The Science of Meaning in Life

Reliability, validity, and sensitivity of the Chinese Life Attitude Self-rating Questionnaire for Breast Cancer

RATIONALE, AIMS AND OBJECTIVES

Psychometrics of the Chinese Life Attitude Self-rating Questionnaire for Breast Cancer (LASQ-BC) has not yet been conducted in a larger sample of women with breast cancer. This study aimed to examine the reliability, validity, and sensitivity of the LASQ-BC in Chinese mainland female breast cancer patients.

METHOD

This is a cross-sectional study. Reliability was determined by Cronbach's α and Guttman split-half coefficient. Convergent and discriminant validity were evaluated via item-subscale and item-total score correlations. Factorial validity was estimated using a principal component analysis with varimax rotation. Sensitivity was identified via Cohen's effect size (ES) and an independent sample t-test between the new and recurrent cases. Multiple linear regression analysis was used to further examine sensitivity of the LASQ-BC under the influence of newly diagnosed breast cancer (yes vs. no).

RESULTS

A total of 429 patients completed the questionnaire. Cronbach's α of the LASQ-BC was 0.96, ranging from 0.86 to 0.92 for the four subscales (i.e., choice and responsibility, life meaning, benevolence, and life experiences). The Guttman split-half coefficient was 0.90. The hypothesised item-subscale and item-total score correlations were higher than the critical value of 0.50. Four factors were extracted from the 23 items, explaining 69.29% of the total variance. Eligible ES (range: 0.38-0.48) was found in the four subscales and total score between the new and recurrent cases (independent sample t-test), and under the influence of newly diagnosed breast cancer (yes vs. no; multiple linear regression analysis).

CONCLUSION

The Chinese LASQ-BC has acceptable reliability, validity, and sensitivity in women with breast cancer of mainland China. It can be used to female breast cancer patients as an invaluable metric and a crucial instrument for assessing and discerning those grappling with a suboptimal life attitude, and in gauging the efficacy of psychological interventions tailored to enhance this perspective.

"It doesn't Always Have to Be an Expert": Professionals' Perceptions of Practical Aspects of the Existential Dimension of Care for People Approaching Death

'Existential' can be seen as a broad term for issues surrounding people's experiences and way of thinking about life. This study examined availability of existential care and found that many different staff categories performed existential care. Existential care is associated with conversations and experienced as both easy and difficult; several factors were cited, e.g. insufficient time, stress and the difficulty of addressing existential questions for oneself. Respondents reported need for education, guidance and reflection around existential issues and care. Existential care is described as a natural part of patient care that all professional categories have a responsibility to offer.

Being as Having, Loving, and Doing: A Theory of Human Well-Being

ACADEMIC ABSTRACT

Stronger theory on the nature of human well-being is needed, especially as well-being indicators are increasingly utilized in policy contexts. Building on Erik Allardt, who argued that a theory of well-being is, in essence, a theory of human nature, I propose four modes of existence each capturing one dimension central to human well-being: Having recognizes humans as biological creatures requiring certain material resources for survival. Loving captures human social nature and our dependence on others for well-being. Doing highlights the active and agentic nature of human existence. Being acknowledges humans as experiencing their existence. Each mode of existence gives rise to a few more specific needs, and a full assessment of human well-being requires both subjective and objective indicators tapping into these needs. The proposed theory integrates psychological well-being research with sociological and philosophical traditions and contributes to debates about how the progress of nations and sustainability should be measured.

PUBLIC ABSTRACT

Well-being is something we all value individually, and it is also a key political goal. Accordingly, how we define and measure well-being influences what physicians, managers, policy-makers, politicians, and international organizations aim to improve through their work. Better theories of well-being make better measurement of well-being possible, which makes possible more effective and evidence-based advancement of human well-being. In this spirit, the present article argues that there are four fundamental dimensions to human well-being: Having highlights that as biological creatures, we have physical needs, loving highlights human social needs, doing highlights that we are active and agentic beings with goals and strivings, and being highlights that we feel and evaluate our lives. To assess well-being, we need measures tapping into all four of these dimensions. And to assess the sustainability of well-being, we need to examine how to provide well-being for all humanity while remaining within planetary boundaries.

Strengthening the meaning in life among college students: the role of self-acceptance and social support - evidence from a network analysis

Meaning in life, which has two possible sources: self-acceptance and social support, is essential to the mental health and development of college students. The current study aims to further clarify the symptom-level relations between meaning in life, self-acceptance, and social support, finding possible ways to improve meaning in the life of college students. Thousand three hundred and forty-eight Chinese college students completed the online questionnaire, including Self-acceptance Questionnaire, Social Support Rating Scale, and Meaning in Life Questionnaire and the data from 1,263 participants was used. Cross-sectional network analysis was used to examine the relation between self-acceptance and social support. We also explored the relation between dimensions of self-acceptance and social support and meaning in life using the flow network. The results show symptom "SlA" (self-acceptance) is the bridge symptom linking self-acceptance and social support. In the flow diagrams, "SlA" is directly and positively associated with the presence of meaning. Objective Support shares the strongest positive association with the search for meaning. The symptom "SIA" may be an important targeting symptom when trying to improve the meaning in life of college students. Additionally, social support is essential for college students to develop meaning in life.

The mediating roles of optimism, loneliness, and psychological distress in the association between a sense of community and meaning in life among older adults

A sense of community is known to be a protective factor for the well-being of older adults and meaning in life associated with positive mental outcomes. Nevertheless, there is a need to expand the knowledge of the role of a sense of community in meaning in life, particularly among older adults. Intending to broaden the empirical understanding from this perspective, the current study examined the mediating roles of optimism, loneliness, and psychological distress in the association between a sense of community and meaning in life. Participants included 740 community dwelling Israeli older adults (M = 71.96; SD = 5.81). Participants completed questionnaires on a sense of community, optimism, loneliness, psychological distress, meaning in life, and sociodemographic characteristics. A positive association was found between a sense of community with optimism, and a negative association with loneliness. A negative association between optimism with psychological distress and a positive link between loneliness with psychological distress was found, while a higher level of psychological distress was associated with a lower level of meaning in life. Practitioners should focus interventions with older adults on developing a sense of community, with the aim to promote optimism and, at the same time, reduce loneliness and thus decrease psychological distress while strengthening meaning in life.

