Dying Is Unexpectedly Positive

Mindsets of suicide trajectories: An Linguistic Inquiry and Word Count analysis of suicide hotline conversations

OBJECTIVE

The aim of the study was to explore the psychological characteristics of the individuals with various suicide risks using computerized text analysis, in the hopes of a better understanding of suicide trajectories.

METHODS

627 first-time callers' records were randomly selected from Taiwan An-Shin Hotline database between 2013 and 2018. The voice records were evaluated by two psychologists to determine the levels of suicide risk (156 with uncertainty of risk, 177 with low suicidal ideation, 157 with high suicidal ideation, and 137 with suicide preparation/attempt) and transcribed into text. The Linguistic Inquiry and Word Count 2015 (LIWC2015) program combined with Chinese dictionary were then used to calculate the frequency of word categories.

RESULTS

Exploratory factor analysis identified four mindsets of language characteristics, named "opposition and questioning", "active engagement", "negative rumination", and "focus on death". Psychological descriptions of the mindsets were also obtained through correlation analysis with the LIWC2015 categories and indicators. The four mindsets effectively distinguished the callers with different levels of suicide risk.

CONCLUSION

The psychological characteristics of people with various suicide risks can be described and differentiated via the closed-word categories and composite indicators. These results provide useful information for practitioners and researchers.

Can generative AI infer thinking style from language? Evaluating the utility of AI as a psychological text analysis tool

Generative AI, short for Generative Artificial Intelligence, a class of artificial intelligence systems, is not currently the choice technology for text analysis, but prior work suggests it may have some utility to assess dynamics like emotion. The current work builds upon this empirical foundation to consider how analytic thinking scores from a large language model chatbot, ChatGPT, were linked to analytic thinking scores from dictionary-based tools like Linguistic Inquiry and Word Count (LIWC). Using over 16,000 texts from four samples and tested against three prompts and two large language models (GPT-3.5, GPT-4), the evidence suggests there were small associations between ChatGPT and LIWC analytic thinking scores (meta-analytic effect sizes: .058 < rs < .304; ps < .001). When given the formula to calculate the LIWC analytic thinking index, ChatGPT performed incorrect mathematical operations in 22% of the cases, suggesting basic word and number processing may be unreliable with large language models. Researchers should be cautious when using AI for text analysis.

Happiness in Hospice Care in The Netherlands: A Case Study Design

Happiness is central in spirituality but has hardly been explored in palliative care. The objective of this study is to explore happiness in hospice care in the Netherlands. A case study design consisting of participatory observations and semi-structured interviews was used. Happiness was associated with all dimensions of health. Patients spoke about a growing receptivity and a deepening of connections with themselves and others. Hospice staff related their happiness to feeling a true connection and their work supported them in appreciating their own lives in new ways. This study suggests that happiness can be found in settings that are frequently associated with suffering.

Dehumanization Through Degendering the Death Row Inmate: A Systematic Review of the Research

Purpose: To provide an overview of how gender identity is treated in death row research. Methods: By use of a systematic review of 56 peer-reviewed journal articles that were identified as empirical, employing either qualitative or quantitative data, concepts measuring the use of gender and race identity were developed. Results: Findings were presented by the methodology employed, area of research, sample composition, and key concepts which included the use of gendered terminology in titles, abstracts, and manuscripts, as well as by the author(s)'s gender identities. Conclusion: In general, regardless of methodology or area of research, death row research does not account for the effects of gender or intersectional identities unless the sample participants or subject matter pertains to women.

