A hierarchy of personal agency for people with life-limiting illness

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The purpose of the study was to discover how individuals diagnosed with a life-limiting illness experienced themselves as agents, even in the face of death. In this qualitative, multiple case study design four female outpatient hospice patients with terminal illnesses received humanistic counselling to explore their experiences of themselves and their illness. A graded set of 8 levels of personal agency emerged from analyses of the texts of their sessions, ranging from a passive, objectified Non-agentic mode to an active, autonomous Fully Agentic mode, with multiple subcategories representing further gradations within levels. Our results are consistent with guidelines for supportive and palliative care with advanced cancer, which specify that dying patients’ needs be assessed and that they be involved in decisions about their care.
Original languageEnglish
Pages (from-to)594-601
Number of pages8
JournalAmerican Journal of Hospice and Palliative Medicine
Issue number6
Early online date19 Sept 2013
Publication statusPublished - 1 Sept 2014


  • hospice care
  • quality of life
  • psychological care
  • life-limiting illness
  • palliative care
  • personal agency


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