objective:

Wisdom is a complex trait, and previous research has identified several components of wisdom. This study explored the possible impact of a diagnosis of a terminal illness on the conceptualization and evolution of wisdom while facing the end of life.

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. The interviews were audiotaped, transcribed, and coded by the research team using a grounded theory analytic approach based on coding consensus, co-occurrence, and comparison.

Results:

Broad concepts of wisdom described by the hospice patients align with the extant literature, thereby supporting those general conceptualizations. In addition, hospice patients described how their life perspectives shifted after being diagnosed with a terminal illness. Post-illness wisdom can be characterized as a dynamic balance of actively accepting the situation while simultaneously striving for galvanized growth. This delicate tension motivated the patients to live each day fully, yet consciously plan for their final legacy.

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. This paradox, when embraced, may lead to even greater wisdom while facing one's own mortality.

Type
Original Research Article
Copyright
Copyright © International Psychogeriatric Association 2018 

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References

Ardelt, M. (2004). Wisdom as expert knowledge system: a critical review of a contemporary operationalization of an ancient concept. Human Development, 47, 257285. doi:10.1159/000079154.CrossRefGoogle Scholar
Baltes, P. B. and Smith, J. (2008). The fascination of wisdom: its nature, ontogeny, and function. Perspectives on Psychological Science, 3, 5664. doi:10.1111/j.1745-6916.2008.00062.x.CrossRefGoogle ScholarPubMed
Bangen, K. J., Meeks, T. W. and Jeste, D. V. (2013). Defining and assessing wisdom: a review of the literature. American Journal of Geriatric Psychiatry, 21, 12541266. doi:10.1016/j.jagp.2012.11.020.CrossRefGoogle ScholarPubMed
Bellizzi, K. M. (2004). Expressions of generativity and posttraumatic growth in adult cancer survivors. The International Journal of Aging and Human Development, 58, 267287. doi:10.2190/DC07-CPVW-4UVE-5GK0.CrossRefGoogle ScholarPubMed
Boyatzis, R. E. (1998). Transforming Qualitative Information: Thematic Analysis and Code Development. London; New Delhi: Sage Publications.Google Scholar
Carstensen, L. L., Isaacowitz, D. and Charles, S. T. (1999). Taking time seriously: a theory of socioemotional selectivity. American Psychologist, 54, 165181. PMID:10199217.CrossRefGoogle ScholarPubMed
Chochinov, H. M. (2007). Dignity and the essence of medicine: the A, B, C, and D of dignity conserving care. BMJ, 334, 184197. doi:10.1136/bmj.39244.650926.47.CrossRefGoogle Scholar
Clayton, V. (1975). Erikson's theory of human development as it applies to the aged: wisdom as contradictive cognition. Human Development, 18, 119128.CrossRefGoogle ScholarPubMed
Damon, W. (2000). Setting the stage for the development of wisdom: self-understanding and moral identity during adolescence. In Understanding Wisdom: Sources, Science, and Society (pp. 339360). Philadelphia: Templeton Foundation Press.Google Scholar
Dedoose (2015). Web Application for Managing, Analyzing, and Presenting Qualitative and Mixed Method Research Data. Los Angeles, CA: SocioCultural Research Consultants, LLC.Google Scholar
Depp, C. A. and Jeste, D. V. (2006). Definitions and predictors of successful aging: a comprehensive review of larger quantitative studies. The American Journal of Geriatric Psychiatry, 14, 620. doi:10.1097/01.JGP.0000192501.03069.bc.CrossRefGoogle ScholarPubMed
Diamond, L. M. and Aspinwall, L. G. (2003). Emotion regulation across the life span: an integrative perspective emphasizing self-regulation, positive affect, and dyadic processes. Motivation and Emotion, 27, 125156.CrossRefGoogle Scholar
Erikson, E. H. (1950). Childhood and Society, revised 1963. New York, NY: Norton.Google Scholar
Glaser, B. G. and Strauss, A. L. (1967). The Discovery of Grounded Theory: Strategies for Qualitative Research. Chicago: Aldrine Publishing Company.Google Scholar
Glück, J., Bluck, S., Baron, J. and McAdams, D. P. (2005). The wisdom of experience: autobiographical narratives across adulthood. International Journal of Behavioral Development, 29, 197208. doi:10.1177/01650250444000504.CrossRefGoogle Scholar
Hammarskjöld, D., Auden, W. H. and Sjöberg, L. (1964). Markings ["Vägmärken"] by Dag Hammarskjöld. Translated by Leif Sjöberg and W.H. Auden, with a Foreword by WH Auden. New York, NY: Ballantine Books.Google Scholar