La confiance dans le dispositif : une obstination déraisonnable

L’évolution législative récente relative à la fin de vie, qui tend à substituer la procédure à la relation, interroge. Aujourd’hui, chaque question semble devoir être obstinément transformée en problème à résoudre, et donc à résoudre techniquement. Nous évoluons dans un contexte marqué par la primauté de la technique et du droit sur le sens et sur le rapport humain. Ce paradigme, confronté à nos limites, accentue la double angoisse de la fin de vie : la peur de souffrir et la peur de mourir. Il favorise également une compréhension nominaliste de la liberté : l’autonomie n’est plus comprise comme un accomplissement, mais comme un refus, une émancipation du réel. La loi du 2 février 2016 rend compte de ce déplacement, elle qui nous invite à placer notre confiance non plus dans la personne mais « dans le dispositif ». Ainsi des directives anticipées, dont la finalité est de faire droit à l’autonomie, réduite à la maîtrise, au contrôle des conditions du mourir. Le dispositif, qui fera dépendre l’autonomie d’une exigence de conformité à la technique, devient le symptôme d’une profonde désubjectivation. La médicalisation de la mort obère la question de la mort. Et cette désymbolisation de la mort va de pair avec son individualisation, le sujet étant laissé de plus en plus seul. Il conviendrait de rendre à la parole et au sens leur souveraineté. Car les enjeux de la fin de vie sont des enjeux de sens — non de moyens.

Exploring the Impact and Lived Experiences of Hospice Staff Working in End-of-Life Care: An Interpretative Phenomenological Analysis (IPA)

Current research surrounding the experiences of hospice staff is significantly underdeveloped. Additionally, the stigmatisation of death in Western society has formed delusions of hospice care amongst the general public. These findings gained an insight of the lived experiences of six hospice staff across England and Wales, through an interpretative phenomenological analysis. Eight superordinate themes were identified; 'COVID-19 as a barrier to care delivery', 'Discomfort is key for personal growth', 'Self-preservation is paramount', 'Psychological impact of hospice environment', 'Internal conflict surrounding life and death', 'Complexities of a firm belief system', 'Utopian view of hospices' and 'Colleagues are a pillar of support'. All narratives shared overarching themes on growth, acceptance, and morality. These findings have future implications at the organisational level, identifying areas for adjustment for employee wellbeing. Furthermore, this may also educate aspiring end-of-life care staff in preparation for the reality of hospice environments.

Patient, Caregiver, and Oncologist Predictions of Quality of Life in Advanced Cancer: Accuracy and Associations with End-of-Life Care and Caregiver Bereavement

OBJECTIVE

Informed treatment decision-making necessitates accurate prognostication,including predictions about quality of life. We examined whether oncologists, patients with advanced cancer, and caregivers accurately predict patients' future quality of life and whether these predictions are prospectively associated with end-of-life care and bereavement.

METHODS

We secondary analyses of clinical trial data. Patients with advanced cancer (n=156), caregivers (n=156), and oncologists (n=38) predicted patient quality of life 3 months into the future. Patients subsequently rated their quality of life 3 months later. Medical record data documented chemotherapy and emergency department (ED)/inpatient visits in the 30 days before death (n=79 decedents). Caregivers self-reported on depression, anxiety, grief, purpose, 21 and regret 7-months post-mortem. In mixed-effects models, patient, caregiver, and oncologist quality-of-life predictions at study entry were used to predict end-of-life care and caregiver outcomes, controlling for patients' quality of life at 3-month follow-up, demographic and clinical characteristics, and nesting within oncologists.

RESULTS

Caregivers (P<.0001) and oncologists (P=.001) predicted lower quality of life than what patients actually experienced. Among decedents, 24.0% received chemotherapy and 54.5% had an ED/inpatient visit. When caregivers' predictions were more negative, patients were less likely to receive chemotherapy (P=.028) or have an ED/inpatient visit (P=.033), and caregivers reported worse depression (P=.002), anxiety (P=.019), and grief (P=.028) and less purpose in life (P<.001) 7-months post-mortem.

CONCLUSION

When caregivers have more negative expectations about patients' quality of life, patients receive less intensive end-of-life care, and caregivers report worse bereavement This article is protected by copyright. All rights reserved.