Routineness of Social Interactions Is Associated With Higher Affective Well-Being in Older Adults

OBJECTIVES

Some research conceptualizes routineness of daily life as an indicator of cognitive vulnerability that would lead to lower well-being in older age, whereas other research expects routineness to give rise to more meaning and stability in life and thus to higher well-being. Further research is needed to understand routineness in older adults in relation to cognitive abilities and well-being. This study examined routineness of social interactions.

METHODS

We examined data from an event-contingent experience sampling study with 103 Swiss community-dwelling older adults (aged 65 to 84 years). Participants completed in-lab cognitive assessments (reasoning, episodic memory, speed, and vocabulary) and reported their well-being (positive affect, negative affect, and life satisfaction). For more than 21 days, participants reported the time and context of their social interactions (including modality, partner type, and location). Routineness of social interactions was defined as social interactions that occurred at the same time of day over the study period. It was calculated using recurrence quantification analysis.

RESULTS

Linear regressions showed that higher routineness of social interaction in general, of social interaction through the same modality, and of social interaction with the same partner type were associated with higher positive affect. Higher routineness of social interaction in general was associated with lower negative affect. Routineness of social interactions was not associated with life satisfaction or cognitive abilities.

DISCUSSION

A routine social life may increase older adults' affective well-being. Results are discussed in the context of activity engagement and time use in older age.

Based on the relationship between anxiety of existential meaninglessness, hope level, and fear of progression, explored the effect of preoperative nursing with Orem theory in the senile cataract population

Background

Cataracts, characterized by a decrease in vision due to the clouding of the lens, can progress to blindness in advanced stages. The rising incidence of cataract cases has led to a significant number of patients experiencing negative emotions associated with vision loss, thereby diminishing their quality of life. In clinical practice, it is imperative for healthcare professionals to consider the psychological well-being of cataract patients. Currently, there is a scarcity of research focusing on psychological evaluations, such as assessing feelings of meaninglessness among individuals with cataracts.

Objective

This study aims to investigate the factors influencing the anxiety of existential meaninglessness and to explore the relationships among existential anxiety, Herth hope index levels and fear of progression in the elderly cataract-affected population. Additionally, it evaluates the effectiveness of Orem's nursing care strategies.

Methods

Utilizing a sociodemographic questionnaire, the Existential Meaninglessness Anxiety Scale (EM-A), Herth Hope Index Level Scale, and the Fear of Progression Questionnaire-Short Form (FoP-Q-SF), this research employed convenience sampling for a cross-sectional and intervention study. The retrospective study sample comprised 1,029 individuals, while the intervention study included 317. The intervention design assessed psychological changes in existential meaninglessness following Orem's preoperative nursing interventions. Multiple linear regression analysis was employed to ascertain the determinants of EM-A within the population of elderly patients with senile cataracts. Pearson correlation analysis elucidated the relationship between EM-A, levels of hope, and the FoP-Q-SF among this demographic. Subsequent investigations, utilizing a t-test, evaluated the effects by comparing the data before and after the implementation of the interventions.

Results

The correlation between EM-A, hope levels, and FoP-Q-SF was statistically significant (p < 0.05). Factors such as age, education level, alcohol consumption habits, hope levels, and FoP-Q-SF scores significantly affected EM-A scores (p < 0.05). Orem's nursing framework significantly reduced existential anxiety (p < 0.05).

Conclusion

Among elderly patients with cataracts, existential anxiety was generally moderate. Hope levels and fear of progression were closely associated with the EM-A. The novel Orem preoperative care model effectively addresses clinical issues. In clinical practice, it is crucial to address psychological problems and enhance patients' quality of life.

Bored to death: Artificial Intelligence research reveals the role of boredom in suicide behavior

Background

Recent advancements in Artificial Intelligence (AI) contributed significantly to suicide assessment, however, our theoretical understanding of this complex behavior is still limited.

Objective

This study aimed to harness AI methodologies to uncover hidden risk factors that trigger or aggravate suicide behaviors.

Methods

The primary dataset included 228,052 Facebook postings by 1,006 users who completed the gold-standard Columbia Suicide Severity Rating Scale. This dataset was analyzed using a bottom-up research pipeline without a-priory hypotheses and its findings were validated using a top-down analysis of a new dataset. This secondary dataset included responses by 1,062 participants to the same suicide scale as well as to well-validated scales measuring depression and boredom.

Results

An almost fully automated, AI-guided research pipeline resulted in four Facebook topics that predicted the risk of suicide, of which the strongest predictor was boredom. A comprehensive literature review using APA PsycInfo revealed that boredom is rarely perceived as a unique risk factor of suicide. A complementing top-down path analysis of the secondary dataset uncovered an indirect relationship between boredom and suicide, which was mediated by depression. An equivalent mediated relationship was observed in the primary Facebook dataset as well. However, here, a direct relationship between boredom and suicide risk was also observed.

Conclusion

Integrating AI methods allowed the discovery of an under-researched risk factor of suicide. The study signals boredom as a maladaptive 'ingredient' that might trigger suicide behaviors, regardless of depression. Further studies are recommended to direct clinicians' attention to this burdening, and sometimes existential experience.

The Impact of Awe on Existential Isolation: Evidence for Contrasting Pathways

We propose that awe has multifaceted relations with existential isolation, a feeling of separation between the self and others or the world. Three studies examined the relation between awe and existential isolation via feelings of small self (vastness, self-size, self-perspectives) and a sense of connectedness. Awe (vs. a control topic) was induced either using virtual reality (Study 1) or a recall task (Studies 2 and 3) and was indirectly associated with higher and lower levels of existential isolation through differing pathways. Awe was associated with lower feelings of existential isolation via an increased sense of vastness, which in turn predicted greater connectedness; whereas awe was associated with higher feelings of existential isolation via increased sense of feeling small, which in turn predicted lower connectedness. This work advances understanding of the complex nature of awe-revealing its competing effects on the self and the social connectedness pathways through which awe can influence existential isolation.

Meaning in life following service among post-9/11 military veterans: A latent growth mixture model analysis

Meaning in life refers to the "sense made of, and significance felt regarding, the nature of one's being and existence." Meaningful living promotes well-being, resilience, and personal growth. Yet, much remains unknown about how meaning changes over time and determinants of meaning, particularly during major life transitions. We identified distinct trajectories of meaning using latent growth mixture models and examined prospective predictors of class membership in a military veteran cohort assessed at multiple time points throughout the first 3 years after leaving service. Three trajectories were identified: consistently high meaning (89.5%; n = 7025), diminishing meaning (6.1%; n = 479), and strengthening meaning (4.4%; n = 348). Veterans with greater posttraumatic stress symptoms, depression symptoms, and moral injury experienced increased odds of a less adaptive trajectory (i.e. diminishing and/or strengthening vs. consistently high meaning), whereas veterans who reported greater psychological resilience, community relationship satisfaction, and intimate relationship satisfaction experienced lower odds of a less adaptive trajectory. Several gender differences were also observed. Results provide insight into veteran subgroups that are more likely to experience lower meaning after leaving military service and thus may benefit from additional support to reduce their risk for poor longer-term health and well-being outcomes.

