How Should We Communicate at the End of Life in Cancer? Should Death Be Discussed?

People generally feel uncomfortable discussing serious illness, especially major health problems in loved ones, and may hesitate to face the facts. Research into communication with families of patients nearing the end of life seeks to address several approaches:

• discussing the importance of talking about death,
• emphasizing the role of family communication during dying, and
• research supporting family communication at the end of life also clearly demonstrates the importance of palliative care .

End-of-life communication research is important because, after losing a loved one, relatives recognize the reality of their own mortality. This article focuses on communication within families of patients nearing the end of life.

Why Is Family Communication Important During Dying in Cancer?

Appropriate communication concerning medical, psychological and relationship issues is essential for those affected by death and dying, including patients and close relatives. However, because many societies believe in avoiding discussion of death-related realities, communication can be difficult at the end of life. Research identifies many reasons for avoiding death and related subjects, including fear, cultural norms, religious beliefs and families treating death as taboo.

Although death is not an unreal situation, discussing it while life continues is generally uncomfortable for family members.

Talking About Dying with Patients Nearing the End of Life and Their Relatives:

• May reduce anxiety for both sides
• May allow their end-of-life treatment wishes to be fulfilled.
• Final conversations between a terminally ill patient and family members may help relatives move on without regrets.
• Focusing on the family at the end of life highlights family members’ importance and their interactions with the patient.
• Families are often the main caregivers even at the end of life, making the most of time with their loved one
• Family members’ responsibilities for decisions and fulfilling the patient’s final wishes are very important.
• Patients nearing the end of life gain the opportunity and openness to speak freely about everything in their minds and hearts. This often eases stress, brings more positive interactions with relatives and helps them feel better prepared for the outcome.

Related topic:

• Talking about dying in cancer - is it not time?

How Does Effective End-of-Life Communication Produce Positive Outcomes?

1. Patients’ end-of-life desires become a priority and their wishes are understood more clearly.
2. Both family members and terminally ill patients become more accepting and prepared for life’s journey to end. Patients entering palliative care therefore generally receive better-quality, less painful end-of-life care, while families gain an important network of social support and guidance.
3. Families accepting the approaching death reduce unnecessary medical interventions that would cause their loved one more suffering.
4. By having substantive, genuine conversations, patients nearing the end of life and their families experience a sense of completion in their relationships.

For the past 20 years, researchers seeking to understand the role, effects and importance of end-of-life communication have conducted substantial work focusing both on communication between patients and family members and communication involving palliative care professionals.

Research Approaches:

• One research article highlights and analyzes new ways to initiate conversations about death and dying in shared settings such as dinner. Talking about death in these safe, socially integrated settings is thought to ease fear of death and help normalize end-of-life communication.
• Another article, titled Family Awareness and Enacting the Decision-Making Role in End-of-Life Decisions, emphasizes determining who in the family will make decisions for the person nearing the end of life and who will make the final decisions.
• Another study emphasizes the need for changes in communication among patients and families facing the difficulties of aging, illness and the end of life. It focuses on tensions in communication when problems create complexity, recommending that family members learn new ways to communicate more appropriately with loved ones at the end of life.
• Another approach emphasizes communication between family members and palliative care professionals to meet needs and achieve goals. For example, one article addresses "Cancer communication and caregiver quality of life." It emphasizes the importance of not overlooking caregivers’ intense stress and of effective communication to improve family members’ overall well-being, which also helps the terminally ill patient feel better.
• A study asking how a good death is possible from family members’ perspectives found that relatives worry about whether their loved one will experience "a good death" or "a bad death".

In conclusion, we support discussing death when communicating with patients nearing the end of life and their families. This research is very important because everyone grieves loved ones’ deaths and faces the reality of their own mortality. Patients in their final days and their loved ones deserve the opportunity to speak freely about everything in their minds and hearts. This communication may also be critical for good palliative care and a good death.

Other Related Topics:

• How should patients, relatives and physicians communicate?
• Relatives of cancer patients face greater difficulties than other patients’ relatives
• Signs that a person with cancer is nearing the end of life and suggestions for relatives