Are patients accurate forecasters of their emotional response to medical conditions? A scoping review on affective forecasting

OBJECTIVE

In this paper, we challenge the premise that patients are capable of accurately predicting their emotional response or quality of life in anticipation of health changes. Our goal was to systematically review the published empirical evidence related to the reliability of affective forecasting in the context of medical conditions.

DESIGN

Scoping review.

SETTING

We conducted a search string using both simple search terms as well as MeSH terms and searched the electronic databases of PubMed, Embase, CINAHL and Cochrane up to April 2021.

PARTICIPANTS

We initially selected 5726 articles. Empirical studies reporting on predicted and/or observed emotions or quality of life concerning deterioration, improvement in health or chronic illnesses were included. Furthermore, empirical studies of healthy individuals predicting emotional response or quality of life compared with patients reflecting on emotions or quality of life concerning deterioration or improvement in health or chronic illnesses were also included. Studies on healthy participants, psychiatric patients and non-English articles were excluded.

RESULTS

7 articles were included in this review. We found that patients generally tend to systematically exaggerate both anticipated happiness and sorrow/grief after health improvement and deterioration, respectively.

CONCLUSION

Patients are less adept in predicting emotional response or quality of life regarding to health changes than we are inclined to assume. We discuss several biases which could explain this phenomenon. Our findings are relevant in the context of treatment decisions, advanced care planning and advanced care directives.

Happiness at the end of life: A qualitative study

OBJECTIVE

Dying is mostly seen as a dreadful event, never a happy experience. Yet, as palliative care physicians, we have seen so many patients who remained happy despite facing death. Hence, we conducted this qualitative study to explore happiness in palliative care patients at the University of Malaya Medical Centre.

METHOD

Twenty terminally ill patients were interviewed with semi-structured questions. The results were thematically analyzed.

RESULTS

Eight themes were generated: the meaning of happiness, connections, mindset, pleasure, health, faith, wealth, and work. Our results showed that happiness is possible at the end of life. Happiness can coexist with pain and suffering. Social connections were the most important element of happiness at the end of life. Wealth and work were given the least emphasis. From the descriptions of our patients, we recognized a tendency for the degree of importance to shift from the hedonic happiness to eudaimonic happiness as patients experienced a terminal illness.

SIGNIFICANCE OF RESULTS

To increase the happiness of palliative care patients, it is crucial to assess the meaning of happiness for each patient and the degree of importance for each happiness domain to allow targeted interventions.

Perception of death and preference for end-of-life care among Asian Buddhists living in Montreal, Canada

Dying with dignity is important in Western culture. The aim of this qualitative study was to explore how Asian Buddhists, exposed to Western cultures, perceive death and dying with dignity, and examine their preferences for end-of-life care. We interviewed 15 Asian Buddhists living in Montreal (Canada). Participants regarded death as inevitable, while a good/dignified death had to be natural, peaceful, and, most of all, conscious. Most preferred palliative care to medical-aid-in-dying and emphasized death preparation through daily contemplation of impermanence. Care providers' understanding and respect of Buddhist patients' perception of a dignified death might help facilitate this important transition.

Words describing feelings about death: A comparison of sentiment for self and others and changes over time

Understanding public attitudes towards death is needed to inform health policies to foster community death awareness and preparedness. Linguistic sentiment analysis of how people describe their feelings about death can add to knowledge gained from traditional self-reports. This study provided the first description of emotive attitudes expressed towards death utilising textual sentiment analysis for the dimensions of valence, arousal and dominance. A linguistic lexicon of sentiment norms was applied to activities conducted in an online course for the general-public designed to generate discussion about death. We analysed the sentiment of words people chose to describe feelings about death, for themselves, for perceptions of the feelings of ‘others’, and for longitudinal changes over the time-period of exposure to a course about death (n = 1491). The results demonstrated that sadness pervades affective responses to death, and that inevitability, peace, and fear were also frequent reactions. However, words chosen to represent perceptions of others’ feelings towards death suggested that participants perceived others as feeling more negative about death than they do themselves. Analysis of valence, arousal and dominance dimensions of sentiment pre-to-post course participation demonstrated that participants chose significantly happier (more positive) valence words, less arousing (calmer) words, and more dominant (in-control) words to express their feelings about death by the course end. This suggests that the course may have been helpful in participants becoming more emotionally accepting in their feelings and attitude towards death. Furthermore, the change over time appeared greater for younger participants, who showed more increase in the dominance (power/control) and pleasantness (valence) in words chosen at course completion. Sentiment analysis of words to describe death usefully extended our understanding of community death attitudes and emotions. Future application of sentiment analysis to other related areas of health policy interest such as attitudes towards Advance Care Planning and palliative care may prove fruitful.

