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Conducting A Life Tape Interview
Ernest Rosenbaum, MD, Robert W. Garlan, PhD, Naama Hirschberger, MA, Alison L. Siegel, MA, Lisa D. Butler, PhD and David Spiegel, MD
Materials & Arrangement
Structure of the Life Tape Interview
The LTP (Life Tapes Project) helps bring families closer together by increasing communication and also acts as an existential intervention, leading to a greater sense of legacy, meaning of life, and increased self awareness. It involves the symbolic immortality that is an aspect of existential coping and social support factors, which benefit patients and their families and meets patient and family needs.
The following is an outline of the basic requirements and procedures for conducting a LT interview. A list of suggested topics for participants can be found at the LTP study recruitment website: www.cancersupportivecare.com/lifetapes.html (This project ended July 1, 2007).
Recording equipment, tripod for camera, adequate lighting. Inexpensive video equipment makes videotape the medium of choice, but audiotape could still be used. The decreasing cost of digital video recording makes it an ever more attractive option, particularly for its ease of editing and reproduction. If ordinary videotape is used, two videotape players are usually required for editing.
Seating should be arranged in a semi-circle such that participants can see each other and can be readily filmed by the interviewer. Make sure that room lighting is in front of the participants-avoid strong back lighting. Patients and family members should sit fairly close together, with the patient on one end sitting next to his or her significant other. Young children may often be held on their parents' laps.
Pre-interview preparation. Provide a list of possible questions or topics one to several days prior to the scheduled interview to allow the patient to think of significant life events and to consider how much he or she wishes to disclose about coping with cancer, etc. Review these topics with the patient on the day of the interview. Find out the names of relatives (e.g., grand parents) that the patient would like to talk about as a form of brief genealogy. Immediately prior to beginning, describe the procedure to all participants and encourage family members to volunteer their memories of and feelings about the patient - particularly the ways in which the patient has influenced them, and what they have learned or observed since the diagnosis.
Conduct the interview. Begin by filming memorabilia (e.g., photographs of forebears) with the patient narrating. Alternatively, this may be done at the end of the interview. Begin the interview by having everyone introduce themselves and state their relationship to the patient. Proceed to asking questions of the patient as described below. Solicit family members' feelings, memories, and reactions that are stimulated by the patient's story. While some camera time will be devoted to family members - particularly as they begin speaking - the camera should focus mostly on the patient as he or she speaks or reacts to the words of others. Continue to the end of the interview, pausing the recording when necessary for participants to get comfortable or for interruptions. A five-minutes-to-go signal should be pre-arranged. Plan for about 90 minutes of interview time.
Ending the interview. Give a pre-arranged signal when about five minutes remain in order to avoid awkward and abrupt endings, and to give participants a last chance to voice their feelings.
- The interview can be seen as having three phases.
Phase 1 - Beginning the interview; birth to young adulthood. Begin with somewhat more factual and safe questions about the participant's ancestry, upbringing, and early life. Move on through high school and college. Typical questions might include:
- What is your earliest memory of life?
Describe your relationship with your parents/grandparents.
What do you remember them teaching you?
What was it like being a teenager?
What were you learning at this time in your life?
What was college like for you? Did you have a favorite area of study?
Proceed to later periods in life and significant relationships and events.
What did you do in your twenties/thirties?
Were there any significant others that came into your life at this time? How did they influence you?
- Phase 2 - Middle of interview. This phase occurs naturally as the patient begins to reveal him or herself in detail. Explore major turning points in life and career up to a few years ago, and important lessons learned. Bring out the significance of events and people for who the patient is today. Family participation is common during this phase - particularly when the interview turns to raising children and important events that the family shared.
- How/when did you meet your future husband/wife?
What discoveries did you make during this time?
How did that experience influence who you are today.
How did having children affect you?
What are you most proud of?
- Phase 3 - End of interview. Questions deepen. Patient discusses coping with cancer, personal legacy, feelings about spirituality and the afterlife, regrets, etc.
- How has your cancer diagnosis affected you and your family?
What has been the most significant change you see in yourself now that you are living with cancer?
What is a typical day like for you now?
During this time, what is of most importance to you?
If you have agreed with the patient that discussion of dying and/or the afterlife would be appropriate, guide the interview there. However, be aware that not all participants are prepared to talk about such matters directly.
What do you think happens when a person dies?
Do you consider yourself religious? Spiritual?
Have you become more spiritual or religious since your diagnosis?
What lessons do you hope to have passed to your children?
How do you hope you will be remembered?
What kind of legacy would you like to leave with your family?
End the interview with a couple of final summary-type questions.
Has this interview been helpful to you? How so?
If you were to live your life over again, what would you do differently or change? What would you keep the same?
What are you grateful for?
Although we have had no reports of serious negative reactions from participating in the LTP, as with any intervention it is possible that issues raised during an LT interview could prompt reactions that the patient finds upsetting. For this reason, the interviewer or physician should contact the patient a few days to a week following the interview, to insure that there have been no serious negative sequelae, or to offer or refer the patient for support, if warranted.
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