Primetime television is again turning its attention to end of life issues. In a recent episode of NBC Nightly News with Brian Williams, Chief Medical Editor Dr. Nancy Snyderman talks about end of life conversations. But for Dr. Snyderman, this was not just another news story- this is personal. The segment featured a conversation with her own parents and focuses on her family’s experience speaking about death and dying. In the piece, Dr. Snyderman talks candidly with her parents about their preferences for end of life care: “have you thought about the things that you don’t want to have done?” she asks.
This is not the first time that the network has addressed this critical issue. In December 2012 “NBC Nightly News” aired a two-part series that also discussed critical conversations. “It’s not always easy, but it’s essential for creating peace of mind for families,” Dr. Snyderman said in the 2012 piece.
But many people still find it tough to initiate these discussions. According to a survey of Californians by the California HealthCare Foundation, 60% of people say that making sure their family is not burdened by tough decisions is “extremely important.” Yet 56% have not communicated their end-of-life wishes.
With her personal story, Dr. Snyderman hopes to inspire other families to face conversations with their loved ones. “It’s important for everyone to own his or her death so that you can make arrangements,” she said.
And the best time to have that conversation? According to Dr. Snyderman- you shouldn’t wait too long. “People talk about what they want to do about death and dying when they are in a crisis and that’s the worst time. You need to spell it out way before the crisis. Talk about it when you’re well. That way you can ask questions and be specific.”
Being specific can avoid conflict or miscommunication when health is in decline. According to Dying Matters Coalition – a project of the National Council for Palliative care- there is a major mismatch between people’s preferences for where they would like to die and their actual place of death. Their research shows that around 70% of people would prefer to die at home, yet around 60% currently die in hospital.
This may be especially important for certain populations such as those over 85 years old. A new study published January 17th in the Journal of Palliative Medicine, for example, found that compared to people under age 85, the over 85 year olds were less likely to be reported to know they were dying, to have a record of their preferences for place of death, to die in their preferred place, to have enough choice about place of death-and more likely to be reported to have had unwanted treatment decisions. The over 85 year olds were also less likely to die at home- which may be explained by a failure to record their preferences about where they would like to die.
Laying out a roadmap for end of life wishes can help. “It’s harder to have these meaningful conversations when you are in a crisis,” says Dr. Snyderman. “People think that if they don’t talk about it, it won’t happen. But the best thing you can for your family and loved ones is to be prepared.”
While the conversation may be tough, it can ultimately lead to more satisfaction at the end of life. A British study published in Palliative Medicine found that people who died in their preferred place felt more positively about their nursing care, pain relief and emotional support during their last 2 days of life.
Experts from The Conversation Project say to encourage people to start small: think about the conversation, try writing a letter or having a practice conversation. Try to figure out the most important things about the care you want at the end of life and when you are ready to talk, don’t be intimidated if you have disagreement with family members.
For basic resources to help start these conversations: visit The Conversation Project.