The death process isn't something we like to talk about. Even when someone has advanced cancer, it's hard to broach the subject. Sometimes we hesitate to talk about the dying process because we don't want to upset our loved one with cancer. And sometimes we fail to initiate (or encourage) a discussion because, as the person with cancer, we don't want to upset our loved ones without cancer. Regardless of the reasons, there seems to be an unspoken rule that says, "if we don't talk about it, it won't happen."
But is there a reason we should talk about the dying process at all? Is it really necessary?
We could take this discussion in many directions, but there is one scenario at least in which discussing dying ahead of time might help us better honor our loved ones - or our own -- wishes.
Dying at home.
I've been saddened many times over the years when I hear about someone dying in the hospital, when their hope had been to die at home. Certainly being at home isn't possible at times. Sometimes only the hospital setting can provide the pain relief or other care needed to keep our loved one as comfortable as possible. But sometimes people die in the hospital when it would have been possible to die at home because they didn't take the time to talk about it ahead of time. And that breaks my heart.
A new study addressed this exact issue. If someone wishes to die at home, what factors make it more likely that this desire can be honored?
Researchers looked at close to 6,000 hospice patients who were asked if they would prefer to die in the hospital or die at home. Of this group, 3152 people indicated that they would prefer to die at home - over 50%. Factors that increased the likelihood that someone would die in their setting of choice included:
- Receiving at least one visit per day in the first 4 days of hospice care
- If they were married
- If they had an advance directive
As would be expected, people who had more severe pain were also less likely to die at home.
There are some factors we can't control, but if someone wishes to die at home, it makes sense to take the time to fill out an advance directive and seek out hospice care. Both of which require taking that step nobody really wants to take - talking about dying.
Jeurkar, N. et al. Which hospice patients with cancer are able to die in the setting of their choice? Results of a retrospective cohort study. Journal of Clinical Oncology. 2012. 30(22):2783-7.