Happé, F. G. E., Winner, E. and Brownell, H. (1998). The getting of wisdom: theory of mind in old age. Developmental Psychology, 34, 358362. doi:10.1037/0012-1649.34.2.358.CrossRefGoogle ScholarPubMed
Jeste, D. V. and Vahia, I. V. (2008). Comparison of the conceptualization of wisdom in ancient Indian literature with modern views: focus on the Bhagavad Gita. Psychiatry, 71, 197209. doi:10.1521/psyc.2008.71.3.197.CrossRefGoogle ScholarPubMed
Jeste, D. V., Ardelt, M., Blazer, D., Kraemer, H. C., Vaillant, G. and Meeks, T. W. (2010). Expert consensus on characteristics of wisdom: a delphi method study. The Gerontologist, 50, 668680. doi:10.1093/geront/gnq022.CrossRefGoogle ScholarPubMed
Kierkegaard, S. (1843). Journalen JJ. In Søren Kierkegaards Skrifter (vol. 18, p. 306). Copenhagen: Søren Kierkegaard Research Center.Google Scholar
Kross, E. and Grossmann, I. (2012). Boosting wisdom: distance from the self enhances wise reasoning, attitudes, and behavior. Journal of Experimental Psychology: General, 141, 4348.CrossRefGoogle ScholarPubMed
Lerner, R. M. (2008). Spirituality, positive purpose, wisdom, and positive development in adolescence: comments on Oman, Flinders, and Thoresen's ideas about “Integrating spiritual modeling into education”. The International Journal for the Psychology of Religion, 18, 108118.CrossRefGoogle Scholar
Meier, E., Gallegos, J. V., Thomas, L.P., Depp, C.A., Irwin, S. A. and Jeste, D. V. (2016). Defining a good death (successful dying): literature review and a call for research and public dialogue. American Journal of Geriatric Psychiatry, 24, 261271.CrossRefGoogle Scholar
Montross-Thomas, L. P. (2015). What are the most loving moments of your life? Journal of Palliative Medicine, 18, 398. doi:10.1089/jpm.2015.0006.18.5.CrossRefGoogle ScholarPubMed
Morley, J. E. (2004). The top 10 hot topics in aging. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 59, M24–M33. doi:10.1093/gerona/59.1.M24.CrossRefGoogle Scholar
Morse, J. M. (1995). The significance of saturation. Qualitative Health Research, 5, 147149. doi:10.1177/104973239500500201.CrossRefGoogle Scholar
Murray, S. A., Kendall, M., Grant, E., Boyd, K., Barclay, S. and Sheikh, A. (2007). Patterns of social, psychological, and spiritual decline toward the end of life in lung cancer and heart failure. Journal of Pain and Symptom Management, 34, 393402. doi:10.1016/j.jpainsymman.2006.12.009.CrossRefGoogle ScholarPubMed
NHPCO (2015). Facts and Figures: Hospice Care in America. (vol. 2016, p. 7). Alexandria, VA: National Hospice and Palliative Care Organization.Google Scholar
Niebuhr, R. (2015). Major works on religion and politics. In Sifton, E. (ed.), The Library of America. New York, NY: Literary Classics of the United States, Inc.Google Scholar
Pasupathi, M., Staudinger, U. M. and Baltes, P.B. (2001). Seeds of wisdom: adolescents' knowledge and judgment about difficult life problems. Developmental Psychology, 37, 351361. doi:10.1037/0012-1649.37.3.351.CrossRefGoogle ScholarPubMed
Pinder, M. M. and Hayslip, B. Jr. (1981). Cognitive, attitudinal, and affective aspects of death and dying in adulthood: implications for care providers. Educational Gerontology: An International Quarterly, 6, 107123. doi:10.1080/0380127810060201.CrossRefGoogle Scholar
Smith, J. and Baltes, P. B. (1990). Wisdom-related knowledge: age/cohort differences in response to life-planning problems. Developmental Psychology, 26, 494. doi:10.1037/0012-1649.26.3.494.CrossRefGoogle Scholar
Sternberg, R. J. (1990). Wisdom: Its Nature, Origins, and Development. New York, NY: Cambridge University Press.CrossRefGoogle Scholar
Strauss, A. L. and Corbin, J. (1998). Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. Thousand Oaks, CA: Sage.Google Scholar
Takahashi, M. (2000). Toward a culturally inclusive understanding of wisdom: historical roots in the East and West. International Journal of Aging and Human Development, 51, 217230. doi:10.2190/H45U-M17W-3AG5-TA49.CrossRefGoogle Scholar
Thomas, M. L. et al. (2017). A new scale for assessing wisdom based on common domains and a neurobiological model: the San Diego Wisdom Scale (SD-WISE). Journal of Psychiatric Research, 1–8. doi:10.1016/j.jpsychires.2017.09.005.Google Scholar
Vachon, M., Fillion, L. and Achille, M. (2009). A conceptual analysis of spirituality at the end of life. Journal of Palliative Medicine, 12, 5359. doi:10.1089/jpm.2008.0189.CrossRefGoogle ScholarPubMed
Willms, D. G. et al. (1990). A systematic approach for using qualitative methods in primary prevention research. Medical Anthropology Quarterly, 4, 391409. doi:10.1525/maq.1990.4.4.02a00020.CrossRefGoogle Scholar
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