The Meaning of Everything: Communication at the End of Life

Communication about end-of-life care is increasingly recognized as a core clinical skill, but doctors are often unprepared to have these conversations. Crisis situations at the end of life, such as when a hospitalized patient with a poor prognosis requests that “everything” be done, pose even greater communicative challenges. Such decisions are often regarded as a demand for care that may be burdensome or even harmful, rather than the start of an important conversation about values and goals. Situations such as this have prompted the development of prescriptive approaches to communicating with patients, which have limitations since they focus more on the physicians’ message than on developing a relationship with the patient or eliciting the meaning of the illness and its treatment. Current models of communication are less about accurate transmission of information and more about the ways in which communication constitutes our social world. Thus, the goal of communication training for physicians should be less about tools and scripts, and more about doctors learning to engage patients in conversation. We suggest strategies for promoting dialogue to more effectively explore the concerns and misunderstandings that might underlie decisions to “do everything.

Caregivers\u27 positive emotional expression and children\u27s psychological functioning after parental loss.

The death of a loved one, particularly a parent, has been identified as not only the most common, but also the most distressing form of adversity youth may experience in their lifetime. Surviving caregivers\u27 communication with their children may play a critical role in shaping bereaved children\u27s psychological functioning. However, few studies have examined the specific content (e.g., word usage) of caregivers\u27 verbal communication as a predictor of psychological functioning in bereaved youth. In a sample of 39 parentally-bereaved children and their surviving caregivers, we investigated whether the frequency of caregivers\u27 use of positive emotion words (e.g., love , happy , hope ) during a reminiscing task about the deceased was associated with children\u27s psychological functioning and coping. In a cross-sectional analysis, we specifically examined whether these associations were moderated by the amount of time passed since children lost their parents. The Linguistic Inquiry and Word Count Program (LIWC) was used to code and evaluate the percentage of positive emotion words caregivers used during the discussion. When caregivers used more positive emotion words, children were less likely to experience depression, anxiety, and avoidant coping. Those associations were present for children who had experienced parental loss at least 105 days prior to the study. Our findings have implications for how caregivers can support their children and help to alleviate psychological distress in the aftermath of parental loss