Talking about death: Living life to the fullest

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Talking about death Living life to the fullest

• Lucia D. Wocial, PhD, RN
• Woltman Inter-professional Communication Scholars
  Program
• IU School of Nursing

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Objectives

• Identify barriers to having conversations about
  end-of-life planning.
• Demonstrate essential skills for initiating and
  participating in discussions about of end-of-life
  planning.
• Identify resources for clients to assist them in
  having these conversations with the important
  people in their lives.
• Discuss why having these conversations matters.

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A Tale of Two Parents
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What keeps us from talking?
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Death What we wish it could be
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Death How it is
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Low rates of AD

• lt50 of the severely or terminally ill patients
  have an AD in the medical record.
• Only 12 of patients received input from their
  physician in its development.

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Inadequate training

• Between 65 and 76 of physicians whose patients
  had an advance directive were not aware that it
  existed.
• Until fairly recently, conversations about end of
  life planning was not part of training for
  physicians.

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Enamored with technology

• General public predicts 54 survival to discharge
  for in-hospital CPR
• Overall, survival for victims of cardiac arrest
  to hospital discharge has been estimated between
  0 and 10.
• Marco Larkin, 2008

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Talk about what people need to know, not just
what they want to hear
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Why conversations matter
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The Four Things That Matter Most

• Please forgive me.
• I forgive you.
• Thank you.
• I love you. 
• The Four Things That Matter MostA Book About
  Livingby Ira Byock, M. D.

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Beyond Advance Directives

• identify values
• choose surrogates wisely
• decide whether to grant flexibility
• inform others of your wishes
• McMahan, Knight, Fried, and Sudore, 2013

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Patients value discussions

• Patients who had advance planning discussions
  with their physicians continued to discuss and
  talk about these concerns with their families.
• Such discussions enabled patients and families to
  reconcile their differences about end-of-life
  care.
• AHRQ Report

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What would you want?

• You have a good chance at recovery.
• 30
• Six months in a skilled nursing facility
• Will not return to independent living

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http//www.nhdd.org/
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An Opportunity

• Imagine

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The Question

• Have you and your loved ones ever talked about
  what you would want if things dont go the way
  you hope?

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It is about LIVING

• Learn about your options, choices and decisions
• Implement your advance directive plans
• Voice your end-of-life wishes
• Engage others to talk about their wishes

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The Other Objective

• Change the way you talk to your clients.
• Make time for these conversations, personally and
  professionally.
• Enthusiastically assist clients when they want to
  discuss advance care planning.

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Motivation

• 2.5 million people die each year.
• 80 who die in hospitals have no decision making
  capacity.
• gt30 of these patients are on life support.
• Decision making falls to surrogates, usually
  family members.

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Karen Ann Quinlan
Nancy Beth Cruzan
Terri Schiavo
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The New Culture
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Reframing your challenge

• If people think you care they will trust you
• This is the most caring conversation you will
  have
• It cannot be the last slide in your presentation

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• You matter because you are and you matter to the
  last moment of your life
• Cicely Saunders