Activating values intervention: an integrative pathway to well-being

Introduction

The present study expands the existing knowledge base regarding positive psychology interventions (PPIs), by employing an integrative approach to explore the potential benefits of translating values into action.

Methods

Participants (n = 476) were randomly assigned to the Activating Values intervention, the affirmation-only, or the control (no treatment) group. The intervention involved participants choosing a life area they valued, affirming its importance, identifying a specific action related to that valued area, and then planning and carrying out that chosen action within the following week. Data was collected at baseline and three follow-up points: one, two, and three weeks after the intervention.

Results

Results suggest that the intervention contributes to the participants' well-being, including increased self-insight, sense of coherence, and prioritizing meaning, and decreased symptoms of psychopathology. Exploratory content analyses provide a deeper understanding of the content and frequency of activities chosen and the enabling conditions.

Discussion

The discussion explores the findings within this intersection as well as ramifications for brief, scalable interventions to support and promote well-being.

Developing and Validating the Senior Meaning in Life Evaluation (SMiLE) Scale

The Senior Meaning in Life Evaluation scale encompasses not only older adults' personal motivation and growth but also the meaning for them in society and in their relationships: With this scale, we aimed to present their voices. A three-phase process was followed: The scale's items were developed empirically from interviews of older adults; exploratory factor analysis (EFA) was conducted to test convergent and concurrent validity; and finally, confirmatory factor analysis (CFA) was performed. EFA resulted in 18 items grouped into 4 factors (i.e., proactive on life, overcoming emptiness, acceptance in life, and social contribution), which was supported by the CFA.

On Creating Deeper Relationship Bonds: Felt Understanding Enhances Relationship Identification

Relational experiences play a critical role in shaping how individuals see themselves. In four studies (N=945) using person-perception, longitudinal, and experimental designs, we demonstrate that feeling understood changes individuals' self-concept by increasing the centrality of a specific relationship (relationship identification). Study 1 showed that participants perceived an individual to be more identified with their relationship when their partner was high (vs. low) in understanding. Study 2 extended these results by examining individuals in romantic relationships longitudinally. The results of Studies 1 and 2 were distinct for understanding compared to acceptance and caring. Studies 3 and 4 manipulated felt understanding. Recalling many versus few understanding instances (Study 3) and imagining a close other being low versus high in understanding (Study 4) led individuals to feel less understood, which reduced identification in their friendships and romantic relationships. Furthermore, Study 4 suggests that coherence may be one mechanism through which felt understanding increases relationship identification.

The impact of social support for older adults in nursing homes on successful aging: a moderated mediation model

Objective

To investigate the connection between social support (SS) and successful aging (SA) in older adults residing in nursing homes, examining the mediating role of meaning in life (MIL). Additionally, this study aims to assess whether frailty moderates the mediation model.

Methods

A cross-sectional survey approach was employed to recruit older adults from six nursing homes in Sichuan Province between August 2022 and December 2022. Questionnaires, including the General Information Questionnaire, Social Support Rating Scale (SSRS), Meaning in Life Questionnaire (MLQ), Tilburg Frailty Indicator (TFI), and Successful Aging Inventory (SAI), were administered. Data obtained from the completed questionnaires were analyzed using SPSS and its macro program PROCESS.

Results

SS emerged as a noteworthy positive predictor of SA in older adults of nursing homes. MIL was identified as a partial mediator in the link between SS and SA. Furthermore, frailty attenuated the positive predictive impact of MIL on SA and moderated the latter part of the mediation model, wherein SS influences SA through MIL. The influence of MIL on SA was more pronounced in older adults with lower frailty levels in nursing homes, while it was diminished in those with higher levels of frailty.

Conclusion

Apart from ensuring the availability of essential medical resources in long-term care for older adults, workers in nursing homes should also recognize the significance of "spiritual aging" to cultivate a sense of MIL among older adults. Simultaneously, attention must be directed toward screening for frailty indicators in older adults. Psychological care and physical exercise programs should be intensified for older adults with a high level of frailty, aiming to decelerate the progression of frailty in nursing home residents. This approach leverages the mediating role of MIL and the moderating influence of frailty, ultimately enhancing SA and promoting healthy aging in older adults within nursing home settings.

Social contributions to meaning in life: the role of romantic relationship quality, parenting, and gender

Introduction

The present study tests the association between romantic relationship quality and number of children on meaning in life (i.e., sense of purpose, coherence, and significance) and considers interactions between these constructs and gender.

Methods

A survey was conducted approximately one year into the pandemic among 473 individuals in the United States.

Results

Models demonstrated that relationship quality and number of children are positively associated with meaning, though relationship quality was more strongly related to meaning for men than women. We showed that for women there was an equally positive link between relationship quality and meaning regardless of number of children. However, for men, the positive association between relationship quality and meaning was strongest for those with more than one child, decreased in magnitude for those with one child, and was no longer significant for men with more than one child.

Discussion

These findings provide empirical evidence that social relationships benefit meaning in life and underscore the complexity of these associations. Results have implications for theoretical perspectives on meaning in life, as well as for policies that encourage family wellbeing.

"It was the first time someone had died before my eyes…": A qualitative study on the first death experiences of nursing students

BACKGROUND

Accompanying a person at their death is a common experience in nurse education. In addition to all death experiences that are a meaningful part of the nursing profession, the first death experience is very important. However, there is limited understanding of nursing students' first death experiences.

OBJECTIVES

This study aimed to explore nursing students' experiences of the death of a person for the first time during clinical practice.

DESIGN

This study was conducted as a qualitative study using a phenomenological design.

PARTICIPANTS

A total of 17 nursing students participated in this study.

METHODS

Data were collected through online individual in-depth interviews and were analyzed using content analysis.

RESULTS

Four main themes and eleven sub-themes emerged. The themes were meaning of death (first death, a part of life), process management (death information, physical environment, bad news), after death (empty bed, questioning, death with dignity) and education (curriculum, support, professional perception).

