Talking about death and dying

Burgess, 2004Cancer Australia, 2014

Some patients approach death with calm acceptance and a sense of completion, while others are filled with fear, anguish, and a sense of loss of control or loss of meaning; this has been described as demoralisation, existential distress, spiritual pain or total pain. Talking openly about death and dying can bring considerable relief.

Patients generally expect their healthcare professionals to raise the subject of death and dying. Encouraging a patient to talk about their fears helps them to put into words what previously may have seemed unspeakable. These conversations should move at a pace with which the patient is comfortable. They may generate strong emotions, including sadness, anger or despair; be aware of the patient’s reaction—at times there will be clear signals that talking is too uncomfortable, or the timing is not right. For some patients, a direct conversation about their death may never be possible, but they should be offered the opportunity to explore the subject if they wishScott, 2013.

Note: Patients generally expect their healthcare professionals to raise the subject of death and dying.

Emotional suffering is a complex human experience, and at times the healthcare professional’s role may be simply to create a safe space for the patient to express their suffering and explore its meaning. Listening and ‘being there’ may be the best that can be offered at this time; shared silence can provide as much benefit as anything else.

Healthcare professionals can support patients by facilitating communication between the patient and their family or carers. Patients are often isolated when family or carers feel inadequate and uncertain how to react when facing the death of a loved one. A healthcare professional can assist by:

  • supporting patients in opening up communication
  • acting as a catalyst or ‘go-between’
  • offering to convey information (eg to other family members, workplace, school).

Family meetings may be helpful to facilitate communication. Healthcare professionals should be aware of any relevant cultural considerations for the patient and their family.