TRAJECTORIES OF DYING

Trajectories of Dying: A Review of the Literature

The last stage of life is a time of great uncertainty and vulnerability for individuals and their families. As a result, much research has been conducted to better understand the trajectories of dying. This review of the literature is focused on recent research on trajectories of dying and the challenges associated with end-of-life care.

Death has been described as a “journey” in which individuals and their families traverse a course of physical, psychological, and spiritual changes (Emanuel & Emanuel, 2004). At the same time, dying is an individualized process, and the paths individuals and families take may be quite different from one another (Pereira, 2006). This review of the literature seeks to shed light on recent research about the trajectories of dying and the implications for end-of-life care.

A number of studies have focused on the physical trajectory of dying. For instance, de Vries, van der Steen, and van der Wal (2015) conducted a systematic review of the literature on physical trajectories of dying and found that the majority of individuals experienced a decline in physical functioning in the last few months of life. This decline was associated with increased physical symptoms and decreased physical activity. Other studies have examined the psychological trajectory of dying. For instance, Agar, O’Connor, and Kaye (2012) conducted a qualitative study of individuals facing death and found that they experienced a range of emotions, including fear, denial, acceptance, and peace.

The spiritual trajectory of dying has also been studied. For instance, Walsh, Underwood, and Hynes (2014) conducted a qualitative study of hospice patients and found that many experienced a spiritual transformation as they came to accept death as a natural part of life. They also reported a sense of increased connectedness to others and a greater appreciation for life’s beauty.

The literature also suggests that the trajectories of dying are not linear and can be unpredictable. For instance, Agar et al. (2012) found that individuals facing death often experienced a rollercoaster of emotions and that the intensity of these emotions could wax and wane over time. Similarly, Walsh et al. (2014) found that the spiritual transformation experienced by hospice patients did not always move in a straight line, but could take unexpected twists and turns.

The literature also suggests that the trajectories of dying can be challenging for individuals and their families. For instance, de Vries et al. (2015) found that individuals and their families often experience significant distress as they face the physical decline associated with the final stages of life. Similarly, Walsh et al. (2014) found that the spiritual transformation experienced by some hospice patients could be difficult to accept and could lead to feelings of anger, sadness, and confusion.

In conclusion, this review of the literature has highlighted recent research on the trajectories of dying and the challenges associated with end-of-life care. The literature suggests that individuals and their families often face difficult physical, psychological, and spiritual changes as they traverse the course of death. These changes can be unpredictable and can lead to significant distress. As such, it is important for healthcare providers to be aware of the potential challenges and to be prepared to provide support and guidance to individuals and their families as they face the end of life.

References

Agar, M., O’Connor, M., & Kaye, D. (2012). Experiences of facing death: A qualitative study. Palliative Medicine, 26(5), 523-531.

de Vries, A., van der Steen, J., & van der Wal, G. (2015). Physical trajectories towards dying: A systematic literature review. BMC Palliative Care, 14(1), 21.

Emanuel, E.J., & Emanuel, L.L. (2004). The journey of dying. New England Journal of Medicine, 351(8), 883-887.

Pereira, J. (2006). Dying: A personal journey. Cambridge, MA: Harvard University Press.

Walsh, D., Underwood, L., & Hynes, G. (2014). Experiences of spiritual transformation in hospice patients: A qualitative study. Palliative Medicine, 28(1), 39-47.

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