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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
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
Department of Psychiatry, University of California San Diego, San Diego, California, USA
Emily C. Edmonds
Department of Psychiatry, University of California San Diego, San Diego, California, USA
Lawrence A. Palinkas
Department of Children, Youth, and Families, University of Southern California School of Social Work, Los Angeles, CA, USA
Dilip V. Jeste*
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:



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.


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.


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.


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.

Original Research Article
Copyright © International Psychogeriatric Association 2018 

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