Dealing With Temporality in Patients With Life-Limiting Disease: An International Qualitative Study

The prospect of death influences people's thoughts about and how they deal with their remaining time. We aimed to understand whether patients with progressive, life-limiting diseases are oriented in the past, present, or future and how they deal with temporality. We conducted 57 in-depth interviews with end-of-life patients in 10 countries using thematic analysis at three levels (i.e., locally in three countries, with codes shared in the three-country subgroup, and in all 10 countries with a codebook that we developed). We found that the patients' thoughts were oriented toward all three time levels (i.e., past, present, and future). Complementing these levels, we identified another, namely, the future after death. Each time level included patients actively and passively dealing with their thoughts. Past themes were <i>remorse and regret</i>, <i>nostalgia</i>, and <i>coming to terms with past choices</i>; present themes were <i>feeling grateful for being alive</i>, <i>a time for farewells</i>, and <i>living for the day</i>; future themes were <i>worries about the future</i>, <i>to miss out</i>, <i>hope</i>, <i>ideas about death and dying</i>, and <i>planning the near future</i>; and future after death themes were <i>not being there</i>, <i>worries about loved ones</i>, and <i>preparations for a future after death</i>. A <i>changed view on lifetime</i> and <i>avoidance of thinking about a certain time level</i> related to several time levels, while <i>desire to die</i> fluctuated between levels and between acting on and feeling about it. <i>Living for the day, worries about the future</i>, and <i>worries about the well-being of loved ones</i> were common themes in all countries.