Authoring life chapters

The Singapore Cancer Society Psychosocial Services and Hospice Team supports the terminally ill in living out their life narratives in unique and creative ways.

Death and terminal illnesses can be difficult. topics to navigate. A 2014 Lien Foundation study¹ found that 45% of respondents said that not knowing how to broach such topics is a significant barrier to death-related conversations.

Yet, end-of-life conversations are possible when space is created in diverse and creative ways so that people can be supported when telling and authoring their narratives in “ways that make them stronger” amid their grief² (Wingard & Lester, 2001). These conversations start by having a deep respect of people’s life narratives and understanding what is meaningful to them.

When people face terminal illnesses, narratives of death and hardship are profoundly present, yet narratives of life and resilience can be honoured³ (Moxley- Haegert, 2015).

This article showcases the different ways people facing terminal illnesses are supported by the Singapore Cancer Society Psychosocial Services and Hospice Team to author their life narratives.

When he was diagnosed with terminal cancer, Mr Ong’s wish of publishing a book of his own came to light in a conversation with a social worker about leaving a legacy for his family. The social worker facilitated the conversation regarding his life experiences, values, and lasting words for his family, and compiled them into a legacy book. Mr Ong and his family gathered to celebrate and read it. This journey allowed him to fulfill his wish of being the author of his life and to leave a legacy that would be passed on to his descendants. His book was also shared with neighbours and friends.

Mr Woo has been a caregiver for his wife who is terminally ill, bed bound and assessed to lack mental capacity due to her illness for about three years. Despite the years of ongoing caregiving, financial challenges and his own serious health issues while caring for her, he won the Singapore Health Inspirational Patient & Caregiver Award 2022 for his unwavering commitment and learned expertise in caring for his wife’s every need at home. His expertise and values were elicited. through conversations with the social worker using S.T.E.P.S (see box) as she acknowledged his struggles while noticing the ways in which he responded to them. He was also able to share his expertise with a caregiver facing a similar situation, which provided much-needed support, and in turn, reinforced his expertise.

MADAM CHIN’S FIGHT-BACK JOURNEY

Life had never been easy for advanced cancer patient, Madam Chin, who was given away as a child and had no formal education. She has neither children nor sibling support to look after her elderly frail husband and herself. Undaunted by her cancer diagnosis, she built a social network for the two of them Singapore Cancer Society (SCS) home hospice care, Lion’s Befriending, Blossom Seeds eldercare and medical and transport services, church and neighbour support. She also converted to Christianity to receive spiritual calm and peace. Madam Chin does not wish to burden social services and prefers to use her own CPF savings from her past cleaning jobs for her living and medical expenses. To sparkle up her fight-back journey, Madam Chin recruited SCS to organise her first-ever birthday celebration, which she deemed as “really precious” as she’s able to “leave this world in peace”. Madam Chin has been participating actively in outreach events with her support network and it is her hope to encourage more volunteers to come forward and help the elderly who are struggling with old age and. illness. Madam Chin has since outlived her prognosis and is still running a robust fight-back race. She won the Singapore Health Inspirational Patient & Caregiver Award 2022.

One step at a time

S.T.E.P.S is a guide that supports navigation of conversations to encourage individuals to share and author their life narratives of death/hardships and life/resiliences in facing terminal illness. This guide is adapted from narrative therapeutic practices⁴ (White, 2007) in the local hospice context. One can consider exploring the aspects of S.T.E.PS as one way among many to converse with and support people facing terminal illness:

Struggles/suffering: Acknowledging the struggles and suffering people go through
Tracing responses: Noticing and affirming values and expertise people take to cope
Enriching memories and legacy: Uncovering enriching life narratives
Persons on the journey: Inquiring of the people in their life narratives that matter to them
Steps of contribution: Providing opportunities for people to contribute to their care planning and to contribute
to others.