Talking about death: Living life to the

fullest

Talking about death: Living life to the

fullest

Lucia D. Wocial, PhD, RNWoltman Inter-professional Communication

Scholars ProgramIU School of Nursing

ObjectivesObjectives

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 ParentsA Tale of Two Parents

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What keeps us from talking?What keeps us from talking?

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Death: What we wish it could be

Death: What we wish it could be

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Death: How it isDeath: How it is

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<50 % 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.

Low rates of ADLow rates of AD

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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.

Inadequate trainingInadequate training

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General public predicts 54% survival to discharge for in-hospital CPROverall, survival for victims of cardiac arrest to hospital discharge has been estimated between 0% and 10%.

Marco & Larkin, 2008

Enamored with technologyEnamored with technology

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Talk about what people need to know, not just what they want to

hear

Talk about what people need to know, not just what they want to

hear

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Why conversations matterWhy conversations matter

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The Four Things That Matter Most

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.

04/19/23 13

• identify values • choose surrogates wisely • decide whether to grant flexibility• inform others of your wishes

McMahan, Knight, Fried, and Sudore, 2013

Beyond Advance DirectivesBeyond Advance Directives

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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

Patients value discussionsPatients value discussions

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

What would you want?What would you want?

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04/19/23 18

http://www.nhdd.org/

Imagine…

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An OpportunityAn Opportunity

The QuestionThe Question

“Have you and your loved ones ever talked about what you would want if things don’t go the way you hope?”

LLearn about your options, choices and decisions

IImplement your advance directive plans

VVoice your end-of-life wishes

EEngage others to talk about their wishes

It is about LIVINGIt is about LIVING

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The Other ObjectiveThe 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.

MotivationMotivation

2.5 million people die each year.80% who die in hospitals have no decision making capacity.>30 % 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

The New CultureThe New Culture

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If people think you care they will trust youThis is the most caring conversation you will haveIt cannot be the last slide in your presentation

Reframing your challengeReframing your challenge

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

Cicely Saunders