Do you remember having "the talk"? Maybe it was with the school nurse? Or perhaps it was a health class presentation in which you sat amongst your same-sexed classmates, under duress? Or maybe were you uncomfortably introduced to the "birds and the bees" by a well-intentioned parent? In any case, this much was true--the subject matter was of utmost importance, time was of the essence and at some point during the discussion you wished you could just disappear. Fast forward a handful of decades and it's time, once again, for "the talk".
Whether you are a teen, young adult, middle aged or a baby boomer, this talk is for you! Although a different kind of talk, this latter conversation is just as essential to one's life. Specifically, how to approach the end of life--death. Consider the following disconnects(1):
90% of people say talking about end of life issues is important.
27% have actually done so.
80% say that if they were seriously ill, they would want to talk to their doctor about end of life issues.
23% have done so.
82% say it is important to put such end of life issues in writing.
23% actually have done it.
Why aren't these conversations happening?
It seems most would agree that they are important. Perhaps it comes down to the same fundamental issues that plagued the birds and the bees. Finding the confidence to broach the topic, feeling informed enough to discuss the topic and taking comfort in the fact that talking about it doesn't make it happen.
Why should these conversations be happening?
The talk can bring family together and promote an exchange of ideas and core values. Having a discussion about end-of-life issues leaves supporting family with a clear roadmap for future decision making and brings comfort to the individual whose personal wishes are now known. Equipped with this valuable information, families can more confidently approach a loved one's end and facilitate decisions in keeping with their loved one's wishes. This simple planning allows for mutual understanding and support of family, as well as health care providers.
A study of seven cancer centers found that of those being treated there, only 1/3 had a discussion with their doctors. The study went on to show that the 1/3 who did discuss, had better end-of-life outcomes. These individuals had less suffering, better pain control and were less likely to die in the hospital. Their family was better off too. The study found fewer family members suffered from depression when followed up six months later. (2)
The Gunderson Clinic in La Crosse, WI has used a series of questions to reach beyond the technicalities of end-of-life decisions and assess the patient's experiences with death and dying. They specifically ask about personal experiences with sickness and death and what a "good day" for them would look like. They further inquire as to the deep values or beliefs that might influence decisions.
After reflection, a family's goal should be to get those expressed wishes on paper. This should include consideration of assigning a Medical Power of Attorney and drafting a living will and advance directives.
An organization founded by Ellen Goodman in 2010 has made initiating the talk easy. The Conversation Project has a downloadable Conversation starter kit. This kit provides simple fill-in, save, print and email options for families to prepare and guide them through the process of detailing and documenting end-of- life care.
Lastly, new Medicare regulations, approved just this month, are also making this process even easier. Beginning in 2016, Medicare recipients will have an opportunity to discuss these end-of-life matters with their physician as a covered benefit. It is thought that private insurance companies will soon follow suit.
Equip loved ones with a clear understading of end-of-life wishes and desires--have the talk! This simple act of communication can bring families closer together while providing valuable peace of mind.
1. Retrieved from http://theconversationproject.org/
2. ABC News, 9/26/12, An Interview with Dr. Atul Gawande, Retrieved from http://abcnews.go.com/Health/video/conversation-dr-atul-gawande-17330322