The Gift of Timely Conversations:
How to discuss end of life care

Grandfather and GranddaughterWhen is the right time to make end-of-life decisions?

It always seems like it’s too early to have conversations about your end-of-life healthcare wishes. Yet so many people wind up waiting until it’s too late. 

Now is the time to start talking about it. Whether you're making the decisions for yourself, or you're an adult child looking for advice on discussing EOL issues with your parent, here are some end of life conversation starters.

Sure, it's uncomfortable. But, don't be shy about taking the lead.

Debbie said her mom picked her sister as the person who would speak for her if she could not speak for herself due to illness or sudden accident. Who would you pick?

Use news and social media to help expand the discussion.

I read a New York Times article about the benefits of hospice care. It was about having a better death. Would you want to be at home when you pass away?

Use a recent hospital visit to initiate conversation.

Now that we're at the ER for the second time this month, we should talk about filling out an advance directive with your healthcare wishes. How do you feel about resuscitation if your heart stops, or being on a ventilator if you can't breathe on your own?

What would you do?

If you want control over what happens at the end of your life, we need to talk about it. So you were always disappointed that Grandma died all alone in the hospital. What would you like to be different for you when you reach that time?

When you talk about your end-of-life wishes with your loved ones, you’re truly giving them a gift — a gift of understanding that will bring them peace in years to come.  

How to Make End-of-life decisions

Samaritan recommends a three-part approach to the end of life care discussion: 
  • Think about your wishes.

Start thinking about your wishes now. Who would speak for you if you could no longer speak for yourself? Would they know your healthcare wishes? Do you want to donate your organs or body? Do you want life-sustaining treatments? Do you want comfort care? Spiritual support? Music, massage? Surrounded by family at home?

  • Talk about your choices with your family and healthcare providers.

Once you've made decisions about your healthcare wishes, you need to tell people. Tell your family, friends, and healthcare providers. It's important to let these key people know your wishes so they can be followed.

  • Act by writing it down and sharing copies with those who need to know.

The most important step is writing down your healthcare wishes. Access a free living will workshop in the county you live. Get a free copy of Five Wishes. Write down all your physical, spiritual, and emotional wishes. Make copies and give them to important members of your family. Do not put these papers in a lock box or place you will lose them or not find them easily!

Have this conversation now at the kitchen table, not later in the ICU. 

These milestones are good "triggers" for meaningful discussions:

  • At family gatherings - birthdays, holidays, funerals
  • At key milestones, such as when you get your driver’s license, graduate college, change jobs
  • When you have a child 
  • When you plan to retire
  • When you start military training or are deployed 
  • During well visits with your primary care provider 
  • When you’re diagnosed with with a chronic, life-limiting illness | Get help >>
  • As your health worsens.
  • When you enter your final year of expected life |  Get help >>

Make sure you complete your advance directive.

Five WishesUse our resources for help in writing down your wishes.

Or fill out a Five Wishes booklet.

Consult with a living will or elder law attorney.


How to discuss end-of-life care with your patients

end of life care discussionOne of the most difficult things a physicians does is deliver bad news to their patients and their families.

It is often much easier for them to continue pursuing an unlikely cure than to have the difficult conversation about allowing a natural death.

The fear of removing hope, lack of training or time, and a lack of cultural understanding are just a few factors that influence this communication. Sometimes it's even the physicians own fear of mortality or inaccuracy of prognostication.

However, a wise physician knows when to transition the discussion from curative treatments to palliative and/or hospice care options. Patient and family satisfaction greatly increase when this transition is made, and look to their primary care physician or specialist to start this conversation.

When you begin the conversation about palliative and hospice care, consider the following:

Do not avoid the subject and try to be clear and direct. When you think of becoming critically ill, what worries you most?

Be clear, sensitive, and use language they understand. How can we help? We are hear to answer any of your questions.

Be actively involved in the conversation and be present. What questions do you have? I want to be sure I explained this well, can you tell me what you understand?

Show empathy. It sounds like you're frustrated. I'll make sure you have what you need. Could you say more about that?

Find out what the patient and family already know. What have the other doctors told you? Tell me what you understand.

Find out how much the patient and family wants to know. Would it be ok to discuss the results of your CT scan...?

Explore realistic options and discuss the benefits/burdens of these options. How do you define quality of life? Have you thought about whether you'd want CPR if you were to stop breathing?

Review the goals of palliative care. We can offer many options to control your symptoms and make you feel better.

Make time and space for these important conversations.

Avoid these common statements. There's nothing we can do for you. It's time to think about withdrawal of care. You've failed treatment.

Engaging in these difficult conversations with your patients and their families will ensure they experience quality of life at the end of life. They value being able to prepare for death. 

Conversations


FAST FACT

According to a national survey by The Conversation Project in 2013, more than 90% of people think it’s important to talk about their wishes for end-of-life care. Yet, less than 30% of people have discussed it.

Dr. Angelo Volandes

Watch this short video for tips about having conversations about making medical decisions.

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