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Bendel Y, Gesualdo C, Pinquart M, von Blanckenburg P. Better than expected? Predictors of coping with expectation violations in the communication about death and dying. Front Psychol 2023; 14:1256202. [PMID: 38022934 PMCID: PMC10654619 DOI: 10.3389/fpsyg.2023.1256202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
Background End-of-life (EOL) communication is often avoided, especially among young adults. Negative expectations concerning EOL conversations with relatives or significant others are one major reason. Objective To investigate how best to violate negative expectations concerning EOL conversations by identifying predictors of coping with expectation violations in this context. Methods Vignettes describing expectation violations in the context of EOL communication were presented to a sample of 261 university students. In a first experiment, the credibility of the expectation-disconfirming information was manipulated. In a second experiment, the valence of the disconfirming evidence was manipulated. As outcome measures, the subjective likelihood of two different responses to the expectation violation was assessed: (1) ignoring the disconfirming evidence (immunization) and (2) changing expectations (accommodation). Results Overall, participants experiencing a worse-than-expected event showed more immunization [F(1, 257) = 12.15, p < 0.001, ηp = 0.05], while participants experiencing a better-than-expected event showed more accommodation [F(1, 257) = 30.98, p < 0.001, ηp = 0.11]. Participants with higher fear of death [F(1, 257) = 12.24, p < 0.001, ηp = 0.05] as well as higher death avoidance tendencies [F(1, 257) = 17.16, p < 0.001, ηp = 0.06] showed less accommodation in response to a better-than-expected event. Conclusion In general, young adults appear to update their expectations quickly in response to unexpectedly positive experiences in the context of EOL communication. However, individuals with higher fear of death and higher death avoidance tendencies appear to be at higher risk of maintaining negative expectations despite disconfirming evidence.
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Affiliation(s)
- Yannik Bendel
- Clinical Psychology and Psychotherapy, Department of Psychology, Philipps University of Marburg, Marburg, Germany
| | - Chrys Gesualdo
- Developmental Psychology, Department of Psychology, Philipps University of Marburg, Marburg, Germany
| | - Martin Pinquart
- Developmental Psychology, Department of Psychology, Philipps University of Marburg, Marburg, Germany
| | - Pia von Blanckenburg
- Clinical Psychology and Psychotherapy, Department of Psychology, Philipps University of Marburg, Marburg, Germany
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2
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Mroz EL, Bluck S. Narrating Final Memories From Spousal Loss: The Role of Place and Quality of Death. Am J Hosp Palliat Care 2023:10499091231204965. [PMID: 37776113 PMCID: PMC10980595 DOI: 10.1177/10499091231204965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023] Open
Abstract
Objective: Personal memories of the death of a spouse can guide bereavement adjustment. Place of death and quality of death are end-of-life factors that are likely to influence death experiences and formation of subsequent personal memories. The current study employs narrative content-analysis to examine how place and quality of death relate to affective sequences present in older adults' final memories from the death of their spouse. Method: Based on power analyses, 53 older adults were recruited and completed a Final Memory Interview. They also reported place of spouse's death (ie, in hospital, out of hospital) and quality of death across four subscales. Final memory narratives were reliably content-analyzed (interrater agreements >.70), revealing positive and negative affective sequences, including: redemption, contamination, positive stability, and negative stability. Findings: Experiencing the death of a spouse in hospital was related to narrating final memories with contamination. In terms of quality of death, reporting a less comforting social environment at time of death was related to the presence of redemption in final memories. Reporting that one's spouse received appropriate medical care related to narrating memories that showed positive stability. Conclusions: Final memories are carried with the bereaved long after their loss. Positive final memories appear to stem from witnessing a comfortable, medically appropriate death outside of a hospital setting. End-of-life 'that is' between care and aligned with patients' values for place and treatment may be critical for spouses' formation of constructive final memories and bereavement adjustment.
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Affiliation(s)
- Emily L. Mroz
- Department of Internal Medicine, Yale University, New Haven, CT, USA
- Department of Psychology, University of Florida, Gainesville, FL, USA
| | - Susan Bluck
- Department of Psychology, University of Florida, Gainesville, FL, USA
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3
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Tenzek KE, Lapan E, Ophir Y, Lattimer TA. Staying connected: Alzheimer's hashtags and opportunities for engagement and overcoming stigma. J Aging Stud 2023; 66:101165. [PMID: 37704283 DOI: 10.1016/j.jaging.2023.101165] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 07/21/2023] [Accepted: 07/27/2023] [Indexed: 09/15/2023]
Abstract
Alzheimer's disease (AD) is a terminal, neurodegenerative disease, and consequently is difficult to communicate about as it is stigmatized, and discussions are rife with misconceptions. By situating AD conversations in the sociocultural space of the opportunity model of presence during the end-of-life process, a framework developed illustrating the potential trajectory from living with illness through death and into bereavement, we examined networked discussions surrounding Alzheimer's related hashtags on Twitter (N = 132,803) between January 1st, 2010, and September 29th, 2021. Using the mixed-method approach of the Analysis of Topic Model Network (ANTMN) framework, results revealed 30 topics clustered into five distinct themes: promotion, education, action, "You aren't alone", and dementia. Results indicated that discussions surrounding World Alzheimer's Day focused on changing stigma and promoting engagement in difficult conversations. The frequency of themes over time remained relatively stable. By understanding how Twitter's online discourse may be used to overcome stigmatized topics, we can continue to tailor messages to reduce stigma and provide support for those who experience similar health issues.
