Divergent Patterns of Confrontation With Death Using the Anticipated Farewell to Existence Questionnaire (AFEQT): Cross-Sectional Comparative Study of Four Samples With Increasing Proximity to Death.

Abstract

Background: Based on the concept of “Daseinsverabschiedung”, an anthropological theory of “Anticipated Farewell to Existence” (AFE) was suggested on the basis of six grounding dimensions (“derived in AFE”): selfhood (“expiration of the time of existence”), interpersonality (“altruistic preoccupation”), temporality (“struggle for acceptance”), corporeality (“wounded physical integrity”), worldliness (“reconciliation with own existence”), and transcendence (“self-transcendence”). The purpose of the study is to investigate the extent to which the relevance of these anthropological dimensions differs between people in different stages of life, especially those facing their own death.Methods: The sample (N=485) consists of dying individuals in palliative wards and hospices (n=121); old people living in nursing homes not suffering from a mortal disease (n=62); young adults (n=152), and middle-aged adults (n=150). The relevance of anticipated farewell to existence was measured by means of the “Anticipated Farewell to Existence Questionnaire” (AFEQT). Further assessment tools: Big Five Inventory (BFI-10), Life Attitude Profile (LAP-R), Eastern Cooperative Oncology Group (ECOG), and Basic Documentation for Psycho-Oncology (PO-Bado). The internal consistency of the AFEQT was assessed using Cronbach’s alpha and convergent validity by means of dimensions of LAP-R. Differences in the relevance of the AFEQT dimensions among stages of life were estimated by means of multiple regression models.Results: According to Cronbach’s alpha, the internal consistency of the AFEQT subscales was sufficient for the whole sample. Convergent validity with dimensions of LAP-R was found for young and middle-aged participants. Dying people scored significantly higher for most of the dimensions than young and middle-aged as well as elderly people. Personality traits of “oenness” and “agreeableness” are positively associated with the extent of assessed dimensions of AFEQT.Conclusions: Anthropological reflections on the structure of human beings, which is activated or actualized in a special way in the face of death, can provide a framework for practice facing a humanization of medicine at the end of life, considering real experiences, possible needs, and underlying human conditions when facing end of life. The dimensions proposed can be taken into account in a sensitive way by supporting dialogues with dying people and their relatives.Trial registration: observational study.