Living Well During the End of Life Stage

When we think about the end of life, it is natural to think about sadness, loss, uncertainty, and fear. At the same time, research in palliative care suggests that this stage of life can also involve meaning, connection, reflection, and opportunities to focus on what matters most.

Living well near the end of life does not mean minimizing the seriousness of illness or trying to maintain a positive outlook at all times. Rather, it can involve supporting quality of life, maintaining meaningful relationships, addressing emotional and existential concerns, and making care decisions that reflect a person's values and priorities.

At Authentic Living London, we believe that every stage of life deserves compassionate, respectful care. Psychological support can be an important part of helping individuals and families navigate the emotional realities of serious illness and the end of life.

What Does It Mean to Live Well Near the End of Life?

There is no single definition of what it means to live well at the end of life. Individual priorities, relationships, culture, beliefs, health circumstances, and personal values all influence what quality of life means to someone.

For some people, living well may involve spending meaningful time with family and friends. For others, it may involve maintaining independence, addressing unfinished relationships, reflecting on their life, engaging in spiritual or creative practices, or making decisions about care that are consistent with their values.

Psychological interventions that focus on meaning, dignity, and existential concerns have shown promise in supporting people with advanced illness. Research suggests that meaning-centred approaches can improve aspects of psychological and spiritual well-being and may help people experience greater meaning and quality of life (Kang et al., 2019; Bauereiß et al., 2018).

Living well may involve:

• Emotional connection: Spending time with people who matter and expressing thoughts, feelings, memories, or affection.

• Comfort and dignity: Participating in decisions about care and treatment in ways that reflect personal priorities.

• Meaning and purpose: Reflecting on experiences, values, relationships, accomplishments, and what continues to matter.

• Legacy: Sharing stories, memories, values, messages, or meaningful experiences with loved ones.

• Presence: Focusing attention on meaningful moments, relationships, and experiences in the present.

These priorities can change over time. What matters most is creating space for the individual to identify what feels meaningful to them.

The Emotional Experience of the End of Life

Serious illness and the end of life can bring a wide range of emotions. A person may experience sadness, fear, anger, anxiety, gratitude, uncertainty, relief, or a sense of peace. These emotions can change over time and may sometimes occur together.

Existential concerns can also become more prominent. People may wonder about the meaning of their life, their relationships, unfinished business, how they will be remembered, or what death will mean for themselves and the people they love.

Research examining psychological and existential interventions in palliative care suggests that addressing these concerns can be an important part of comprehensive care. Approaches that incorporate meaning, dignity, relationships, and spiritual or existential concerns have demonstrated potential benefits for psychological well-being (Bauereiß et al., 2018; Ghafoori et al., 2019).

Family members can also experience significant emotional distress during this period. Watching someone you love become seriously ill can bring grief, uncertainty, caregiving stress, and concerns about what life will look like after the death. Psychosocial interventions for family caregivers have been associated with improvements in areas such as coping, stress, quality of life, and depressive symptoms (Alam et al., 2023).

The Importance of Meaning and Life Review

As people approach the end of life, reflecting on their lives can become particularly meaningful. Life review involves looking back at important experiences, relationships, accomplishments, challenges, and memories.

Research suggests that structured life-review interventions may contribute to quality of life among people with advanced or terminal illness. A systematic review and meta-analysis found that life-review interventions were associated with improvements in quality of life among terminally ill patients (Huang et al., 2019).

More recent research continues to examine life-review approaches in palliative care, including their potential effects on psychological and spiritual outcomes (Pascoal-Carvalho & Reis-Pina, 2026).

Life review might involve:

• Remembering meaningful relationships

• Sharing stories from childhood or important life stages

• Reflecting on accomplishments and challenges

• Identifying values that have guided one's life

• Creating letters, recordings, photographs, or other forms of legacy

• Talking about important memories with family members

These conversations can provide opportunities for connection and may help family members better understand the person's experiences, values, and hopes.

Dignity and Quality of Life

Dignity is an important consideration in end-of-life care. For some people, maintaining a sense of identity, autonomy, purpose, and connection becomes particularly important as illness progresses.

Dignity Therapy is one psychological approach developed specifically for people facing advanced illness. It involves guided conversations about important aspects of a person's life, values, relationships, accomplishments, and hopes, often resulting in a document that can be shared with loved ones.

Research examining Dignity Therapy has found promising results, although outcomes vary across studies. Systematic reviews and meta-analyses have found improvements in areas such as dignity-related distress, hope, and some aspects of quality of life, while effects on anxiety, depression, and spiritual well-being have been less consistent (Xiao et al., 2019; Zheng et al., 2023; Haneef & Abdullah, 2024).

For family members, the opportunity to receive or participate in a legacy document may also provide comfort and help with preparation for the person's death (Grijó et al., 2021).

This does not mean that everyone will find life review or dignity-focused work helpful. These approaches should be guided by the individual's preferences, needs, culture, and circumstances.

Having Difficult Conversations

End-of-life conversations can be challenging. People may avoid talking about death because they are afraid of upsetting one another or because they are unsure how to begin.

However, communication can provide an opportunity to clarify wishes, express love, address concerns, and make decisions together.

Research examining interventions designed to facilitate end-of-life communication suggests that structured support can help patients and family caregivers engage in these conversations more effectively (Jung & Matthews, 2021).

A therapist can help individuals and families navigate conversations about:

• Fears surrounding illness or death

• Changing family roles

• Unresolved relationship concerns

• Caregiving responsibilities

• Personal values and priorities

• Wishes for future care

• What family members need from one another

• Memories and legacy

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These conversations do not need to be perfectly resolved. Sometimes the most meaningful outcome is simply creating an opportunity for people to hear and understand one another.

