The Loss of a Loved One: Remembering the Life and the Dying Days
The Social Function of Autobiographical Memory in the Personal and Virtual World
Well-being in the Second Half of Life
Palliative Care Needs Assessment
Functions of Recent and Distant Memories
Life Events in the Life Story
“In Memoriam:” Identity Strivings in Emerging Adulthood
Self Continuity
The “Brush with Death” Study
Dignity Therapy
Death Over Dinner
Evaluating the Comfort Shawl Project


The Loss of a Loved One: Remembering the Life and the Dying Days

This work focuses on reminiscence about a particular topic: recalling the life and the dying days of a lost loved one. Research has explored how individuals who have lost a loved one remember the experiences shared together over their lifetime. We propose that remembering is central to two positive aspects of the initial grief experience: meaning-making and personal growth. When the initial period of responding to a significant loss has concluded, however, memory still has a role to play. Individuals continue to recall days and moments of the life they shared with their loved one, often holding these memories dear for the rest of their lives. As part of that, they may recall a particularly intimate period: their loved one’s dying days. This includes memories of final conversations with, or the last time they saw, the deceased. What function might memories from the dying days serve? We argue that these memories can be used to maintain self-continuity and encourage social bonding. If so, this has implications for shaping the environments in which individuals die: place of death may affect the content and quality of the final memories formed.


The Social Function of Autobiographical Memory in the Personal and Virtual World

Little is known about whether autobiographical memory sharing via popular social media modes (i.e., Instant Messaging) can encourage social bonding in the same way that it does when memories are shared in-person. In this project, university students listened to a stranger tell either a positive or negative autobiographical memory face-to-face or via social media. Social bonds (i.e., affect, interest, closeness) with the stranger were assessed. Face-to-face autobiographical memory sharing led to stronger positive feelings and closeness towards the stranger, but greater interest in the stranger was evident following social media sharing. We also see a valence effect: positive memories led to higher levels of positive feelings and interest about the stranger, but negative memories led to greater feelings of closeness. Thus, the ability for memories shared by strangers to develop social bonds depends on both the form of communication and the valence of the memory being shared.


Well-being in the Second Half of Life

This study examines whether looking back in autobiographical time and one’s place in chronological time affect current well-being. Participants (N = 470) in the second half of life (age 50 – 90 years) completed a life story matrix, rating positive life events for perceived control, and influence on who they have become. They also reported negative and positive well-being. Findings show that recalling one’s self in the reminiscence bump years, not non-bump years, is related to well-being. While perceived control links to greater life satisfaction, viewing bump events as highly influential on the current self relates to lower self-esteem. Chronological age is associated with lower well-being but only very late in life. Findings are discussed in relation to the functional approach to autobiographical memory and lifespan developmental theory.


Palliative Care Needs Assessment

Research indicates that Palliative Care efforts nationwide are not ideal. There is a disconnect between Palliative Care needs that are recognized and needs that are actually met, which leads to patient dissatisfaction (McIlfatrick, 2006; Harrison, Young, Price, Butow, & Solomon, 2009). Recently, UFHealth began the process of transitioning to a service model where Palliative Care is of equal importance to curative care across departments. This transition includes gathering a comprehensive understanding of employee involvement in Palliative Care and assessing areas of weakness and improvement opportunities. In partnership with the Neuromedicine Interdisciplinary Clinical and Academic Program (NICAP), we have created a Palliative Care Needs Assessment to identify employee understanding of Palliative Care, barriers to providing optimal care, and specific groups of employees that may need additional education. Currently, we are analyzing Needs Assessment data from the Neurointensive Care unit, as well as adjusting the Assessment to be sent to departments throughout the hospital for a large- scale assessment. Responses will record Palliative Care knowledge within UFHealth and help us identify strategies to overcome barriers. The assessment itself may also be analyzed for efficacy so that other hospitals nationwide can utilize it within similar Quality Improvement projects.