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Affiliation(s)
- Kelly E Tenzek
- 359 Department of Communication, Baldy Hall University at Buffalo, Buffalo, NY 14260, United States of America.
| | - Emily Lapan
- 359 Department of Communication, Baldy Hall University at Buffalo, Buffalo, NY 14260, United States of America
| | - Yotam Ophir
- 359 Department of Communication, Baldy Hall University at Buffalo, Buffalo, NY 14260, United States of America
| | - Tahleen A Lattimer
- 359 Department of Communication, Baldy Hall University at Buffalo, Buffalo, NY 14260, United States of America
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4
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Scheinfeld E, Tenzek KE, Cherry J. Survivors' perspectives on saying goodbye: Implications for end-of-life engagement across the lifespan and grieving process. DEATH STUDIES 2023; 48:571-583. [PMID: 37632691 DOI: 10.1080/07481187.2023.2250999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/28/2023]
Abstract
Family members are often unaware of their loved ones' final wishes and underestimate the need to talk about them before parents reach end-of-life (EOL). The benefits of engaging in EOL conversations alleviate needless suffering and can allow an opportunity to say goodbye in a meaningful way. We examined final conversations 13 adults recalled having with their aging parents through the lens of the opportunity model for presence (OMP) during the EOL process, a communication process model based on engagement in the dying process from diagnosis through bereavement, to understand the process from the survivor's perspective, looking at content of conversations and where they occurred in the dying process. Findings illustrate final conversations that align with the socio-cultural space of the OMP before the knowledge that a parent was dying, and when entering imminent death engaging in the critical moments, have implications for the grief and bereavement.
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Affiliation(s)
- Emily Scheinfeld
- School of Communication and Media, Kennesaw State University, Kennesaw, Georgia, USA
| | - Kelly E Tenzek
- Department of Communication, University at Buffalo, Buffalo, New York, USA
| | - Jessica Cherry
- Department of Communication Studies, Ohio University, Athens, Ohio, USA
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5
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Tey MQ, Lee GL. Understanding the influence of bereaved family caregivers' perception of a good death on their caregiving experiences: A meaning making perspective. DEATH STUDIES 2023:1-11. [PMID: 36757907 DOI: 10.1080/07481187.2023.2175926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
This retrospective qualitative study aimed to examine the influences of bereaved family caregivers' perception of good death for their dying spouse or parent on their caregiving experiences. A purposive sample of 15 participants were recruited from a hospice and their narratives were analyzed. Using the interpretative phenomenological analysis approach, five key components of a perceived good death that intermixed well-established Western attributes with deeply rooted Asian values were identified and meanings ascribed to their caregiving experiences were based on that. These findings suggested implications for practice on the entire service continuum from palliative and end-of-life care to bereavement services.
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Affiliation(s)
- Mei Qi Tey
- Department of Social Work, National University of Singapore, Singapore
- Psychosocial Support Services, Assisi Hospice, Singapore
| | - Geok Ling Lee
- Department of Social Work, National University of Singapore, Singapore
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Mejía Grueso A, Ramírez Pazos J, Roldán Bernal MC, López Sanmiguel A, Velásquez DA. Buen morir en la persona mayor:. UNIVERSITAS MÉDICA 2022. [DOI: 10.11144/javeriana.umed63-4.bmpm] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
El buen morir es un fenómeno que se construye desde múltiples perspectivas de los actores involucrados en la atención del adulto mayor. El objetivo de este trabajo es realizar una revisión temática con análisis cualitativo del contenido 50 artículos relacionados con el buen morir en el adulto mayor publicados en los últimos 10 años. Se encontró que el buen morir carece de una definición universal y está configurada por elementos que varían según el actor involucrado, variables sociodemográficas y aspectos culturales. Visibilizar los elementos más relevantes de lo que configura el buen morir permite ampliar su comprensión, con el objetivo de mejorar la atención en el fin de vida del adulto mayor.
