Today I have a snippet from renowned hospice specialist Barbara Karnes to share a little on delivering bad news. Her insights on end-of-life care taught me to pause and reflect in an effort to do better in both my private and professional life. Often, we do not realize our perspective is practiced ritualistically. Without question or reason, for many a culture we were raised with and do not waiver from.
Since I began caring for the aging community 23 years ago, I have seen an evolution in this thinking. Perhaps it is the readily available knowledge on the information highway (the internet) or a shift in our cultural thinking regarding palliative and hospice care. There is definitely a repositioning from traditional delivery of bad news regarding health and wellbeing in the way of more transparency and having more input in one’s treatment or care plans.
“No one wants to be the bearer of bad news,” says Barbara. “Americans are a death-denying society. We view death as the enemy and a failure: something to be feared and avoided. Like ostriches we hide our head in the sand to keep from addressing the fact that we are all going to die someday (just don’t let someday be today or of someone I care about).
While there are dynamics to dying from disease or old age, dying is also unique to each person. The closest we can get to determining a prognosis is months, weeks, days or hours. There are too many factors involved in dying to be so specific as to say six months, three weeks, or 24 hours. This inability to be specific and the individual uniqueness makes the job of addressing end of life issues all the more difficult.
I think the fear of telling a patient and or family that nothing can be done, that we are talking about months/weeks/days of life, keeps us healthcare professionals from saying just that. What if we say a person is entering the dying process and they aren't or don’t die when we think they will? What if we are wrong? Looking at the emotional pain we will have caused can keep us quiet.
A “safe” area of conversation can be found in Advance Directives, speaking of end of life before faced with end of life. Medical facilities are now required to ask if Advance Directives are in place, but it is more often than not hurried over.”
It would be helpful for the patient, family and even the physicians if there was an Advance Directives “talk” before treatments are begun to hear from the patient what their end-of-life wishes are before they are actually at the end of their life. Having that conversation, physician and patient, before treatment would make it easier for the physician to reopen the door when treatment options are futile.
For more information on how, when and what questions to discuss, call Home Instead Senior Care for the 40/70 booklet. We can send one to you.
Julie Ann Soukoulis is the owner of Home Instead Senior care office in Rohnert Park, mother of two and passionate about healthy living at all ages. Having cared for her own two parents, she understands your struggles and aims, through her website, www.homeinstead.com/sonoma to educate and encourage seniors & caregivers. Have a caregiving or aging concern? She’d love to hear from you at 586-1516 anytime.