Functions of Recent and Distant Memories

Theory suggests that self- and memory-related factors influence use of autobiographical memory to serve adaptive functions in daily life. No research has empirically identified the factors that predict specific functional memory use (e.g., self-continuity, social-bonding, directing behavior). In two studies (Study One, N = 100; Study Two, N = 354), select self and memory factors were related to reports of functional memory use. Study Two replicated Study One findings and also included additional self-related variables. Across studies, self-relevant memories were more frequently reported to serve all functions. Beyond that, however, findings were function-specific. In terms of self-related factors: adults with lower self-concept clarity more frequently used memories to serve a self-continuity function. Trait personality predicted memory function, with extraversion related to the self-continuity function and neuroticism and agreeableness related to the social-bonding function. With respect to memory-related factors: recent memories were more likely than distant ones to serve self-continuity and directing-behavior functions. More negative memories were used for directing behavior and more positive memories were used for social bonding. Findings are discussed in terms of the multiple self- and memory-related factors that come into play to allow human use of memory to serve functions that help navigate daily life. 


Life Events in the Life Story

This  study  is being  completed in  collaboration with  researchers at  the  University of Vienna as  part of the European Study  of Adult Well-being.  Participants (N = 800) from 50-90 years of age completed a questionnaire in which they report the significant life events that have been markers in their life story from birth to the present day. Each event is then rated on a number of dimensions including how positive or negative it was, and how much it influenced the path that their life has taken. Participants also reported at least one wisdom event and one regretted  event. Data analyses are currently underway to examine the structure and content of individual’s life stories.


“In Memoriam:” Identity Strivings in Emerging Adulthood

In this study, Emerging adults provided  an open-ended autobiographical self-defining memory narrative (Blagov & Singer, 2004)  and three self-attributes representing how  they would like to be remembered after death. Narratives were reliably content-coded for Fundamentality, (Baltes &Smith, 1990) and Event Type (Thorne & McLean, 2004), and self-attributes were reliably coded for Identity Strivings (Rammstedt & John, 2007; Ryff, 1989). The study investigates emerging adults’ identity in self-defining memories in terms of: (1) Fundamental vs. Non-Fundamental events, (2) Event Types, (3) Identity Strivings, (4) Interrelation of Fundamentality, Event Type,and Identity Striving, and (5) whether 1 – 3 differ by gender, personality, or death experience. Study 1 examines: (i) the extent to which recalling stressful autobiographical events results in anxiety, (ii) whether an open orientation toward the future acts as a buffer when recalling past mortality-related events, and (iii) and whether intimacy acts as an anxiety buffer after recalling a brush with death (Mikulnicer, Florian, & Hirschberger 2003). As predicted, recalling stressful events resulted in current feelings of anxiety, and recalling mortality-related events specifically resulted in greater death anxiety. Having an open ended future time perspective buffered anxiety for the everyday stress condition, but not for the mortality- related condition. Anticipation of a close intimate relationship in future was related to lower anxiety levels after recalling a brush with death (but not in the everyday anxiety or control groups.

Study 2 examined gender differences and also whether narrating one’s closeness to others when recalling a brush with death buffers anxiety. Emerging adults (N = 50; 25 males; 18-22 years) recalled an autobiographical“brush with death” followed by the State Anxiety Inventory (Marteau & Bekker, 1992). Results reveal women’s narratives show a greater concern that they might die during the event (i.e., subjective death-threat) than men’s, though they do not differ on the actual threat faced.


Self Continuity Project

Older and younger individuals face difficult events in their lives that can challenge their identity (e.g., loss of a loved one, illness, job loss) thereby negatively affect their psychological well-being. What psychological processes aid people in the face of such events? The current study examines how older and younger adults use personal memory of the events of their life (i.e., autobiographical memory) to maintain a continuous sense of self in the face of difficult events. Specifically, autobiographical reasoning (i.e., self-event and event-event connections) presented in narratives of challenging life events and one’s phase in life (i.e., age) are proposed to be key in predicting the experience of self-continuity. It is expected that autobiographical reasoning plays a mediating role linking the relation between age and experiential self-continuity in two adult age groups (N = 130; emerging adults, 18-27 years; older adults, 60-75 years). 


