Impactful End-of-Life Conversations

By Jennifer Clark, MD and Linda Scaz, RN, PhD, FCN

In America, we have become a death denying culture. We are actually “scared to death” of dying.  Consequently, some of the most difficult conversations for healthcare professionals to have with patients are those involving care at the end-of-life. Influenced by this ubiquitous culture, clinicians enter the healthcare field armed only with their own personal experiences of death and dying, and sadly, many students’ primary experience of death is on the first day of anatomy lab.

Despite this known experience, health professions education has little to no formal training around death and dying, rendering these very human topics as “taboo” with nowhere for this much needed, deep learning to occur.  Further reinforced by the healthcare system’s commonly held belief that death is a failure, clinicians are ill-equipped and often paralyzed in caring for those at the end-of-life. With this lack of “deathing education” for professionals and the influence of our own personal biases and experiences around death, patients’ cultural considerations remain ignored.  When this happens, clinicians are not only unable to relieve the pain and suffering of their patients but inadvertently perpetuate a cycle of stress activation where death and dying are experiences of intense trauma that further reinforce our death denying culture.

Developing the communication skills to facilitate impactful end-of-life conversations, begins with a personal inventory: What are my personal experiences of death and the resulting beliefs and fears? How have they influenced my patient care?  Have my clinical experiences involving death and dying negatively sensitized me, creating a vulnerability in my patient care?

As we come to understand our  own experiences, we can then more fully participate in conversations about death and dying.  By purposefully engaging in controlled, moderate, and predictable experiences where we learn the tools and skills involved in end-of-life care, we are more equipped to remain regulated and resilient when faced with caring for those who are dying.  The patient and family experience is then allowed to take center stage.

Ultimately, as healthcare professionals, we need to befriend death in our own lives and in our conversations to transform the care we provide throughout the entire continuum of life.

The Institute for Healthcare Excellence recently hosed a virtual 4-hour summit dedicated to fostering clinicians’ comfort in facilitating impactful end-of-life conversations.  Please contact us at (904) 834-7408 or info@iheteam.org to hear more about Key Elements of Impactful End of Life Conversations- Where do RELATIONS® show up?.

Let’s regain focus on the work which connects us to the deep meaning and purpose of why we practice Medicine on a daily basis.