Thesis

Personal agency in hospice patients

Downloadable Content

Download PDF
Creator
Rights statement
Awarding institution
  • University of Strathclyde
Date of award
  • 2025
Thesis identifier
  • T17263
Person Identifier (Local)
  • 201456799
Qualification Level
Qualification Name
Department, School or Faculty
Abstract
  • The concept of personal agency depicts the person as a proactive contributor, motivated to meet challenges and to plan and execute appropriate action to exert influence over their functioning and life circumstances. Thus, the person is perceived as a non-deterministic but biological being who, when their environment poses a new significant challenge, enacts the concepts of free-will, self-efficacy and self development to survive. A hostile condition like the diagnosis of a life-limiting illness may challenge how the person experiences themselves as being able to work out ways to overcome their environmental constraints. Substantial evidence exists representing the person as having the capacity to face adversity and to effect appropriate action across different situations. Despite how common a diagnosis of a life-limiting illness is, a literature search did not reveal studies that have specifically focused either on the expression or measurement of personal agency in hospice patients. This lack of research and knowledge within literature highlights the need to investigate how and to what extent hospice patients experience personal agency. The purpose of this research was to carry out a systematic inquiry, involving three distinct studies, using a mixed methods design to investigate how and to what extent hospice patients experienced their personal agency. The principal objective of this research was to investigate a) how hospice patients express their sense of personal agency and b) whether that sense of personal agency can be measured. A secondary objective was to find out if Emotion-Focused Therapy (EFT; Elliott et al., 2004) can be used as an agency enhancing treatment to help hospice patients to experience an increase in their personal agency. Study 1 was a descriptive-interpretive, qualitative study, with a multiple case study design adopted as the strategy of data collection. The aim was to discover whether a previously described hierarchy of levels of personal agency would be supported with a new sample of four out-patients and four in-patients. Each patient received up to six sessions of Emotion-Focused Therapy, with therapy sessions audio-recorded and transcribed for qualitative analysis. The second study, a measure development study, used a quantitative approach to create and to evaluate a self-report questionnaire and an observation measure for assessing personal agency in hospice patients. The self-report questionnaire (based on Likert-type items) and the observation measure (based on a behaviourally anchored rating scale) were used in a pilot study with a sample of 10 out-patients. Data from an initial pilot study helped to a) reduce the number of items in the self-report measure and b) clarify descriptors on the observation measure with a new sample of 12 out-patients and 12 in-patients. Study 3, a mixed method, multiple systematic case study design that integrated both qualitative and quantitative approaches, built on the data from Studies 1 and 2. This study, a) implemented and evaluated the new self-report questionnaire and observation measure with a new sample of four out-patients and three in-patients and b) determined whether Emotion Focused Therapy could be associated with a change in personal agency in hospice patients by tracking them over time. Results of Study 1supported the hierarchy of levels and sub-levels of personal agency that emerged in the earlier MSc study. The sub-levels were expanded to reveal more subtle distinctions of personal agency in hospice patients. With categories of agency robust within and across patients, the hierarchy was developed in Study 2 into a self-report questionnaire and an observation measure for assessing personal agency in hospice patients. The original 53 item self-report questionnaire was reduced to a 16-item revised version, with a good level of internal consistency reliability for outpatients and a less than acceptable level for in-patients. Results indicated that the level of test-retest reliability was acceptable for in-patients but less than acceptable for outpatients. Results of Study 2 showed moderate to strong levels of inter-rater reliability for the observation measure, for out-patients and in-patients, respectively. However, the convergent validity between the self-report and the observation was not acceptable. Regarding face validity, the observation measure required no revision. Results of Study 3 indicated a very good level of internal consistency, an almost perfect inter-rater reliability and an excellent test-retest reliability. The convergent validity between the two measures was again not statistically significant. Overall, results of this three-part research study established that, with further research, the newly developed self-report questionnaire and the observation measure could be used for assessing personal agency in hospice patients and that change over time in hospice patients could be associated with Emotion-Focused Therapy.
Advisor / supervisor
  • Rasmussen, Susan
Resource Type
DOI

Relations

Items

Thumbnail Title Date Uploaded Visibility Actions
file details PDF of thesis T17263 2025-05-30 Public Download