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2025 ; 24
(1
): 269
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Narrative identity at the end of life: a qualitative analysis of dignity therapy
interviews from an existential perspective
#MMPMID41131554
Devuyst P
; Leiter RE
; Milliken A
; Jenewein J
; Blum D
; Seiler A
BMC Palliat Care
2025[Oct]; 24
(1
): 269
PMID41131554
show ga
BACKGROUND: Confronting terminal illness and the prospect of death and dying can
severely undermine an individual's sense of identity, meaning and purpose in
life, leading to existential suffering, increasing hopelessness, depressive
symptoms, and death anxieties. OBJECTIVES: This study explored how narrative
approaches can alleviate existential suffering, promote emotional healing, and
consolidate identity for individuals confronted with death and dying.
Specifically, the study aimed to (1) analyze dimensions of identity reflected in
Dignity Therapy (DT) legacy documents from a randomized controlled trial,
applying Ricoeur's framework of selfhood and identity; (2) deepen the
understanding of existential suffering in relation to identity and its potential
transformation into meaningful adaptation; and (3) synthesize these findings into
a conceptual Model of Narrative Identity at the End of Life. METHODS: Thirty-two
DT interviews were analyzed using MAXQDA software for qualitative data analysis.
An inductive category development approach was employed to construct a
three-tiered coding system capturing key dimensions of identity. Drawing on
Ricoeur's framework of selfhood and identity, a hermeneutic and
existential-phenomenological approach was employed to deepen understanding of the
lived experiences and narrative reconstruction of self and identity in the
context of vulnerability, suffering, loss, and the approaching end of life.
RESULTS: The identified dimensions of narrative identity included "origin",
"family", "movement", "societal", "work", "recreation", "disruption", "experience
of the now", "feelings", "sense of self", and "future". Analysis of patients'
narratives yielded an in-depth understanding of existential suffering, as well as
the contrasting experiences of authenticity, integrity, and wholeness at the end
of life. Three core mechanisms emerged through which narrative work may mitigate
existential suffering while reaffirming selfhood and identity: (1) cultivation
healing connections and embracing hope; (2) the search for coherence and
meaning-making; and (3) inner growth and transformation. These findings informed
the development of a conceptual Model of Narrative Identity at the End of Life.
CONCLUSIONS: Confronting death and dying is challenging, yet it may serve as a
catalyst for increased self-awareness, self-growth, and transformation towards
greater authenticity. Storytelling is a simple yet powerful tool for reclaiming
narrative identity and alleviating existential suffering during a time marked by
loss of control and powerlessness. Our Model of Narrative Identity at the End of
Life illustrates how narrative work facilitates depth work, through which healing
connections and hope can be embraced, enabling meaning-based adaptation to
terminal illness, thereby empowering individuals to retain a sense of control,
agency, and autonomy, even in the face of their own mortality. TRIAL
REGISTRATION: This study was registered with Clinical Trial Registry
(ClinicalTrials.gov - Protocol Record NCT02646527; date of registration:
04/01/2016).