CONCLUSIONS

While the first experience of death provides an opportunity for students to learn, this experience reveals various negative emotions and the need for support.

Relationships Between Meaning in Life and Positive and Negative Spirituality in a Field Setting in Japan

This study examined the relationships between positive/negative spirituality and meaning in life at two religious sites in Japan. Participants reported greater sadness and less meaning in life at Koyasan Okunoin, a temple with graves surrounded by nature, than at Nachi Kumano Taisha, a shrine with a waterfall. However, greater feelings of happiness protected meaning in life in the presence of sadness at Koyasan. Additionally, participants who felt a sense of awe reported greater meaning in life through self-liberation, regardless of the sites. The results provide new insights into meaning in life from the two sides of spirituality.

Development and Validation of the "Lying Flat" Tendency Scale for the Youth

In recent years, "lying flat" has been enthusiastically pursued by young people in China, and it is worth studying its cause and social impact. However, there is still a lack of measurement tools that can scientifically evaluate an individual's tendency for "lying flat." In this study, a 6-item "Lying Flat" Tendency Scale was developed and cross-validated for reliability and validity in different samples from China. The findings demonstrated that the scale showed good internal consistency in three different samples; both exploratory factor analysis and confirmatory factor analysis supported the single dimension model of the scale, indicating good construct validity; the LFTS total score was negatively correlated with the satisfaction of basic psychological needs, happiness index, and positive emotions, and was positively correlated with negative emotions; simultaneously, the LFTS total score was also significantly positively correlated with the choice of "lying flat" behavior in the simulated situation. These results show that the scale has good validity and reliability, and can be used as a measuring tool for subsequent empirical research. It will help to promote the development of empirical research on the phenomenon of "lying flat", help to understand the causes and consequences of "lying flat" more deeply, and also help to find effective ways to help young people break out of the "lying flat" dilemma.

Profiles, Transitions, and Resilience Factors of Suicide Risk in Early Chinese Adolescents

As a severe public health concern directly endangering life safety, adolescent suicide has been extensively investigated in variable-centered studies. However, gaps remain in the knowledge of heterogeneous suicide risk patterns and their developmental nature. Additionally, little is known about protective factors associated with suicide risk patterns and changes. This study applied person-centered approaches to explore suicide risk profiles and transitions over time in early Chinese adolescents, along with their protective factors. A total of 1518 junior high school students (49.6% girls, Mage = 13.57, SD = 0.75) participated in two surveys within a 12-month interval. Latent Profile Analysis and Latent Transition Analysis were used to model the profiles and transitions of suicide risk. Three risk profiles were identified at both time points: low risk profile (73.9, 78.3%), medium risk-high threat profile (16.2, 10.2%), and high risk profile (9.9, 10.2%). Low risk profile was stable, while medium risk-high threat and high risk profiles showed great transitions over 12 months. Sense of control, meaning in life, and regulatory emotional self-efficacy served as protective factors against suicide risk profiles and transitions. Findings underscore the importance of comprehensively illustrating suicide risk states from multiple aspects, as well as understanding the fluid nature of transitions between different risk states. Prevention and intervention strategies aimed at enhancing resilience, such as increasing sense of control, perceived meaningfulness, and belief in emotional regulation, may contribute to reducing the risk of suicide among adolescents.

Belief in a just world and meaning in life among Chinese adolescents: The mediating role of basic psychological need satisfaction

Previous literature has shown that adults with higher belief in a just world (BJW) experience greater meaning in life than those with less pronounced BJW. However, the role of BJW in adolescent meaning in life and the associated psychological mechanisms remain unclear. Thus, two studies were conducted to explore the roles of personal belief in a just world (PBJW) and general belief in a just world (GBJW) in meaning in life as well as the explanatory role of basic psychological need satisfaction among Chinese adolescents. Study 1 offered cross-sectional evidence that individuals higher in PBJW and GBJW displayed greater meaning in life, and basic psychological need satisfaction accounted for these associations. Study 2 provided longitudinal evidence that individuals higher in PBJW and GBJW at Time 1 exhibited greater meaning in life six months later (Time 2), wherein basic psychological need satisfaction at Time 1 served as a mediator. These findings contribute to understanding the adaptive benefits of PBJW and GBJW in meaning in life during adolescence and point to a crucial channel connecting BJW and meaning in life.

"What it is like to be human": The existential dimension of care as perceived by professionals caring for people approaching death

OBJECTIVES

Existential/spiritual questions often arise when a person suffers from a serious and/or life-threatening illness. "Existential" can be seen as a broad inclusive term for issues surrounding people's experience and way of thinking about life. To be able to meet patients' existential needs, knowledge is needed about what the existential dimension includes. The aim of this study was to investigate how professionals caring for people with life-threatening disease perceive the existential dimension of care.

METHODS

This study is based on a mixed method design utilizing a digital survey with open- and closed-ended questions. Descriptive statistics were applied to closed-ended questions and a qualitative descriptive approach was used for the responses to the open-ended questions. Healthcare professionals at specialized palliative care units, an oncology clinic and municipal healthcare within home care and a nursing home in Sweden answered the survey.

RESULTS

Responses from 77 professionals expressed a broad perspective on existential questions such as thoughts about life and death. Identifying existential needs and performing existential care was considered a matter of attitude and responsiveness and thus a possible task for any professional. Existential needs centered around the opportunity to communicate, share thoughts and experiences, and be seen and heard. Existential care was connected to communication, sharing moments in the present without doing anything and was sometimes described as embedded in professionals' ordinary care interventions. The existential dimension was considered important by the majority of respondents.

SIGNIFICANCE OF RESULTS

This study indicates that with the right attitude and responsiveness, all professionals can potentially contribute to existential care, and that existential care can be embedded in all care. The existential dimension of care can also be considered very important by health professionals in a country that is considered secular.

The COVID-19 pandemic as an existential threat: Evidence on young people's psychological vulnerability using a Multifaceted Threat Scale

Research offers evidence that younger generations suffered the most psychologically from the COVID-19 crisis. In this article, we look at the onset of the pandemic to understand the reasons for this increased vulnerability. We use the COVID-19 Multifaceted Threat Scale to explore potential mechanisms underlying generational differences in psychological well-being. In a sample of 994 individuals (+18) obtained in the USA and India, we first assess levels of perceived psychological well-being across the generations. Thus, we measure cross-generational differences in the perceived levels of financial, relational, existential, health and lifestyle threats experienced by respondents seven months after the pandemic broke out. In accordance with earlier findings, the results confirm that people from Generation Z and Generation Y reported worse levels of psychological well-being than older adults. Our results suggest that the heightened existential threat, as reflected in a loss of meaning and feelings of being "trapped", mediate the association between younger generations and worse psychological well-being. No substantial intergenerational differences were found for other threat dimensions. The observed effects were consistent across both national contexts, hence stressing the importance of existential concerns as a mechanism underlying the psychological vulnerability of younger people in the historical contingencies of the COVID-19 pandemic.

