August 28th, 2012 at 10:00 am
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End-of-life conversations about a good death

by Dorian Martin

Over the weekend, I watched “The Descendants.” The film portrays a family’s struggles in coming to grips with end-of-life decisions for the mother, who is unconscious and on life support. But what if she was awake and had an incurable disease? What sort of end-of-life conversations should take place?

Families and health care personnel need to know the priorities and preferences of individuals nearing the end of life. Various research studies have explored what patients, medical staff and family members see as the components of a good death.

End-of-life care

A Japanese report, Good death in cancer care: a nationwide quantitative study, surveyed people under palliative care for cancer regarding end-of-life concerns. Patients described the components of a good death as including physical and psychological comfort, dying in a favorite place, a good relationship with medical staff, maintaining hope and pleasure, not being a burden to others, a good relationship with family, physical and cognitive control, environmental comfort, being respected as an individual and life completion.

A study out of North Carolina — “Patients, family members, and providers identified 6 components of a ‘good death’” — appeared in Evidence-Based Nursing. Nurses, social workers, hospice volunteers, chaplains, physicians, patients and bereaved family members listed these elements of a good death: pain and symptom management, clear decision making, preparation for death, completion, contributing to others and affirmation of the whole person.

Doctors may not always understand how to make the most of conversations about death with patients and their families. In End-of-Life Care Discussions Among Patients With Advanced Cancer: A Cohort Study, 73 percent of these patients with stage IV lung or colorectal cancer discussed end-of-life care with medical personnel. Most conversations took place one month before death and primarily involved a general medical physician or medical oncologist. Conversations typically occurred during short hospitalizations instead of during stable periods of outpatient care. Most frequently these conversations focused on hospice care and resuscitation, while palliative care and other venues for dying appeared as less common topics.

End-of-life communication

End-of-life discussions are difficult but important conversations to have. If caregivers can find out what the person who is sick considers to be a good death, then they can better steer these encounters with doctors to the benefit of everyone involved.

In addition, caregivers and adult children can help elders clarify legal and financial issues before the end comes, with tools such as a Power of Attorney, health directive and will. If a health directive or living will is on file, the family and health care providers know about a dying person’s wishes.

Posted in Caregiving, Death | 1 Comment »
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One Response to “End-of-life conversations about a good death”

  1. Sarah Foster

    Great article! Thanks for bring such an important topic to light!

    End-of-life conversations are extremely important, but not just for those who are near death. They are good conversations for parents to have with their adult children too. Most adult children, or caregivers, do not know what financial or legal obligations their parents have. They also do not know what their parents would deem a “good death”; or what direction the medical decisions should take if someone else would make the decision for them.

    End-of-life topics are not easy to discuss, but would be easier to navigate if a doctor would help lead the discussion. Most doctors do not approach the subject of end-of-life care unless it is in the near future. By that time the person whose wishes most caregivers wish to follow might not be capable of making such decisions. Discussing advanced directives and other end-of-life topics would be easier done in advance, before the patient becomes sick. It ultimately makes the whole process easier on the adult children who would have to make the decisions during this traumatic time.

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