Happiness at the End of Life: A Qualitative Study

BACKGROUND

Happiness is a core ingredient of health and well-being, yet relatively little is known about what happiness means for individuals near the end of life, and whether perceptions of happiness change as individuals approach the end of their lives.

AIM

The aim of this study was to explore, through interviews, how individuals experiencing hospice care understood and conceptualized happiness.

DESIGN

Qualitative interviews with hospice patients were analyzed thematically.

SETTING/PARTICIPANTS

Adult patients (n = 20) in a New Zealand hospice who were receiving palliative care and who could give their informed consent were invited by hospice nurse coordinators to an interview.

RESULTS

Four themes emerged from analysis of the transcribed interviews. Participants defined happiness most frequently and in most depth in relation to connection with others. They identified being in the present moment, particularly in relation to nature, and that happiness had become less associated with money, status, or possessions. They had an attitude of determination to focus on what mattered now.

CONCLUSION

Patients receiving palliative care were generally happy with their lives, appreciated the simpler aspects of life away from the material. There was a common exhortation to young people to avoid focusing too much on acquisition and the internet and to prioritize instead social connection and engagement with the natural world.

Age-related variability in decision-making: Insights from neurochemistry

Despite dopamine's significant role in models of value-based decision-making and findings demonstrating loss of dopamine function in aging, evidence of systematic changes in decision-making over the life span remains elusive. Previous studies attempting to resolve the neural basis of age-related alteration in decision-making have typically focused on physical age, which can be a poor proxy for age-related effects on neural systems. There is growing appreciation that aging has heterogeneous effects on distinct components of the dopamine system within subject in addition to substantial variability between subjects. We propose that some of the conflicting findings in age-related effects on decision-making may be reconciled if we can observe the underlying dopamine components within individuals. This can be achieved by incorporating in vivo imaging techniques including positron emission tomography (PET) and neuromelanin-sensitive MR. Further, we discuss how affective factors may contribute to individual differences in decision-making performance among older adults. Specifically, we propose that age-related shifts in affective attention ("positivity effect") can, in some cases, counteract the impact of altered dopamine function on specific decision-making processes, contributing to variability in findings. In an effort to provide clarity to the field and advance productive hypothesis testing, we propose ways in which in vivo dopamine imaging can be leveraged to disambiguate dopaminergic influences on decision-making, and suggest strategies for assessing individual differences in the contribution of affective attentional focus.

Parents' perceptions of parent-child interactions related to eating and body image: an experimental vignette study

Parents are key to children's health because they can influence children's eating behavior and body image and can make health-related decisions for children. Despite their influence, research on parents' opinions about parenting practices related to weight and eating is limited. Experimental vignettes examined parents' perceptions of parent-child interactions around body image, eating, and weight loss. We manipulated vignette-child weight (healthy-weight, overweight) and communication tone (positive, negative, neutral) to assess their influence on parents' perceptions. Parents (N = 233, 27.5% fathers, 72.5% mothers) were randomly assigned to read one of six vignettes. When the vignette-child had overweight, parents were more likely to recommend seeking help for body image and that the vignette-parent should choose the restaurant food order. Parents were less opposed to commenting on the vignette-child's weight when tone was positive. Parents were more likely to recommend weight-loss efforts that could be implemented by the family rather than those requiring professional assistance. This study is among the first to examine parents' opinions about parenting practices related to weight and eating using an experimental design. Findings might inform future research and continued work on prevention and treatment applications to help align parents' existing opinions about weight and eating with evidence-based health-promoting strategies.