A pathway to greater meaning in life and well-being for senior executives beset by anti-meaning

Introduction

Although work is a significant source of meaning for most people, the role of senior executive generates different meaning and well-being complexities than those experienced or faced by general employees. This study explored how meaning and anti-meaning components affect senior executives' experiences of meaning in life and well-being. The findings enabled devising a pathway to enhance senior executives' net experiences of meaning in life and well-being.

Methods

A cross-sectional, semi-structured interview study design was used to gather rich qualitative data. Eight participants from southern and eastern Africa, who had held the position of chief executive officer or managing director for at least five years, were interviewed.

Results

The findings demonstrated that senior executives' work roles provide a significant source of meaning. However, the roles are accompanied by unavoidable anti-meanings, which are likely to generate additional anti-meanings if not tempered sufficiently, thus reducing the net meaning experienced.

Discussion

From the findings, a practical pathway was devised to assist top executives to deal with the bipolar relationship between meaning and anti-meaning. Consulting and counseling practitioners can utilize the pathway to guide, support, and counsel senior executives towards improved meaning, temper anti-meaning and improve well-being.

Longitudinal evolution of meaning in life and its relationship with coping strategies in Spanish patients with a breast cancer diagnosis

BACKGROUND

Changes in Meaning in life (MIL) have been shown to be particularly important when people face very stressful events such as receiving a cancer diagnosis and treatment. Active coping strategies have been related to higher levels of MIL in people with a diagnosis of cancer.

OBJECTIVE

To explore the evolution of MIL in a sample of cancer patients at the time of their diagnosis and three, six, and nine months after surgery, and identify the association between coping strategies three months after diagnosis (T2) and levels of MIL at the different moments in the cancer process (T1-T4).

METHODS

We assessed MIL at diagnosis and three, six, and nine months after surgery, and coping strategies (fighting spirit, anxious preoccupation, hopelessness, fatalism, and cognitive avoidance) three months after surgery, in 115 women with a diagnosis of Stage I-III breast cancer.

RESULTS

We found higher levels of MIL nine months after surgery, compared to previous stages. MIL correlated significantly and positively with a fighting spirit and cognitive avoidance, and negatively with hopelessness and anxious preoccupation.

CONCLUSIONS

Results highlight the importance of coping in relation to meaning-making processes in cancer. Meaning-centred interventions could help patients who are in the process of coping with cancer to make sense of their lives and the experience.

Beyond Finding Purpose: Motivating a Translational Science of Purpose Acquisition

A broad interest in finding purpose is understandable, as having purpose is situated in notions of "the good life" and is linked in studies to greater health and wellbeing. Yet, the empirical basis for whether purpose is truly findable is inadequate, lacking guidance from theories predicting behavioral capacities that drive its acquisition. If feeling purposeful is as favorable as studies suggest, then more transparent and precise explanations of how it is derived are needed; otherwise, the field risks illuminating this resource while leaving the pathways to it unlit. Here, I call for a translational science of purpose acquisition directed at gathering and disseminating evidence of the processes by which this sense can be cultivated. I introduce a minimal viable framework for integrating basic and applied investigations into purpose by bridging laboratory research, intervention and implementation efforts, community-engaged practices, and policies to accelerate testing and strategies for enhancing this salubrious sense in people's lives.

Delving into the role of creativity on meaning in life: A multiple mediation model

How to enhance the sense of meaning in life is a topic deserving of extensive research. The impact of creativity on finding meaning in life, however, has not been thoroughly explored in empirical research. This paper studies the relationship between creativity and meaning in life, and the cognitive and emotional factors underlying this relationship. The participants of this study were 359 Chinese college students (38 males and 321 females; aged from 17 to 41 years) in learning English as a foreign language (EFL). Four instruments were utilized in the survey, namely, the Kaufman Domains of Creativity Scale (K-DOCS), the Positive Affect Scale, the General Self-Efficacy Scale (GSES), and the Meaning in Life Questionnaire (MLQ). The correlation analysis shows that creativity, positive affect, general self-efficacy, and meaning in life are all positively correlated. According to a bootstrap method to assess the significance of the indirect effect, general self-efficacy and positive affect play multiple mediating roles in the relationship between creativity and meaning in life via three mediating pathways: general self-efficacy alone, positive affect alone, and the effect of general self-efficacy on positive affect. The mediating effect accounts for nearly half (44.18%) of the total effect. This study examines the theoretical connection between creativity and meaning in life, and uncovers the psychological process that underlies this connection. On a practical level, these results indicate that stimulating Chinese college students to engage in creative activities in various fields can enhance their sense of meaning in life.

Prosocial behavior predicts meaning in life during the COVID-19 pandemic: The longitudinal mediating role of perceived social support

The COVID-19 pandemic was an unexpected, long-term negative event. Meaning in life has been linked to better psychological adjustment to such events. The current study uses longitudinal data collected during the COVID-19 pandemic to discover whether perceived social support mediates the relationship between six dimensions of prosocial behavior (Altruistic, Anonymous, Public, Compliant, Emotional, and Dire) and meaning in life. A sample of Chinese college students (N = 514) was tracked at three time points (T1, T2, and T3) during the COVID-19 outbreak. A cross-lagged panel model (CLPM) was used for mediation analysis. The mediation effect was found in all the dimensions of prosocial behavior except for Public prosocial behavior. We also found a longitudinal, bidirectional association between perceived social support and meaning in life. The current study contributes to the growing literature on the significance of prosocial behavior in predicting meaning in life.

Vitality Revisited: The Evolving Concept of Flourishing and Its Relevance to Personal and Public Health

Human flourishing, the state of optimal functioning and well-being across all aspects of an individual's life, has been a topic of philosophical and theological discussion for centuries. In the mid-20th century, social psychologists and health scientists began exploring the concept of flourishing in the context of health and high-level wellness. However, it is only in recent years, in part due to the USD 43 million Global Flourishing Study including 22 countries, that flourishing has entered the mainstream discourse. Here, we explore this history and the rapid acceleration of research into human flourishing, defined as "the relative attainment of a state in which all aspects of a person's life are good" by the Harvard University's Flourishing Program. We also explore the construct of "vitality", which refers to a sense of aliveness, energy, and motivation; we contend that this has been neglected in the flourishing movement. We explore why incorporating measures of vitality, together with a broader biopsychosocial approach, considers all dimensions of the environment across time (the total exposome), which will greatly advance research, policies, and actions to achieve human flourishing.