Palabras clave: Anciano, muerte, morir, cuidados paliativos, final de vida
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Tenzek KE, Grant PC, Depner RM, Levy K, Byrwa DJ. Clinician Communication in Hospice: Constructions of Reality Throughout the End-of-Life Process. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221116719. [PMID: 35861222 DOI: 10.1177/00302228221116719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The current study examined qualitative data from hospice clinicians' perspectives on language, surrounding end-of-life (EOL), to understand challenges and opportunities for constructing a trajectory of communication leading towards a good death experience. Findings from two focus groups with nine clinicians' and 12 individual interviews, four of which were follow up interviews after the focus groups, were guided by framework analysis and revealed three themes, constructing language choices, roles and responsibilities, and socio-cultural considerations. We used the Opportunity Model for Presence during the End-of-Life Process (OMP-EOLP) to make sense of the findings and discuss implications for language use throughout the EOL process. We argue additional efforts should be made in recognizing the value of presence checks, re-constructing advance care planning, and utilizing different forms of media as an educational tool and connection mechanism for clinicians with patients and families to achieve a timely engagement of EOL conversations for all healthcare participants.
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Affiliation(s)
- Kelly E Tenzek
- Department of Communication, Baldy Hall University at Buffalo, Buffalo, NY, USA
| | - Pei C Grant
- Phronesis Consulting LLC, Clarence, NY, USA
- Hospice and Palliative Care Buffalo, Cheektowaga, NY, USA
| | - Rachel M Depner
- Department of Psychiatry and Human Behavior, Alpert Medical School at Brown University, Providence, RI, USA
| | - Kathryn Levy
- Department of Research, Hospice and Palliative Care Buffalo, Cheektowaga, NY, USA
- Department of Planning and Research, Trocaire College, Buffalo, NY, USA
| | - David J Byrwa
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
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8
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Margavio Striley K, Tenzek KE, Field-Springer K. Difficult dialogues about death: applying risk orders theory to analyse chaplains’ provision of end-of-life care. HEALTH, RISK & SOCIETY 2022. [DOI: 10.1080/13698575.2022.2056582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Katie Margavio Striley
- Interpersonal Communication, Department of Communication, The University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Kelly E. Tenzek
- Department of Communication, University of Wisconsin-Milwaukee (Data Collection)1
- Department of Communication, University at Buffalo, North Campus, Buffalo, New York, USA
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9
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Turner S, Littlemore J, Taylor J, Parr E, Topping AE. Metaphors that shape parents' perceptions of effective communication with healthcare practitioners following child death: a qualitative UK study. BMJ Open 2022; 12:e054991. [PMID: 35078846 PMCID: PMC8796225 DOI: 10.1136/bmjopen-2021-054991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES To offer an interpretation of bereaved parents' evaluations of communication with healthcare practitioners (HCPs) surrounding the death of a child. DESIGN Interpretative qualitative study employing thematic and linguistic analyses of metaphor embedded in interview data. SETTING England and Scotland. PARTICIPANTS 24 bereaved parents (21 women, 3 men). METHODS Participants were recruited through the True Colours Trust website and mailing list, similar UK charities and word of mouth. Following interviews in person or via video-conferencing platforms (Skype/Zoom), transcripts first underwent thematic and subsequently linguistic analyses supported by NVivo. A focused analysis of metaphors used by the parents was undertaken to allow in-depth interpretation of how they conceptualised their experiences. RESULTS The findings illuminate the ways parents experienced communication with HCPs surrounding the death of a child. Key findings from this study suggest that good communication with HCPs following the death of a child should acknowledge parental identity (and that of their child as an individual) and offer opportunities for them to enact this; taking account their emotional and physical experiences; and accommodate their altered experiences of time. CONCLUSIONS This study suggests that HCPs when communicating with bereaved parents need to recognise, and seek to comprehend, the ways in which the loss impacts on an individual's identity as a parent, the 'physical' nature of the emotions that can be unleashed and the ways in which the death of a child can alter their metaphorical conceptions of time.
