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• W2184845712 abstract "e live our lives through stories. The stories we tell ourselves about ourselves help us anticipate the events of our lives and move orderly and predictably through our days. These stories make sense of our past and give direction to our future through a process of meaning construction. Our life stories are shaped by our experiences, as filtered through our expectations and core beliefs. For many individuals and families the diagnosis of a chronic life-altering or lifethreatening illness requires a revision of the assumptions that have ordered and guided experiences and necessitates the construction of a new life story. The way individuals re-create meaning and construe their illnesses can have significant implications for long-term physical and emotional well-being. The challenge for the patient and family is to construct a meaningful tale—to write a new chapter of the life story that accommodates a changed reality and lived experience. The palliative care practitioner plays an important role in helping patients and families reconstruct their lives and create meaning at the end of life. Telling a Healing Story All patients have stories to tell, and most are eager to tell them. Some illness stories are familiar and expected. Patients facing illness at the end of a long life may engage in a retrospective reappraisal and seek to maintain connections with others; they often express a sense of acceptance and spiritual well-being. They tell poignant and compelling stories, and patients can be helped to author a meaningful final chapter that is consistent with their life goals. However, illness and death often do not arrive “on schedule.” Unscheduled illnesses (i.e., those that occur outside the social time frame that associates illness with advanced age), stigmatized illnesses such as HIV/AIDS, and acute illnesses that cause rapid deterioration in patients all challenge the implicit social rules and roles, order, and predictability that afford life its meaning and purpose. Patients and families are thrust into chaos, and the illness stories they tell reflect this. 1 Because telling a story is an inherently social act, and because stories do not reflect an objective reality as much as a narrative truth created by perception and expectancy, stories can be reshaped and retold to be more adaptive and helpful when faced with life-altering or life-threatening illness. 2 Many psychotherapeutic techniques are based on this premise, and the process of meaning reconstruction is also useful in the practice of palliative care. In the presence of a respectful listener, the narrator or patient tells and retells a story, working on the illness story and working through losses until the account feels coherent and complete. The narrator experiences healing when he or she can tell a story of illness and loss that gives meaning and purpose to his or her life. 3 Healing in the narrative sense is not achieved through the “laying on of hands” of a highly trained specialist; rather, healing is in the “laying on of ears.” 4 The ability to be present for a suffering patient and the willingness to simply listen can be restorative for patients. The goal in palliative care is not to analyze or change the story the patient tells. Rather, the goal is to hear and honor the patient’s story, no matter how often the patient needs to tell it. There is nothing that needs to be fixed. It is the act of telling the story in the presence of an empathic witness 5 that fosters healing. In this sense, all members of the palliative care team play an important role by encouraging patients and families to tell and review the stories of their lives and by witnessing the profound existential concerns that occupy their consciousness." @default.
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• W2184845712 title "Narrative Approaches in End-of-Life Care" @default.
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