An everlasting love: The relationship of happiness and meaning

Happiness is of great importance to people. Although happiness constitutes a central theme in psychology, the absence of a unifying theory and inconsistent terminology undermine scientific progress. The present article goes beyond attempting to define “types of happiness” or its contributing factors and addresses the role of happiness (i.e., embodied positive emotional patterns) as a function of a dynamic multisystem (i.e., an individual) and its relationship to meaning (i.e., ongoing bidirectional cognitive processes). As a dynamic multisystem, a person strives for stability as they move in physical space, and during their development, across time (i.e., dynamic balance). A primary requirement for dynamic balance is maintaining consistency by connecting the cognitive system to behavior. In psychological terms, such a connection is facilitated by meaning. The model suggests that happiness serves as a marker of a person’s consistency and meaningful interpretations of their lived experience. The model points to a new research direction.

Meaning-making following loss among bereaved spouses during the COVID-19 pandemic (the CO-LIVE study)

This study investigates how individuals construe, understand, and make sense of experiences during the first wave of the COVID-19 pandemic. Seventeen semi-structured interviews were conducted with bereaved spouses focusing on meaning attribution to the death of their partner. The interviewees were lacking adequate information, personalized care, and physical or emotional proximity; these challenges complicated their experience of a meaningful death of their partner. Concomitantly, many interviewees appreciated the exchange of experiences with others and any last moments together with their partner. Bereaved spouses actively sought valuable moments, during and after bereavement, that contributed to the perceived meaning.

Is Religion Special?

Religion makes unique claims (e.g., the existence of supernatural agents) not found in other belief systems, but is religion itself psychologically special? Furthermore, religion is related to many domains of psychological interest, such as morality, health and well-being, self-control, meaning, and death anxiety. Does religion act on these domains via special mechanisms that are unlike secular mechanisms? These could include mechanisms such as beliefs in supernatural agents, providing ultimate meaning, and providing literal immortality. We apply a critical eye to these questions of specialness and conclude that although it is clear that religion is psychologically important, there is not yet strong evidence that it is psychologically special, with the possible exception of its effects on health. We highlight what would be required of future research aimed at convincingly demonstrating that religion is indeed psychologically special, including careful definitions of religion and careful attention to experimental design and causal inference.

Professional identity formation: linking meaning to well-being

Trainee distress and burnout continue to be serious concerns for educational programs in medicine, prompting the implementation of numerous interventions. Although an expansive body of literature suggests that the experience of meaning at work is critical to professional wellbeing, relatively little attention has been paid to how this might be leveraged in the educational milieu. We propose that professional identity formation (PIF), the process by which trainees come to not only attain competence, but additionally to "think, act and feel" like physicians, affords us a unique opportunity to ground trainees in the meaningfulness of their work. Using the widely accepted tri-partite model of meaning, we outline how this process can contribute to wellbeing. We suggest strategies to optimize the influence of PIF on wellbeing, offering curricular suggestions, as well as ideas regarding the respective roles of communities of practice, teachers, and formative educational experiences. Collectively, these encourage trainees to act as intentional agents in the making of their novel professional selves, anchoring them to the meaningfulness of their work, and supporting their short and long-term wellbeing.

Effects of positive reappraisal and self-distancing on the meaningfulness of everyday negative events

Current work on meaning-making has primarily focused on major negative life events such as trauma and loss, leaving common daily adversities unexplored. This study aimed to examine how utilizing meaning-making strategies such as positive reappraisal and self-distancing (in isolation or in combination) can facilitate an adaptive processing of these daily negative experiences. Overall meaning and facets of meaning (coherence, purpose, and significance/mattering) were assessed at both global and situational levels. Results suggested that positive reappraisal was generally effective for enhancing situational meaning but not under all conditions. Specifically, when negative experiences were high on emotional intensity, reflecting on the experience from a distanced (third-person) perspective enhanced coherence and existential mattering more than engaging in positive reappraisal. However, when negative experiences were low on intensity, distanced reflection led to less coherence and mattering than positive reappraisal. The findings of this study elucidated the importance of examining the multidimensional construct of meaning at the facet level and highlighted the importance of applying different coping strategies to effectively make meaning out of daily negative experiences.

Sense of meaning and purpose in life and risk of incident dementia: New data and meta-analysis

PURPOSE

A greater sense of meaning and purpose in life is associated with lower dementia risk. The present research examines meaning and incident dementia in the largest sample to date, the UK Biobank, and combines the findings with the published literature on meaning/purpose and dementia risk in a meta-analysis.

METHOD

Participants from the UK Biobank reported on their meaning in life in the 2016/2017 mental health assessment (N=153,445). All-cause and cause-specific dementia were derived from hospital and death records through November 2021. Cox regression was used to test the association between meaning in life and risk of incident dementia. Results from the UK Biobank were combined with published studies identified through a systematic literature review in a random-effect meta-analysis (k=8; total N=214,270).

RESULTS

UK Biobank participants were followed up to five years after their assessment of meaning in life; 551 participants developed dementia. For every one-point higher feeling of meaning, there was a 35% decreased risk of all-cause dementia (HR=.74, 95% CI=.67-.82, p<.001). The association was similar controlling for clinical and behavioral risk factors and was not moderated by age, sex, education, or APOE risk status. Similar associations were found for Alzheimer's disease and vascular dementia. The meta-analysis supported the protective association between meaning/purpose and lower dementia risk (HR=.76, 95% CI=.72-.79, p<.001).

CONCLUSIONS

The present research supports the growing literature that meaning and purpose in life have a robust association with lower risk of developing dementia. Meaning/purpose is a promising intervention target for healthier cognitive outcomes in older adulthood.

Nostalgia supports a meaningful life

We review research on the role of nostalgia in supporting the ability to find, maintain, and restore meaning in life. We consider evidence that nostalgia promotes aintaining and restoring meaning by protecting against meaning threats, repairing meaning in the face of challenges, and generally compensating for lack of meaning. We also review evidence that nostalgia'' potency to support meaning has positive implications for advancing psychological well-being and adaptive human functioning. Finally, we propose future research important for establishing the applicability of nostalgia as a strategy or intervention to facilitate meaning-making and support psychological health.