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Affiliation(s)
- Sarah Turner
- Faculty of Arts and Humanities, Coventry University, Coventry, UK
| | | | - Julie Taylor
- School of Nursing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Eloise Parr
- English Language and Linguistics, University of Birmingham, Birmingham, UK
| | - A E Topping
- School of Nursing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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10
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Lattimer TA, Tenzek KE, Ophir Y, Sullivan SS. Exploring Online Twitter Conversations surrounding National Healthcare Decisions Day and Advance Care Planning from a Socio-Cultural Perspective: A Computational Mixed-Methods Analysis (Preprint). JMIR Form Res 2021; 6:e35795. [PMID: 35416783 PMCID: PMC9047726 DOI: 10.2196/35795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/07/2022] [Accepted: 03/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background Within the cultures and societies of the United States, topics related to death and dying continue to be taboo, and as a result, opportunities for presence and engagement during the end of life, which could lead to a good death, are avoided. Several efforts have been made to help people engage in advance care planning (ACP) conversations, including completing advance care directives so that they may express their goals of care if they become too sick to communicate their wishes. A major effort in the United States toward encouraging such challenging discussions is the annual celebration of the National Healthcare Decisions Day. Objective This study aimed to explore ACP from a sociocultural perspective by using Twitter as a communication tool. Methods All publicly available tweets published between August 1, 2020, and July 30, 2021 (N=9713) were collected and analyzed using the computational mixed methods Analysis of Topic Model Network approach. Results The results revealed that conversations driven primarily by laypersons (7107/7410, 95.91% of tweets originated from unverified accounts) surrounded the following three major themes: importance and promotion, surrounding language, and systemic issues. Conclusions On the basis of the results, we argue that there is a need for awareness of the barriers that people may face when engaging in ACP conversations, including systemic barriers, literacy levels, misinformation, policies (including Medicare reimbursements), and trust among health care professionals, in the United States. This is incredibly important for clinicians and scholars worldwide to be aware of as we strive to re-envision ACP, so that people are more comfortable engaging in ACP conversations. In terms of the content of tweets, we argue that there is a chasm between the biomedical and biopsychosocial elements of ACP, including patient narratives. If used properly, Twitter conversations and National Health Care Decision Day hashtags could be harnessed to serve as a connecting point among organizations, physicians, patients, and family members to lay the groundwork for the trajectory toward a good death.
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Affiliation(s)
- Tahleen A Lattimer
- Department of Communication, University at Buffalo, SUNY, East Amherst, NY, United States
| | - Kelly E Tenzek
- Department of Communication, University at Buffalo, SUNY, East Amherst, NY, United States
| | - Yotam Ophir
- Department of Communication, University at Buffalo, SUNY, East Amherst, NY, United States
| | - Suzanne S Sullivan
- School of Nursing, University at Buffalo, SUNY, East Amherst, NY, United States
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11
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Zaman M, Espinal-Arango S, Mohapatra A, Jadad AR. What would it take to die well? A systematic review of systematic reviews on the conditions for a good death. THE LANCET HEALTHY LONGEVITY 2021; 2:e593-e600. [PMID: 36098155 DOI: 10.1016/s2666-7568(21)00097-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/31/2021] [Accepted: 04/19/2021] [Indexed: 11/16/2022]
Abstract
The medicalisation of life under the influence of health-care systems, focused on curing diseases, has made dying well challenging. This systematic review identifies common themes from published systematic reviews about the conditions for a good death as a means to guide decisions around this universal event. MEDLINE, Embase, APA PsycInfo, and AMED were searched for citations with "good death" or "dying well" in their titles on Sept 23, 2020, and complemented with backward reference and forward citation screening with Google Scholar. Articles published in peer-reviewed journals in any language were included. Articles that focused on the identification of conditions for a good death and described how primary studies were sought and selected were also included. Data on general characteristics, quality, and themes were extracted independently. 13 of 275 potentially eligible reviews were included. Common themes were dying at the preferred place, relief from pain and psychological distress, emotional support from loved ones, autonomous treatment decision making, avoidance of futile life-prolonging interventions and of being a burden to others, right to assisted suicide or euthanasia, effective communication with professionals, and performance of rituals. No reviews specified the meaning or timing of death, connected themes, or prioritised them. Vague jargon was often used to describe complex concepts. Most conditions for a good death could be offered to most dying people, without costly medical infrastructure or specialised knowledge. Efforts to describe these conditions clearly, to identify whether there are exceptions or missing items, and whether they apply in non-dominant settings (ie, outstide institutional, affluent, anglophone, and Christian settings) are needed.
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12
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Saunders R, Seaman K, Glass C, Gullick K, Andrew J, Davray A. Improving the safety and quality of end-of-life in an Australian private hospital setting: An audit of documented end-of-life care. Australas J Ageing 2021; 40:449-456. [PMID: 34342382 DOI: 10.1111/ajag.12986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 06/20/2021] [Accepted: 07/05/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study reviewed the audit outcomes of the documented end-of-life care in a private hospital against the Australian Commission on Safety and Quality in Health Care's five recommended processes of care (Essential Elements (EE) 1-5). METHODS A retrospective database review of deaths over a three-year period was undertaken. This was followed by a sequential medical record audit (n = 100) to evaluate the end-of-life care documented in the three days preceding death. RESULTS There were 997 deaths from 2015 to 2017. The audit found communication to family the patient was dying (91%) and to the patient (36%) (EE1); evidence of specialist referral (68%) (EE2); assessment of the ability to eat/drink in the last 72 hours (86%) (EE3); advance care directives (13%) and hospital resuscitation plans (92%) (EE4); and response to patient or family concerns (100%) (EE5). CONCLUSIONS Components of the processes of care of the Essential Elements need to be addressed to improve patient-centred communication and shared decision-making.