Illness as Transformative Experience: Implications of Philosophy for Advance Care Planning

Advance care planning has been shown to improve patient outcomes and is recommended as part of routine care for people with a life-limiting illness. Nevertheless, developing an advance care plan can be complex and challenging for both patients and family members, and the clinicians who support them. One complexity is that illness and its treatments often cannot be deeply understood without lived experience. In this paper, we explore this idea, highlighting how lived experience can bring about unpredictable changes in an individual's values and preferences. We examine the implications of such "transformative experiences" for advance care planning, using the hypothetical case study of Jean, an older person with advanced kidney disease. Finally, we consider consequences for clinical practice and how an understanding of transformative experience might enhance current approaches to advance care planning.

Forgiveness, spirituality and love: thematic analysis of last statements from Death Row, Texas (2002-17)

BACKGROUND

Psychological features associated with execution are not fully understood.

AIMS

To analyse demographics of individuals executed in Texas and investigate whether there has been any change in common themes and psychological factors evident in last statements before execution between 2002 and 2017.

DESIGN

Analysis of last statements from Death Row, Texas.

METHODS

We (a) studied themes and psychological factors in last statements in Texas between August 2011 and May 2017; and (b) combined our 2011-17 data with our previous data (2002-06 and 2006-11) to present an overall analysis of last statements from 2002 to 2017.

RESULTS

Between April 2002 and May 2017 (279 executions; 240 last statements), the execution rate in Texas fell from 25 per year to 12; median time on death row increased from 108.5 months to 149.5; median age at execution increased from 38 years to 40.5; and the proportion of offences involving multiple victims rose from 28.4% to 47.1%. The most common themes in last statements were love (78%), spirituality (58%), regret (35%) and apology (35%). The most common psychological factors were identification-egression (51%), unbearable psychological pain (47%) and rejection-aggression (40%). Two themes (forgiveness, use of poetry/literature) and three psychological factors (inability to adjust, interpersonal relations, identification-egression) became less common.

CONCLUSIONS

Between 2002 and 2017, executed prisoners in Texas became fewer and older, spent longer on death row and had committed more serious offences. Themes of love and spirituality were constants, but requests for forgiveness declined.

A Focused Review of Language Use Preceding Death by Execution

Executions are one form of death that can be assumed to be maximally anxiety provoking. Words spoken by death row inmates moments before their execution can provide valuable insights into people's end-of-life communication needs and themes, conveying what individuals choose to express to others in the face of imminent death. In this focused review, we describe findings from quantitative and qualitative text analysis studies that have analyzed affective experiences and meaning-making attempts in transcriptions of actual statements made by Texas death row inmates. Overall, the most prevalent content themes identified in these final acts of verbal communication in the reviewed studies consisted of a strong predominance of emotional positivity, messages to relevant social others, and spiritual references. We subsequently view the reviewed findings in the light of additional research in which people's conceptions of death and dying were explored and language studies in which people's communication before other forms of death was analyzed. Finally, we describe open questions and directions for future analyses of death row inmates' final statements, and we outline practical implications.

Positive emotion communication: Fostering well-being at end of life

OBJECTIVE

Little is known about positive emotion communication (PEC) in end-of-life care. This study aims to identify types and patterns of PEC among hospice nurses, caregivers, and patients.

METHODS

A coding system based on positive psychology theory was applied as a secondary analysis to audio recordings of hospice nurse home visits with cancer patients and family caregivers, collected as part of a prospective longitudinal study. Eighty recordings (4 visits from 20 triads) were coded for humor, connection, praise, positive focus, gratitude, taking joy/savoring, and perfunctory statements.

