Bragi Skúlason, Ph D MAIN FIELD OF WORK
I‘m a husband, a father and a grandfather. I have worked at the University Hospital, Landspítali, since 1989 as a hospital chaplain. A large portion of my work has been in Palliative Care, in crisis work, spirituality, involving gender issues. I‘ve moved into research and have studied Icelandic widowers and, at present, I‘m working on developing educational material inspired by Motivational Interviewing, where talk about own impending death with the terminally ill is the focal point. Ethical and legal issues need to be kept in mind when this work is planned and put into action. The needs of patient and family are at the heart of this work.
ABSTRACT
Death talk
Talk about own impending death.
According to common practice based on a generally agreed interpretation of Icelandic law on the rights of patients, health care professionals cannot discuss prognosis and treatment with a patient’s family without that patient’s consent. This limitation poses ethical problems, because research has shown that, in the absence of insight and communication regarding a patient’s impending death, patient’s significant others may subsequently experience long-term psychological distress. It is also reportedly important for most dying patients to know that health care personnel are comfortable with talking about death and dying. There is only very limited information concerning gender differences regarding death talk in terminal care patients.
A retrospective analysis of detailed prospective “field notes” from chaplain interviews, inspired by Motivational Interviewing, of all patients aged 30–75 years receiving palliative care and/or with DNR (do not resuscitate) written on their charts who requested an interview with a hospital chaplain during a period of 3 years. After all study patients had died, these notes were analyzed to assess the prevalence of patient-initiated discussions regarding their own impending death and whether non-provocative evocation-type interventions had facilitated such communication. The conclusion was that gender differences in terminal care communication may be radically reduced by using simple evocation methods that are relatively unpretentious, but require considerable clinical training. Men in terminal care were more reluctant than women to enter into discussion regarding their own impending death in clinical settings. Intervention based on non-provocative evocation methods may increase death talk in both genders, the relative increase being higher for men.