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Affiliation(s)
- Rosemary Saunders
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia
| | - Karla Seaman
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia
| | - Courtney Glass
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia
| | | | - Julie Andrew
- Hollywood Private Hospital, Nedlands, WA, Australia
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13
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Nickels BM, Tenzek KE, Lattimer TA. This Is Us: An Analysis of Mediated Family Communication at End-of-Life. OMEGA-JOURNAL OF DEATH AND DYING 2021:302228211036307. [PMID: 34338068 DOI: 10.1177/00302228211036307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Death is a ubiquitous theme in television dramas and we argued that mediated depictions of end-of-life experiences have the potential to provide glimpses into the ways in which characters experience real-life issues and can serve as conversation starters within family viewers. The study aimed to identify how a popular television drama, This is Us, depicted end-of-life communication. Analysis of season one revealed 54 conversations about end-of-life, two explicit death scenes, and three implied death scenes. Results also illustrate how the storyline within the show clearly depicts the impact end-of-life has on the family system, emphasizing the ongoing interdependence, hierarchy, and boundary (re)negotiation as a result of death. Findings advance understanding of how mediated narratives can illustrate end-of-life scenarios and conversations within the family system and can provide observational opportunities for modeling end-of-life communication behaviors within their families.
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Affiliation(s)
- Bonnie M Nickels
- School of Communication, 6925Rochester Institute of Technology, Rochester Institute of Technology, New York, United States
| | - Kelly E Tenzek
- Department of Communication, 12292University at Buffalo, University at Buffalo, State University of New York, New York, United States
| | - Tahleen A Lattimer
- Department of Communication, 12292University at Buffalo, University at Buffalo, State University of New York, New York, United States
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14
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Bosco N, Cappellato V. Preparing for a good death? Palliative care representations in the italian public television programming. DEATH STUDIES 2021; 46:1963-1972. [PMID: 33476248 DOI: 10.1080/07481187.2021.1876788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The difficulty in accepting death is a constant that transcends differences of time and place. The literature shows that the dying is often subjected to invasive procedures with significant consequences on individual wellbeing and public health. If death is hard to accept even for the practitioners, what happens in the broader population? What narratives surround the end of life? The study focuses on the Italian context and its transformations, the public's understanding of palliative care, and the television programs dealing with hospice and palliative care aired by the Italian public broadcasting company from the 1950s to the present day.
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Affiliation(s)
- Nicoletta Bosco
- Department of Cultures, Politics and Society, University of Turin, Torino, Italy
| | - Valeria Cappellato
- Department of Cultures, Politics and Society, University of Turin, Torino, Italy
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15
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Han SK, Eo Y. Patients' Dying Process From the Point of View of Family and Hospice Team: A Qualitative Exploration of Family Member and Hospice Team Experiences With Hospice in Korea. OMEGA-JOURNAL OF DEATH AND DYING 2020; 86:533-552. [PMID: 33287647 DOI: 10.1177/0030222820976428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aims of this study is to analyze the experiences of family members and hospice teams regarding hospice care in Korea where culture and institution for well-dying is in the early stage. The study was conducted through in-depth interviews based on the grounded theory method. The participants were 12 individuals, 5 family members and 7 individuals from the hospice team. 133 concepts, 34 subcategories, and 11 categories were derived. The core phenomenon was "maintaining balance by becoming a ballast in the journey toward death". From the analysis of paradigm model, this phenomenon was caused to the medical-centered hospice service, the negative social and cultural context of death. It was strategically responded to the scope and contents of the interventions by the hospice team. Systematic, policy, and implementation plans that could improve the quality of hospice care were discussed.
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Affiliation(s)
- Sooyoun K Han
- Korea Civil Society Campaign for Well-dying, Seoul, Korea
| | - Yugyeong Eo
- Department of Social Services Policy Research, Korea Institute for Health and Social Affairs, Sejong City, Korea
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16
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Gurdogan EP, Aksoy B, Kinici E. The Concept of a Good Death From the Perspectives of Family Caregivers of Advanced Cancer Patients. OMEGA-JOURNAL OF DEATH AND DYING 2020; 85:303-316. [PMID: 32703073 DOI: 10.1177/0030222820945082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study was conducted to examine the importance of the concept of a good death and the contributing factors from the perspectives of family caregivers of advanced cancer patients. This descriptive and cross-sectional study, conducted with 182 family caregivers, were collected using a questionnaire form and the "Good Death Scale". The number and percentage distribution, multiple linear regression were used evaluation of data. The total score of the Good Death Scale was 62.65 ± 4.60. The factors contributing to the importance of the concept of a good death were determined as the presence of chronic disease; the type of treatment given to the patient; the presence of another family member who was previously diagnosed with cancer; the presence of a family member who has died of cancer and previously caregiving to a terminally ill family member. This study revealed that the concept of a good death is seen as very important.