RESULTS

Descriptive statistics revealed the greatest proportion of PEC was made by nurses. Humor was most frequently used across all speakers. Cluster analysis revealed four PEC visit types: Savor/Take Joy; Humor; Perfunctory; and Other-focused Expressions of Positive Emotions. Linear mixed effect regression was used to estimate the trajectory of PEC over time, but no significant change was found.

CONCLUSION

We found that positive emotions are common in nurse, caregiver and patient communication at end-of-life and do not decline closer to death.

PRACTICE IMPLICATION

This study is among the first to explore PEC at end-of-life, and offers a way to bring strengths-based approaches into end of life communication research.

Optimism and Well-Being Among Institutionalized Older Adults

Abstract. Institutionalization is often related to the psychologically negative outcomes of old age. Optimism could alleviate suffering, but little is known about its role in institutionalized settings. We sought to explore optimism correlates and to determine whether it predicts emotional well-being variables, after controlling for potential covariates, by assessing 66 institutionalized elderlies. Optimism was low and associated with failure to do physical exercise, urinary incontinence, increased anxiety, depressive symptoms and feelings of loneliness, and reduced satisfaction with life and positive affect. Optimism predicted emotional well-being, albeit not over and above some covariates. Given the low optimism levels and the correlates, we suggest that intrapersonal resources could be intervention targets. It is our hope that our findings will inspire research to analyze interventions promoting optimism-beneficial combinations of well-being among institutionalized older adults.

How Will We React to the Discovery of Extraterrestrial Life?

How will humanity react to the discovery of extraterrestrial life? Speculation on this topic abounds, but empirical research is practically non-existent. We report the results of three empirical studies assessing psychological reactions to the discovery of extraterrestrial life using the Linguistic Inquiry and Word Count (LIWC) text analysis software. We examined language use in media coverage of past discovery announcements of this nature, with a focus on extraterrestrial microbial life (Pilot Study). A large online sample (N = 501) was asked to write about their own and humanity's reaction to a hypothetical announcement of such a discovery (Study 1), and an independent, large online sample (N = 256) was asked to read and respond to a newspaper story about the claim that fossilized extraterrestrial microbial life had been found in a meteorite of Martian origin (Study 2). Across these studies, we found that reactions were significantly more positive than negative, and more reward vs. risk oriented. A mini-meta-analysis revealed large overall effect sizes (positive vs. negative affect language: g = 0.98; reward vs. risk language: g = 0.81). We also found that people's forecasts of their own reactions showed a greater positivity bias than their forecasts of humanity's reactions (Study 1), and that responses to reading an actual announcement of the discovery of extraterrestrial microbial life showed a greater positivity bias than responses to reading an actual announcement of the creation of man-made synthetic life (Study 2). Taken together, this work suggests that our reactions to a future confirmed discovery of microbial extraterrestrial life are likely to be fairly positive.

Analysis of last statements prior to execution: methods, themes and future directions

Worldwide, over 1000 people were executed in 2016 and over 3000 sentenced to death. Death row prisoners have high rates of mental illness, often combined with neurological impairment. Prolonged confinement has further negative effects on psychological function. There is a growing literature examining key themes and psychological constructs in death row prisoners immediately prior to execution. To date, this literature centres largely but not exclusively on last statements from death row in Texas, owing to ease of availability. The most common themes in last statements are love, spirituality and apology or regret. The most common psychological constructs are 'identification-egression' (e.g. attachment to a lost person or ideal, such as freedom), unbearable psychological pain and rejection-aggression. This is still a relatively new area of research and new techniques, such as computerised quantitative text analysis, are likely to complement rather than replace more traditional forms of thematic and textual analysis. For the future, it is essential that studies in this field continue to specify precisely, which last statements they use, so that overlap can be identified, and that more countries are studied (if possible). It would also be useful to expand the research frame to relate the content of last statements to additional variables relating to prisoners' offences, physical health, mental health, family structure and broader circumstances. Finally, ethical issues require continued consideration in this complex, fascinating, growing field.