No-one wants to think about their loved ones passing away. As difficult as it might be, it is important to prepare for the end of life. It's an eventuality for all of us and we need to make sure we are having open and honest conversations. Death can be an isolating topic but if we don't feel able to talk about it, we run the risk of not having our wishes executed. So, with this in mind, we've written a guide to talking about end of life arrangements with your loved one.
How to Talk About End Of Life Arrangements
There is no wrong way to begin talking about end of life arrangements. Everything depends on how you and your loved one feel. It's going to be a difficult conversation, so try to create the best possible environment to discuss the topic. There are several theories about how to start difficult conversations. The most prevalent though is the 'SPIKES' model from Walter F. Baile. We are going to explain how to use the SPIKES method to discuss end of life care with a loved one.
Setting is an important place to begin. You need to make sure everyone is as comfortable as you can be. Prepare yourself with things like tissues and water. Try and remove distractions by finding a quiet room and turning off mobile phones.
You should consider who else you may want to be in the room for this conversation. Sometimes, it can be helpful to have a healthcare professional to answer practical questions about what you and your loved one should expect. People may also find support in having family and friends around them, but too many people could complicate a situation due to differing opinions. Ask your loved one in advance how they would prefer to discuss their end of life care.
Begin by discussing what has led to this conversation. Talk about the treatments, scans and diagnoses they have had. Ask considerate questions about their current emotional state and listen carefully. You should try your hardest to recognise their concerns and expectations. This will help to understand how they will feel about the coming conversation.
Try to respond to your loved one's feelings and gauge when they are becoming overwhelmed. Take a break if you need to; the conversation is likely to be tough for everyone. Ask open-ended questions and listen patiently to your loved one's answers in order to understand how they feel.
Obviously, you need to be sure that whoever you are discussing end of life care with is ready for the conversation. When you bring it up, pay attention to how they respond and make a judgement call as to whether they are prepared to talk about this. If your loved one doesn't want to talk about it yet, don't force them to. Instead, just let them know that they can talk to you about it whenever they feel able to.
As explained before, some people find it beneficial to have a health practitioner present. They can be useful to answer questions about how your loved one is managing physically and also to explain some options that are available.
Make sure they are presenting the information in a way you are able to understand. If you or your loved one is becoming confused, ask them to stop and clarify or use different language to explain.
Address your loved one's emotions with empathy. The conversation is difficult for everyone involved but thinking about your own mortality can be an extremely jarring thing. Check in with them often to make sure they are coping and are not becoming overwhelmed. Let them know that you understand that this must be hard for them and offer comfort as often as possible.
Present all the available options and allow your loved one to ask questions. Make sure you are using all the previous points to understand what is appropriate and what isn't. Allow them to express themselves openly and let them know that they have autonomy in what they choose.
What Things Should We Be Discussing?
Everybody's situation will be different, so there is no hard-and-fast checklist when it comes to end of life discussions. You should try and cover as many possibilities as you can, to ensure you understand what your loved one wants to happen in different eventualities. Some common questions include: where they would like to be when they die, what pain relief medication they would be willing to take, and where they would like to receive treatment. Explain that they have options to receive palliative care towards the end and consider the benefits for this. They may want to go to a hospice or they may want to sign a Do Not Resuscitate order. There are a variety of considerations to go through. You may wish to also make an Advance Statement or Advance Decision. These are documents that allow you to set out your preferences and wishes regarding end of life care. It's also important to write a Will to handle financial affairs.
If anyone is getting stressed or overwhelmed then take a break. Try to reassure your loved one that the conversation is all about honouring their wishes and implementing them when the time comes.
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