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Affiliation(s)
- Eylem Pasli Gurdogan
- Department of Nursing, Faculty of Health Sciences, Trakya University, Edirne, Turkey
| | - Berna Aksoy
- Department of Nursing, Faculty of Health Sciences, Trakya University, Edirne, Turkey
| | - Ezgi Kinici
- Department of Nursing, Faculty of Health Sciences, Trakya University, Edirne, Turkey
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17
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Gafaar TO, Pesambili M, Henke O, Vissoci JRN, Mmbaga BT, Staton C. Good death: An exploratory study on perceptions and attitudes of patients, relatives, and healthcare providers, in northern Tanzania. PLoS One 2020; 15:e0233494. [PMID: 32649715 PMCID: PMC7351142 DOI: 10.1371/journal.pone.0233494] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 05/06/2020] [Indexed: 12/03/2022] Open
Abstract
IMPORTANCE In the Kilimanjaro region of Tanzania, there are no advance care planning (ACP) protocols being used to document patient preferences for end-of-life (EoL) care. There is a general avoidance of the topic and contemplating ACP in healthcare-limited regions can be an ethically complex subject. Nonetheless, evidence from similar settings indicate that an appropriate quality of life is valued, even as one is dying. What differs amongst cultures is the definition of a 'good death'. OBJECTIVE Evaluate perceptions of quality of death and advance EoL preparation in Moshi, Tanzania. DESIGN 13 focus group discussions (FGDs) were conducted in Swahili using a semi-structured guide. These discussions were audio-recorded, transcribed, translated, and coded using an inductive approach. SETTING Kilimanjaro Christian Medical Centre (KCMC), referral hospital for northern Tanzania. PARTICIPANTS A total of 122 participants, including patients with life-threatening illnesses (34), their relatives/friends (29), healthcare professionals (29; HCPs; doctors and nurses), and allied HCPs (30; community health workers, religious leaders, and social workers) from KCMC, or nearby within Moshi, participated in this study. FINDINGS In characterizing Good Death, 7 first-order themes emerged, and, of these themes, Religious & Spiritual Wellness, Family & Interpersonal Wellness, Grief Coping & Emotional Wellness, and Optimal Timing comprised the second-order theme, EoL Preparation and Life Completion. The other first-order themes for Good Death were Minimal Suffering & Burden, Quality of Care by Formal Caregivers, and Quality of Care by Informal Caregivers. INTERPRETATION The results of this study provide a robust thematic description of Good Death in northern Tanzania and they lay the groundwork for future clinical and research endeavors to improve the quality of EoL care at KCMC.
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Affiliation(s)
- Temitope O. Gafaar
- Duke University School of Medicine, Duke University, Durham, NC, United States of America
| | - Msafiri Pesambili
- Duke University Research Collaboration, Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Oliver Henke
- Cancer Care Center, Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Joao Ricardo Nickenig Vissoci
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
- Duke Emergency Medicine, Duke University Medical Center, Durham, NC, United States of America
| | - Blandina Theophil Mmbaga
- Cancer Care Center, Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Catherine Staton
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
- Duke Emergency Medicine, Duke University Medical Center, Durham, NC, United States of America
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Russell B, Vogrin S, Philip J, Hennessy-Anderson N, Collins A, Burchell J, Le B, Brand C, Hudson P, Sundararajan V. Triaging the Terminally Ill-Development of the Responding to Urgency of Need in Palliative Care (RUN-PC) Triage Tool. J Pain Symptom Manage 2020; 59:95-104.e11. [PMID: 31419540 DOI: 10.1016/j.jpainsymman.2019.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/04/2019] [Accepted: 08/07/2019] [Indexed: 11/28/2022]
Abstract
CONTEXT Evidence-based resource allocation is receiving increasing attention as we strive for equity, transparency, and cost-effectiveness across health care. In the context of finite resources, which of our patients with terminal illness should be prioritized for urgent palliative care? OBJECTIVES To develop the scoring system for the novel Responding to Urgency of Need in Palliative Care triage tool. METHODS Online international discrete choice experiment involving palliative care clinicians to establish the relative importance of seven key attributes of palliative care triage identified during an earlier qualitative study. RESULTS Participants (n = 772) were mainly female (79.9%) with a decade of clinical experience. All attributes contributed significantly (all P-values < 0.001) and independently to clinician assessment of urgency. This study found physical suffering (coefficient 3.45; 95% confidence interval: 3.24 to 3.66) was the most important determinant of urgency, followed by imminent dying (coefficient 1.56; 1.43 to 1.69), psychological suffering (coefficient 1.49; 1.37 to 1.60), caregiver distress (coefficient 1.47; 1.35 to 1.59), discrepancy between care needs and care arrangements (coefficient 1.14; 1.02 to 1.26), mismatch between current and desired site of care (coefficient 0.94; 0.85 to 1.03), and unmet communication needs (coefficient 0.84; 0.76 to 0.92). CONCLUSION Palliative care triage, which is complex and contextual, has been made more transparent through this discrete choice experiment. The Responding to Urgency of Need in Palliative Care triage tool provides an important step toward evidence-based assessment of priority for palliative care. Further research is underway to determine the validity of the tool in clinical practice and its impact on patient and caregiver outcomes.