The “Brush with Death” Study

Classic lifespan theory suggests that individuals’ time perspective shifts as they move across adulthood (Neugarten, 1979), changing the extent to which the experienced past and anticipated future may act as resources. Emerging adults’ past is short with a sense of optimistic anticipation concerning the future (Arnett, 2000). They have, however, already faced everyday stressors and may even have experienced a ‘brush with death. This study examines: (i) the extent to which recalling stressful autobiographical events results in anxiety, and (ii) whether orientation toward the future acts as a buffer when recalling past mortality-related events. Emerging adults’ (N = 120) future time perspective (Carstensen & Lang, 1996) and anticipated future intimacy (Sharabany, 1994) were assessed. They were then assigned to one of three conditions, recalling: a brush with death, an everyday stressor, or past neutral activities. Following narration of the event, state anxiety was assessed (Marteau & Bekker, 1992). As predicted, recalling stressful events resulted in current feelings of anxiety, and recalling mortality-related events specifically resulted in death anxiety. Also as expected, mortality-related anxiety was buffered by future orientation. Anticipation of a close intimate relationship in future, and having a realistic sense of future time were related to lower anxiety levels after recalling a brush with death (but not in the everyday anxiety or control groups). Findings are discussed in terms of shifting relations of past to future orientations across the lifespan. 


Dignity Therapy 

Maintaining dignity at the end of life can be challenging for cancer patients. Dignity Therapy (DT) is an intervention that guides a patient through a structured life review process, resulting in a written Legacy Document that can be shared with the patient’s family members and friends. Though research has demonstrated that patients and families feel they benefit from DT, there has been a call for research to understand mechanisms that produce positive patient outcomes. The current proposal involves a cross-college collaboration aimed at addressing this issue in a sample of 32 elderly cancer patients. We will examine the empathic process involved in DT delivery and the extent of important psychosocial themes (purpose in life, meaning-making and communion) in the final product, the Legacy Document. This work provides a feasibility assessment of our analytic methods with this population. Completion of this project will prepare the way for a larger NCI grant to analyze the full sample (N=280) that is being collected in the parent study. In terms of increasing quality of care at end-of-life, this study will lead to a better understanding of when DT is most efficacious. It will guide honing of the intervention to improve patient care, with the goal of achieving meaningful psychosocial benefits for end-of-life cancer patients and their families. The project goal is in line with Triple Aim in its focus on improving patient experience though partnering with individuals and families. 


Death Over Dinner

Social taboos towards thinking and talking about death create a communication gap concerning end-of-life medical planning (Yingling & Keeley, 2007). Young adults have more anxiety about the concept of death (Twelker, 2004) and show less understanding about end-of-life decision-making (Wiener, 2012) than any other adult age group. A recent death education initiative known as Death over Dinner (initiated in 2012; http://deathoverdinner.org/) has had success in encouraging conversations about death and end-of-life wishes between family, friends, and strangers (South & Elton, 2017). As such, Death Over Dinner may be uniquely helpful in providing the missing link between opportunities for end-of-life planning and populations (e.g., young adults) who have little access to education about end-of-life. This project addresses the level of anxiety and lack of knowledge among young adults by evaluating Death Over Dinner as an intervention in which young adults are encouraged to think about and plan for their eventual death. The study is the first to examine direct effects of this intervention in terms of quantifiable outcomes like death attitudes, conversations with loved ones about end-of-life, and education about end-of-life options. After all, “The dinner table is the most forgiving place for difficult conversation,” (Michael Hebb, co-founder of Death Over Dinner).


Evaluating the Comfort Shawl Project 

Nurses play a vital role in end-of-life care. They provide compassionate and comprehensive care to patients and their families (American Nurses Association, 2016). In 2016, the American Association of Colleges of Nursing identified 17 palliative care competencies (CARES) nursing students should achieve before graduation. This study analyzes how these competencies are practiced and strengthened within a palliative care context. Young nurses with less professional experience display a greater fear of death and therefore negative attitudes towards caring for end-of-life patients (Peters, 2013). As experimental learning has been shown to increase competency in palliative care, (Kaasalainen, 2014), the Comfort Shawl Project was created, bridging psychological research from the Life Story Lab with application among nursing students. The Comfort Shawl Project is a yearlong project for undergraduate nurses in their senior year. The student nurses attend interdisciplinary team meetings of the palliative care consult service, gift handcrafted shawls to patients of all ages who are receiving palliative care and participate in extracurricular events focused on end-of-life care. The shawls themselves are crafted by volunteers including alumni, other nursing students, and Gainesville locals. The Comfort Shawl Project study examines the student nurses’ interactions and experiences while gifting the shawls and analyzes how participation in the project affects the student nurses’ attitudes of palliative care and education.

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