Open awareness and dying: The use of denial and acceptance as coping strategies by hospice patients
Bibliographic record
Abstract
This paper examines the use of denial and acceptance as interdependent and fluctuating coping strategies by dying patients in a hospice, and discusses some of the reasons why denial and acceptance operate for these patients. 'Open awareness' of dying is now accepted as a central feature of palliative care, and full disclosure of prognosis and diagnosis is seen as a desirable element of care for patients who are dying. However, such openness is not without its tensions and conflicts. The study was conducted in a hospice where patients and nurses interact within an 'open awareness' context and where most patients live in the knowledge of 'certain death but at an unknown time'. The paper examines use of denial and acceptance by hospice patients at various times during their dying. The data are derived from the findings of a prospective qualitative study on the experiences of 12 hospice patients and those of their nurses. Unstructured interviews and participant observation were used as the primary methods of collecting data. Data from interviews were coded and comparative analyses between cases were performed. Denial and acceptance of dying among patients fluctuated during the period of dying and appeared to form an important aspect of their coping process. Denial and acceptance appeared to be used to avoid threats as well as to preserve existing relationships within the context of open awareness. In contrast to some commonly held beliefs, which tend to view denial and acceptance as 'singular, either/or entities', denial and acceptance are best seen as interdependent and fluctuating strategies, used continually by dying patients.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.015 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.002 | 0.005 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.001 | 0.004 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".