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Affiliation(s)
- Bethany Russell
- Palliative Medicine Research Group, University of Melbourne & St Vincent's Hospital Melbourne, Melbourne, Australia; Centre for Palliative Care, St Vincent's Hospital Melbourne, Melbourne, Australia; Department of Palliative Care, St Vincent's Hospital Melbourne, Melbourne, Australia.
| | - Sara Vogrin
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Jennifer Philip
- Palliative Medicine Research Group, University of Melbourne & St Vincent's Hospital Melbourne, Melbourne, Australia; Department of Palliative Care, St Vincent's Hospital Melbourne, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia; Victorian Comprehensive Cancer Centre, Melbourne, Australia; Department of Palliative Care, Royal Melbourne Hospital, Melbourne, Australia
| | | | - Anna Collins
- Palliative Medicine Research Group, University of Melbourne & St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Jodie Burchell
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Brian Le
- Victorian Comprehensive Cancer Centre, Melbourne, Australia; Department of Palliative Care, Royal Melbourne Hospital, Melbourne, Australia
| | - Caroline Brand
- Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Australia; Department of Preventive Medicine, Monash University, Clayton, Australia
| | - Peter Hudson
- Centre for Palliative Care, St Vincent's Hospital Melbourne, Melbourne, Australia; Vrije University Brussels, Brussels, Belgium; School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Vijaya Sundararajan
- Centre for Palliative Care, St Vincent's Hospital Melbourne, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia; Department of Public Health, La Trobe University, Bundoora, Australia
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Yang H, Lu Y, Hou X, Guo R, Wang Y, Liu L, Gu Y, Sun H. Nurse‐rated good death of Chinese terminally ill patients with cancer: A cross‐sectional study. Eur J Cancer Care (Engl) 2019; 28:e13147. [PMID: 31433538 DOI: 10.1111/ecc.13147] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 07/07/2019] [Accepted: 08/01/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Hong Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Nursing Department Peking University Cancer Hospital & Institute Beijing China
| | - Yuhan Lu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Nursing Department Peking University Cancer Hospital & Institute Beijing China
| | - Xiaoting Hou
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Oncology Peking University Cancer Hospital & Institute Beijing China
| | - Renxiu Guo
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Oncology Peking University Cancer Hospital & Institute Beijing China
| | - Yun Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Integrative Medicine and Geriatric Oncology Peking University Cancer Hospital & Institute Beijing China
| | - Li Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Nursing Department Peking University Cancer Hospital & Institute Beijing China
| | - Yirong Gu
- Nursing Department Beijing Shijitan Hospital of Capital Medical University Beijing China
| | - Hongyu Sun
- Humanities Teaching and Research Section, School of Nursing Peking University Beijing China
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Johnson S, Kelemen A, Grimes C, Stein S, Groninger H. A thematic analysis of in-hospital end-of-life care experiences of surviving family members. DEATH STUDIES 2019; 45:469-479. [PMID: 31397642 DOI: 10.1080/07481187.2019.1648341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
While end-of-life care (EoLC) priorities for patients dying in the hospital are well-documented, few data characterize needs and experiences of their family members. We conducted thematic analysis of audio recorded interviews of 18 bereaved family members to elucidate these experiences. Participants' memories were organized into two parent themes: those related to satisfaction with the care received and effective communication; those identifying shortcomings in patient care, hospital-family communication, hospital environment, and care burden on the part of family members. These findings provide insight to enhance services to patients and their families at end-of-life and improve postmortem and bereavement services.