Perceived Purpose in Life, Mental Health, and Suicidality in Older U.S. Military Veterans: Results From the National Health and Resilience in Veterans Study

OBJECTIVE

To determine the current prevalence of perceived purpose in life (PIL) and its association with screening positive for mental disorders and suicidality in a nationally representative sample of predominantly older U.S. veterans.

METHODS

Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study (N = 4,069; M_age = 62.2). Veterans were classified into three groups based on perceived PIL level (i.e., low, average, and high). Self-report assessments were administered to screen for mental disorders and suicidality.

RESULTS

Most veterans endorsed average PIL (71.7%), while 16.0% endorsed low PIL and 12.4% endorsed high PIL. A "dose-response" association was observed between PIL and outcomes. High PIL was associated with 42%-94% reduced odds of screening positive for major depressive, generalized anxiety, posttraumatic stress, and substance use disorders, as well as suicide attempts, ideation, and future intent.

CONCLUSION

Higher PIL is associated with lower odds of mental disorders and suicidality in U.S. veterans, underscoring the potential importance of interventions to bolster PIL in this population.

Letting go or giving up? The influence of self-transcendence meaning of life on goal adjustment in high action crisis

When individuals pursuing personal goals encounter setbacks and failures, they often fall into a conflict between disengaging from and striving toward the goal, defined as an action crisis. The present study investigated the influence and mechanism of self-transcendence meaning of life (STML) on goal disengagement and reengagement during a high versus a low action crisis. Study 1 included situations with different action crises. In Study 1, participants with high STML exhibited significantly higher goal disengagement and reengagement during high action crisis compared with low action crisis. Study 2 replicated the findings in Study 1 using participants' personal goals by questionnaires, and further exhibited that action crisis had negative effect on self-efficacy for participants with low STML, and this process subsequently reduced goal adjustment. Interestingly, no mediation effect of self-efficacy was found between action crisis and goal adjustment among participants with high STML. Findings from the present study suggest that releasing obsessions and adopting a dialectical relationship between success and failure may help individuals in high action-crisis situations, and self-efficacy may provide flexibility and autonomy.

Intuition and meaning in life in persons with varying level of depressive symptoms and impairments in personality functioning

OBJECTIVES

The current research explored the interplay between intuition, meaning in life, and psychopathology. Specifically, we investigated whether experiential and reflective components of meaning in life are associated with depressive symptoms and personality pathology, whether intuition is related to the experience of meaning, and whether psychopathology has disruptive effects on intuition as well as on the link between intuition and the experience of meaning.

METHODS

We tested our preregistered hypotheses in two independent studies. In Study 1, N = 448 participants completed self-report instruments assessing the experiential and the reflective dimensions of meaning in life, depressive symptoms, and impairments in personality functioning. Intuition was operationalized as the ability to intuitively detect semantic coherence in an experimental task. Additionally, self-reported confidence in intuition was assessed. In Study 2, we aimed to replicate our findings and hypotheses that emerged from Study 1 with a new sample of N = 1189 participants.

RESULTS

In both studies, participants with more depressive symptoms or higher levels of personality pathology experienced life as less meaningful but reflected significantly more about meaning in life. The intuitive ability to discriminate between coherence and incoherence in the experimental task was neither related to the experience of meaning in life nor to psychopathology, but more confidence in intuition was associated with experiencing life as more meaningful and with less psychopathological symptoms. It was tentatively supported that the association between meaning in life and intuition was moderated by psychopathology.

CONCLUSION

The findings are discussed in terms of their clinical implications and regarding the cognitive-affective processes potentially underlying people's experience of life being meaningful.

Online Gaming Addiction and Basic Psychological Needs Among Adolescents: The Mediating Roles of Meaning in Life and Responsibility

Individuals whose basic needs are naturally satisfied are much less dependent on their environment and more autonomous. Basic psychological needs (i.e., the general motivators of human actions) are significant predictors of online gaming addiction. Moreover, it has been posited that meaning and responsibility in life are at the center of life from an existential point of view. Therefore, a hypothetical model was tested to examine the relationships between basic psychological needs (autonomy, competence, relatedness), online gaming addiction, responsibility, and meaning in life. Data were collected from a sample of 546 participants. Mediation analysis was conducted, and the results indicated that basic psychological needs, online gaming addiction, responsibility, and meaning in life had significant negative and positive relationships. The findings indicated that responsibility and meaning in life had a serial mediating effect in the relationship between basic psychological needs and online gaming addiction. The findings also showed that the inverse relationship between online gaming addiction and basic psychological needs was at least partially explained by meaning in life and responsibility. The results of the present study are of great importance and suggest that interventions to satisfy the basic psychological needs of adolescents may help prevent online gaming addiction.

Photographic intervention effect on positive and negative affects during COVID-19: Mediating role of future self-continuity

Meaning in Life (MIL) is a protective factor that buffers the impact of COVID-19 epidemic on emotions. Our study aimed to explore whether photographic intervention based on MIL could increase Positive Affect (PA) and mitigate Negative Affect (NA), and whether Future Self-Continuity (FSC) functioned as a mediator between them. In this study, 90 college students were randomly divided into an intervention group or a control group. Participants in the intervention group were asked to take a photo and describe it every 2 days lasting 2 weeks. All the participants in the two groups were measured by the Meaning in Life Questionnaire, Positive and Negative Affect Scale, and Future Self-Continuity Scale before and after the intervention. The results showed that: (1) Before the intervention, there were no significant differences in baseline levels of MIL, PA and NA, and FSC between intervention and control groups. (2) In the intervention group, compared to pre-test, the scores of MIL, PA, and FSC of post-test increased significantly, and the score of NA of post-test decreased significantly. (3) After the intervention, the scores of MIL, PA, and FSC in the intervention group were significantly higher than those in the control group; NA score in the intervention group was significantly lower than that in the control group. (4) In terms of the difference score (post-test minus pre-test), FSC was a mediator between MIL and PA. Our study demonstrated that photographic intervention could effectively improve college students' MIL, PA, and FSC while mitigating NA. Moreover, MIL could significantly enhance PA by the mediating role of FSC.

The relationship between meaning in life and apathy in people with Parkinson's disease: a cross-sectional analysis

BACKGROUND

Apathy remains a common and problematic neuropsychiatric feature associated with Parkinson's disease resulting in reductions in health-related quality of life, and effective treatments remain elusive. Meaning in life (MIL) has been implicated in a variety of positive health outcomes, and this study assesses the relationship between apathy and MIL while hoping to identify a potential new interventional target.

