End-of-Life Care & Reminiscing
Hospice and Palliative care providers are dedicated to ensuring that their patients experience a dignified and meaningful transition to death, living out their last days as fully and as comfortably as possible. Nurses, care staff, social workers and volunteers in this area of care provided patients and their families with physical, emotional and spiritual support throughout the journey of being diagnosed with a terminal illness through death and bereavement. Some patients receive care in their own homes. Other providers care for patients in assisted living, hospice houses, hospitals, or skilled nursing facilities.
When someone reaches the end of their life, they naturally reflect on their past. Erikson’s developmental theory stresses the importance of reminiscing to the psychological health of an individual. He describes a person’s last developmental task as the reworking of one’s past. That last task is to reach acceptance of what one’s life was, and for what someone has been. Erikson phrased it as: “to be-- through having been.”
Reminiscence (i.e. the ace or process of recalling past events or experiences) and its therapeutic proclivities has garnered much attention within the healthcare world in recent years. This is especially true for the dementia and end-of-life care fields. Life Story or Legacy Work and Ethical Wills are other valued activities that fall under the umbrella term of Reminiscence. Each of these hold particular importance in hospice and palliative care.
What is Life Story Work?
In its broadest sense, Life Story Work is the act of engaging someone in conversation about their life. It is capturing someone’s personal history and giving them the opportunity to reflect on their own stories, make sense of past situations and feelings, re-frame certain narratives, etc. Life Story Work may often involve an individual’s family members as well. They may help put certain pieces of a life story together where memory fails or someone begins to slip in and out of consciousness. After their loved one departs, family members find it comforting and healing to have access to their loved one’s life story in whatever format it happens to be in.
Life story work can look like:
- A recorded interview (audio file, video file, transcript)
- A Life Story Book with photos
- Using a digital Life Story app/service (the likes of Storii, LifeBio, or Lastly)
- Creating an altar or display of items that tell the story of a person (using photos, artwork, things they love, trinkets from various parts of their life, jewelry/clothing, books, plants, literally anything that represents who they are and what they feel is significant)
- Hosting Storytelling workshops or sessions for patients and their families
How to Conduct Life Story Work in Hospice Care
Life Story Work is a great job for trained hospice volunteers or Death Doulas to conduct. With a little research you may find Death Doulas, Chaplains, Art Therapists, academic researchers, or other practitioners who would be willing to offer their services to start a Life Story service project in your community.
The most important aspect of creating a life story is to involve the individual as much as possible to the extent they’re capable and willing. This ensures that their likes and preferences are considered. It also gives them a sense of ownership, dignity and independence. Only help where needed and be sure to discuss ahead of time what they want out of this or what they envision it forming into.
Tools for Life Story Work
Here are some helpful articles you could refer to when doing Life Story interviews with patients:
Benefits of Life Story Work in Palliative Care
Improve quality of care by giving providers a deep understanding of the individual’s background, personality, interests and needs. This enables them to communicate and care for them in the most patient-centered way possible. Therefore, life story work can benefit both patients and caregivers.
Help an individual connect with their identity and sense of self in their last days. Being able to engage with their own memories and convey who they are or what is important to them can boost confidence, engagement and communication.
Support loved ones through a difficult time by providing them with a keepsake they will treasure forever. Recording a life story with your dying loved one can be a beautiful, emotional, healing, and bonding experience. Furthermore, a Life Story is a legacy that enables future generations to gain an understanding of who this person was and the incredible life they lived. It is something that will live on after the person is gone and that can bring comfort to grieving families.
Reduce depression and suffering. One study of 100 terminally ill cancer patients found that 30-60 minute life story sessions significantly reduced both suffering and depression. The study asserted that “this relatively simple and straightforward psychotherapy can help patients attain the sense of peace they need to die with dignity” (Harvey Chochinov, 2005).
Easing discomfort families feel. Relatives visiting patients who are dying often feel uncomfortable and awkward. They want to be present, or feel strongly that they should be, but they don’t know what to do or discuss. They don’t want to be in the way, but want to be helpful. Providing an activity that gets them involved increases the connection and communication between patients, caregivers, and family members.