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Affiliation(s)
- Shannon Johnson
- The National Catholic School of Social Service,Catholic University of America, Washington, District of Columbia, USA
| | - Anne Kelemen
- Department of Medicine,Georgetown University Medical Center, Washington, District of Columbia, USA
- Department of Palliative Care, Section of Palliative Care, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Coleia Grimes
- The National Catholic School of Social Service,Catholic University of America, Washington, District of Columbia, USA
| | - Susannah Stein
- Department of Social Work, Children's National Medical Center, Washington, District of Columbia, USA
| | - Hunter Groninger
- Department of Medicine,Georgetown University Medical Center, Washington, District of Columbia, USA
- Department of Palliative Care, Section of Palliative Care, MedStar Washington Hospital Center, Washington, District of Columbia, USA
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Chindaprasirt J, Wongtirawit N, Limpawattana P, Srinonprasert V, Manjavong M, Chotmongkol V, Pairojkul S, Sawanyawisuth K. Perception of a "good death" in Thai patients with cancer and their relatives. Heliyon 2019; 5:e02067. [PMID: 31338472 PMCID: PMC6627555 DOI: 10.1016/j.heliyon.2019.e02067] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/22/2019] [Accepted: 07/05/2019] [Indexed: 10/28/2022] Open
Abstract
Background Understanding the perceptions regarding what constitutes a "good death" among cancer patients and their families could help healthcare teams to ensure proper palliative and supportive care. Objectives To demonstrate and compare the wishes cancer patients and the perceptions of their relatives regarding end-of-life care, and to identify factors associated with patients' preferences regarding place of death. Methods A sample of cancer patients and their relatives who attended the Srinagarind Hospital (Thailand) oncology clinic or day chemotherapy from September 2017 to August 2018 were enrolled. Questionnaires were given to the participants, in which the patients were asked to respond based on their own end-of-life preferences, and relatives were asked to imagine how the patients would respond to the questions. Results One hundred eighty pairs of patients and relatives were recruited. Respondents in both groups placed importance on place of death, relationship with family, physical and psychological comfort, and relationship with the medical staff. Both groups generally agreed with the statements on the questionnaire (10/13 statements). Relatives underestimated the preferences of the patients in 3 areas: "not being a burden to others," "preparation for death," and "physical and psychological comfort." Being married (adjusted odds ratio (AOD) 6.4, 95%confidence interval (CI) 1.1,36.5), having had more than 6 years of education (AOD 6.5, 95%CI 1.8,23.7), having lung cancer compared to colon cancer (AOD 12, 95%CI 1.2,118.7), duration after cancer diagnosis (AOD 0.9, 95%CI 0.93,0.99), previous hospital admission (AOD 5.7, 95%CI 1.5,21.2), and life satisfaction (AOD 17.6, 95%CI 2.9,104.9) were factors associated with preference for home death. Conclusion Thai cancer patients and their relatives indicated similar preferences with regard to what constitutes a good death and patients' wishes for their end-of-life period. However, the patients' relatives underestimated the importance patients placed on statements in three domains. Factors that influenced a preference for a home death were identified.
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Affiliation(s)
- Jarin Chindaprasirt
- Division of Oncology Medicine, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Thailand
| | - Nattapat Wongtirawit
- Residency Training in Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Thailand
| | - Panita Limpawattana
- Division of Geriatric Medicine, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Thailand
| | - Varalak Srinonprasert
- Division of Geriatric Medicine, Department of Internal Medicine, Siriraj Hospital, Faculty of Medicine, Mahidol University, Thailand
| | - Manchumad Manjavong
- Division of Geriatric Medicine, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Thailand
| | - Verajit Chotmongkol
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Thailand
| | - Srivieng Pairojkul
- Palliative Care Unit, Faculty of Medicine, Khon Kaen University, Thailand
| | - Kittisak Sawanyawisuth
- Division of Ambulatory Medicine, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Thailand
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Family Communication at the End of Life. Behav Sci (Basel) 2017; 7:bs7030045. [PMID: 28708107 PMCID: PMC5618053 DOI: 10.3390/bs7030045] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 07/11/2017] [Accepted: 07/11/2017] [Indexed: 02/01/2023] Open
Abstract
People often feel awkward and ill at ease when faced with the opportunity for communication at the end of life, thus the overall theme for the articles in this special issue is the creation of more awareness and knowledge regarding the depth, breadth, and importance of current research exploring family communication at the end of life. This introductory essay attempts to accomplish the following: (1) discuss the importance of talk regarding death; (2) highlight the formative role of family interactions on the death and dying process; and (3) outline the articles in this special issue. Scholars contributing to this special issue on “Family Communication at the End of Life” have provided evidence that communication is important between and for terminally ill individuals, family members, and healthcare/palliative care specialists. Overall, research exploring communication at the end of life is especially relevant because every person experiences the death and loss of loved ones, and ultimately faces the reality of their own death.
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