METHODS

A cross-sectional sample of 237 PwPD completed surveys to evaluate MIL and a variety of non-motor symptoms (NMS), and a hierarchical regression analysis was conducted to evaluate relationships of interest.

RESULTS

Correlational analysis indicated the presence of meaning in life was statistically negatively and moderately to strongly correlated with apathy (r = - 0.60, p < .001). Hierarchical regression analysis results showed that presence of meaning in life explained a total of 48% of variance in apathy. More specifically, the presence of meaning in life (β = - 0.43, p < .001) was associated with apathy after controlling for sociodemographic and other potentially confounding variables.

CONCLUSIONS

This study demonstrates the significant negative relationship between MIL and apathy. Considering the lack of effective treatments for apathy, which is one of the most disabling symptoms affecting PwPD, identifying a potential target for intervention is exciting. MIL has the potential to offer clinicians a novel intervention to provide a much-needed treatment option to improve both apathy and HRQoL.

Awareness of meaning and quest for meaning: The mechanisms between future orientation and prosociality among youth during pandemic

Introduction

The positive relationship between future orientation and prosocial tendency has been consistently reported. However, the possible mechanism has not been examined yet. Previous research revealed the positive relationship between future orientation and meaning in life, as well as between meaning in life and prosocial tendency. Hence, it is hypothesized that the two components of meaning in life (presence of meaning and search for meaning) possibly mediate the relationship between future orientation and prosocial tendency.

Methods

During the first half of 2020, 430 Hong Kong youths aged 15-35 (male: 30.5%; female: 69.5%) were recruited to participate an online cross-sectional survey. The survey included three scales: (1) The Scale for Measuring Adult's Prosocialness, (2) Consideration of Future Consequence Scale, and (3) Meaning in Life Questionnaire.

Results

The key findings showed that: (1) females had higher level of prosocial tendency than males, and (2) significant partial mediating effects of both presence of meaning and search for meaning on the relationship between future orientation and prosocial tendency. Nevertheless, the multi-group mediation model did not show significant gender difference.

Discussion

These findings implied that future-oriented and meaning-focused interventions could possibly enhance youth's sense of meaning in everyday life and foster their meaning searching tendency, which further strengthen the positive effect of their future orientation on prosocial tendency, even during life adversities.

Have a good day! An experience-sampling study of daily meaningful and pleasant activities

We organize our daily lives with a relatively high degree of freedom. Some things must be done; others are optional. Some we find meaningful, some pleasant, some both, and some neither. The present study looks at such evaluations of daily activities and how they relate to perceived meaning in life. Sixty-two students from an Austrian university first completed the meaningfulness scale from the Sources of Meaning and Meaning in Life Questionnaire (SoMe). They then participated in a 1-week experience-sampling assessment, wherein they completed a short questionnaire at five random time-points per day. They indicated their current activity and then reported, on a 6-point Likert scale, how pleasant and meaningful they perceived it to be. Activities could thus be categorized as meaningful, pleasant, both, or neither. Results reflected that activities grouped under culture/music, communication, intimacy, and sports are experienced as both highly meaningful and pleasant. A two-level hierarchical linear regression suggested that people with high trait meaningfulness experience their daily activities as more meaningful than people with lower trait meaningfulness if they also enjoy what they are doing. People with low trait meaningfulness, however, tended to experience their daily activities as rather meaningless, even if they enjoyed them very much. Thus, when looking for advice on how to have a good day, clarifying one’s meaning in life seems to represent the best starting point.

[The ambivalent role of spirituality in explaining conspiracy belief and protest intentions in the context of the COVID-19 pandemic]

In the course of the COVID-19-pandemic, groups that present themselves as anchors in problem solving and provide supposed solutions for dealing with insecurities are becoming increasingly visible. There seems to be a tendency for conspiracy belief and esoteric attitudes, which are increasingly being expressed in the protests against measures to contain the pandemic. This raises the question of the role of religious affiliations and spiritual worldviews within such groups. In the present study, spirituality is differentiated and measured independently of religion in order to shed light on these questions. The results show two forms of spirituality that differ in the dimensions of worldviews and ethics, values and meaning of life. Both forms can be found in religious as well as non-religious groups. Analyses show different effects of these forms of spirituality on the openness towards alternative and esoteric explanations of the world as well as a skepticism towards science. Additionally, all spiritual elements also contribute to clarifying the belief in conspiracy stories, the support of COVID-related demonstrations and the willingness to participate in these demonstrations. Active spirituality acts as a protective factor and passive spirituality as a reinforcing (risk) factor for these phenomena. Overall, this multi-dimensional measurement of spiritual worldviews can explain attitudes relevant to conspiracy belief and protests, and in this way can break down the previous ambivalent effects of spirituality as a resilience vs. risk factor for such attitudes.

Vulnerability and Resilience: Phenomenological Analysis of Cancer Patients Value Directives

CONTEXT

Personal values are individual conceptions of the desirable appraisals and actions that guide our attitudes and behaviour. Advance care planning (ACP) now emphasises the consideration of personal life goals and values expressed as a Values Directive (VD) to guide discussions concerning medical treatment.

OBJECTIVE

To investigate the diversity of values, experiences and adaptations expressed in cancer patients VDs.

METHODS

Contents of the VDs of ACPs of cancer patients who participated in a randomised control trial comparing a video intervention showing values communication between cancer patient-caregivers with usual care were analysed. Qualitative phenomenological content analysis was used to understand how participants made meaning of their lived experiences.

RESULTS

Forty-two participants completed an ACP (37.2% response rate), with 97.6% of these completing a VD (57.1% female, mean age 72 years, 30.1% gastrointestinal cancer). Participants described diverse adjustments to frailty and adaptive coping with deteriorating functionality. Emotional and financial concerns were eased through experiencing benevolence and trust established through family and friendship bonds and reciprocation of care. Death anxiety and ambivalence were expressed concurrently with the experiential acceptance of dying. Secular and sacred rituals featured as an affirmation of their faith or beliefs.

CONCLUSION

Cancer patients seek to make meaning of their experiences, concurrently posturing vulnerability and resilience, despite conflicting emotions and experiences. Given that the choices people make as they approach dying relate to their most deeply held values, ACP conversations should explore how patients draw from their values and life goals to optimise their adaptations to illness.