2015-2016 UAB Geriatric Education Center

Faculty Scholars Program

End of Life Conversations

November 6, 2015

Patricia Sawyer, PhD

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“It’s always too early, until it’s too late.”

The Conversation Project, 2013

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Neurology Now: August/September 2015 - Volume 11 - Issue 4 - p 28–33

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Consider. . .• 60% say “making sure their family is not burdened by

tough decisions is “extremely important” • 56% have not communicated their end of life wishes

• 82% say it’s “important to put their wishes in writing”

• 23% have actually done it

• 80% say that if “seriously ill, they would want to talk to their doctor about end of life care

• 7% said they had had an end of life conversation with their doctor

California Health Care Foundation 2012

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Who, what, when, where, why•When to have conversations

• General – early adulthood• Later adulthood before crisis• Facing a potentially terminal situation

•Why so difficult• Cultural Considerations

•Who to include

•Ways to begin the conversation

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IOM “Life-cycle model of advance care planning”

• Milestones in life when an individual experiences either a change in personal risk and/or a major shift in responsibility

• Logical junctures when risks are mostly minimal

• Initial driver’s license, leaving for college, joining the military, getting married, becoming a parent, etc.

•

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IOM “Life-cycle model of advance care planning”

• At the diagnosis of any chronic illnesses or genetic conditions.

• At various turning points of a disease

• Final year of expected life.

https://iom.nationalacademies.org/~/media/Files/Report%20Files/2014/EOL/Report%20Brief.pdf

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Keep the Conversation Going

From Let’s Talk http://www.n4a.org/files/Conversations.pdf

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Cultural Considerations (1) • American norm reflects a lack of acceptance of

one’s own mortality

• “Public’s expectation of a life that can be extended by extraordinary medical measures has been equally matched by a health care system that regards death as a failure”

https://platform.atavist.com/view/excelsiorcollege/newconversationsaboutendoflife

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Cultural Considerations (2)• Personal identity of patient and people around

him/her• Relationships between them• Relative value and power of people in the

care environment• Rituals and Symbols • Values that give meaning to life, and which

may also give meaning to suffering and death

http://www.uwmedicine.org/uw-medical-center/documents/Cultural-Issues-around-End-of-Life.pdf

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Cultural Considerations (3)• Related to EOL, Studies show cultural

differences in

• Truth telling

• Life-prolonging technology

• Decision-making styles

• End-of-life experiences, beliefs, and expectations are linked to cultural values

https://www.osteopathic.org/.../Cultural-Traditions-in-the-EOLcf Tellez-Giron, 2007

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Cultural Considerations (4)

http://www.honoringchoices.org/