Supporting Loved Ones at the End of Life

Families and friends often worry about saying the wrong thing. They may also feel pressure to make the situation better when there is no simple solution.

In many situations, presence and listening can be more helpful than trying to find the perfect words. Sitting together, sharing memories, listening to music, looking through photographs, or simply spending quiet time together can all provide opportunities for connection.

Caregivers also need support. The emotional and practical demands of caring for someone with serious illness can be substantial. Research indicates that psychosocial interventions can help support caregivers' coping, stress management, quality of life, and emotional well-being (Alam et al., 2023).

Seeking counselling or other forms of support can therefore be appropriate not only for the person who is dying, but also for family members and caregivers.

How Therapy Can Help at the End of Life

Therapy during the end-of-life period is not about changing the reality of what is happening. Instead, it can provide a confidential space to process emotions, explore concerns, strengthen relationships, and consider what matters most.

Depending on the person's needs, therapy may involve:

• Processing fear, sadness, anger, anxiety, or uncertainty

• Exploring questions about meaning and purpose

• Reflecting on important life experiences

• Working through relationship concerns or unfinished conversations

• Supporting communication between family members

• Exploring concerns about death and dying

• Developing ways to cope with changing roles and circumstances

• Supporting caregivers through stress and anticipatory grief

• Creating opportunities for meaningful connection and legacy

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Evidence from palliative-care research supports the use of psychological and meaning-focused interventions for addressing a range of emotional, existential, and quality-of-life concerns, although the strength of evidence varies depending on the intervention and outcome being studied (Bauereiß et al., 2018; Kang et al., 2019; Haneef & Abdullah, 2024).

Finding Support That Fits

End-of-life counselling should be individualized. Some people want to talk openly about death and what comes next. Others may want to focus more on relationships, caregiving, anxiety, life review, or practical emotional challenges.

A therapist can work collaboratively with the individual and family to determine what kind of support would be most useful.

At Authentic Living London, Jeanette Leroux provides counselling for individuals and families navigating end-of-life concerns, including grief, MAID-related issues, depression, life review, and concerns related to aging.

Her approach recognizes that end-of-life experiences are deeply personal. Counselling can provide a compassionate space to explore what is happening emotionally while respecting each person's values, beliefs, choices, and circumstances.

A Final Thought

The end of life is a significant human experience that can involve both profound difficulty and meaningful connection. Psychological care can help individuals and families navigate the emotional and relational challenges that accompany serious illness while making room for the things that matter most to them.

For some people, this may mean reflecting on a life well lived. For others, it may mean strengthening relationships, addressing unfinished conversations, creating a legacy, or simply finding support through an uncertain time.

If you or someone you love is facing the end of life and would benefit from emotional support, Authentic Living London is here to help.

Jeanette Leroux, BA, MSW specializes in end of life counselling, including grief, MAID-related issues, depression, life review, and geriatric concerns. Book a free consultation today.

References

Alam, S., Hossain, M. S., & others. (2023). Psychosocial interventions aimed at family members caring for patients with cancer in the palliative period: A systematic review. Palliative & Supportive Care. https://doi.org/10.1017/S1478951523000364

Bauereiß, N., de Pauli, P., Duford, F., & Baumeister, H. (2018). Effects of existential interventions on spiritual, psychological, and physical well-being in adult patients with cancer: Systematic review and meta-analysis of randomized controlled trials. Psycho-Oncology, 27(11), 2531–2545. https://doi.org/10.1002/pon.4829

Grijó, L., Tojal, C., & Rego, F. (2021). Effects of dignity therapy on palliative patients' family members: A systematic review. Palliative & Supportive Care, 19(5), 605–614. https://doi.org/10.1017/S147895152100033X

Haneef, S. H., & Abdullah, M. (2024). Effects of dignity therapy for palliative care patients and family caregivers: A systematic review. Cureus, 16(9), e70431. https://doi.org/10.7759/cureus.70431

Huang, M.-H., Wang, R.-H., & Wang, H.-H. (2019). Effect of life review on quality of life in terminal patients: A systematic review and meta-analysis. Journal of Nursing Research, 27(2), e17. https://doi.org/10.1097/JNR.0000000000000335

Jung, M. Y., & Matthews, A. K. (2021). A systematic review of clinical interventions facilitating end-of-life communication between patients and family caregivers. American Journal of Hospice & Palliative Medicine, 38(2), 180–190. https://doi.org/10.1177/1049909120929323

Kang, K.-A., Han, S.-J., Lim, Y.-S., & Kim, S.-J. (2019). Meaning-centered interventions for patients with advanced or terminal cancer: A meta-analysis. Cancer Nursing, 42(4), 332–340. https://doi.org/10.1097/NCC.0000000000000628

Pascoal-Carvalho, M., & Reis-Pina, P. (2026). Life review interventions in palliative care: A systematic review of patient-centered outcomes. American Journal of Hospice & Palliative Medicine. https://doi.org/10.1177/10499091251414862

Xiao, J., Chow, K. M., & others. (2019). Effects of dignity therapy on dignity, psychological well-being, and quality of life among palliative care cancer patients: A systematic review and meta-analysis. Palliative Medicine.

Zheng, R., Guo, Q., Chen, Z., & Zeng, Y. (2023). Dignity therapy, psycho-spiritual well-being and quality of life in the terminally ill: Systematic review and meta-analysis. BMJ Supportive & Palliative Care.