Speaking of Psychology - Making talking about death easier (SOP51)

Episode Date: December 22, 2017

Talking to loved ones about important end-of-life decisions can spark a complicated land mine of emotions. So much so, many people put it off until it’s too late. In this episode, Brian Carpenter, PhD, talks about why it’s important to have these conversations and how to approach these discussions successfully. APA is currently seeking proposals for APA 2020, click here to learn more https://convention.apa.org/proposals Learn more about your ad choices. Visit megaphone.fm/adchoices

Hello and welcome to Speaking of Psychology, a podcast produced by the American Psychological Association. I am your host, Audrey Hamilton. In this episode, I talk with a psychologist about having those difficult but important end-of-life discussions with your loved ones. Psychology has a lot to add in terms of what we know about how people make decisions, manage their emotions, and handle relationships, all things that can affect how we approach these discussions. These are difficult things for people to bring up. They're not sure how to do it, but we know it's important for them to plan and to think ahead. So we want to give people a sense of confidence and competence that they know how to bring up these topics. Yes, I know. Talking about death sounds depressing.

Yet, if done properly, it can actually lead to less stress as loved ones age and more benefits over time. Brian Carpenter is a clinical psychologist and professor of psychological and brain sciences at Washington University in St. Louis. His research focuses on family relationships in later life, particularly on communication and decision-making. He helps families face and address important end-of-life decisions, such as advanced directives and other health care-related decisions. Welcome, Dr. Carpenter. Thank you. It's great to be here. Nobody likes to talk about death, I mean, particularly with loved ones, especially when everyone is healthy and happy. But your research and clinical work have shown that it's best to deal with end-of-life issues.

as early as possible. You know, what should people be talking about with their families and why or loved ones? Well, you're right that nobody finds these topics particularly easy to talk about, but they are topics that everyone will need to face at some point in their life. And that's true for their family members and their close friends, but also true for themselves. So these are really universal issues that everybody needs to be thinking about. That doesn't mean that you need to be thinking about them every day all day long. but a little bit of advanced thinking and planning can really yield some benefits in the long term. So I like to suggest that people think about how they want their life to play out as they grow older. Now, again, I'll mention, though, that these are not just issues that are relevant only to older adults.

People can die at any age, as you know, although most of the people who do die are older. But being ready for the end of your life is important no matter what age. you are, because it can happen to anybody at any time. So it's important for people to at least start thinking about what they would like their end of life to look like, how they want that to play out, what kinds of care they might like to have, what kinds of care they might not want to have at the end of their life, and how they want other important people in their life to be involved. How do they want them to be involved in terms of taking care of them, helping with their care, arranging for care, and how they might be helpful in making decisions

for people close to the end of their life when some people may not be able to make decisions for themselves. Can you give some examples of, let's say, someone that you've worked with or other families that you've worked with, and when you sit down with them and talk about these issues, what are kinds of questions they have for you? Sometimes people aren't even sure where to begin the conversation. what are the right topics for them to be talking about. So often we start very simply by talking about the things that are important for people to consider.

And that includes thinking about where they want to live, what kinds of housing they might like to have towards the end of their life, where they might like to be if they have serious illness or might be approaching the end of their life. Would they prefer to be at home, in a hospital, some other residential setting, and there are benefits and drawbacks to all of those options? So housing is one thing that's important for people to think about. Medical care, obviously, is another one. What kinds of medical care do people want? And what kinds of medical care do people think they might not want as they become more sick? Another topic would be finances.

Family members and close friends you want to have involved in your life need to know what your financial situation is, where are important documents kept regarding your finance, And another topic has to do with the actual end of life itself. How do you want that to play out? And for some people, what do you want to have happen after you die? What kind of arrangements do you want to have? Who do you want to be there? Who do you want to be involved?

What might a service look like? So a little bit of planning, even though you're not going to be there, about how you want your life to be after you're gone. So all these things you're talking about, you can hit on a lot of hot, controversial buttons within your own family finances, family members, loved ones. How do you recommend bringing it up? I mean, do you bring this up at your holiday gathering or do you do it via email? I mean, is it particular to each situation, I imagine, but how do you recommend people go about it? You're right. Every family is going to be different. Every family has its own style,

its own personality, its own norms about how you talk about these kinds of sensitive topics. So everybody needs to think about their own individual family and what might work best for them. As a rule, I don't encourage people to have these kinds of conversations at important family events, like holidays or other kinds of gatherings. There's enough going on at Thanksgiving, for instance, that you don't really need to have a deep conversation about death and dying in the context of your Thanksgiving dinner. Some people think that that's logical to do it then because people are together in the same place. Let's break out my will and let's talk about it. Shove that pumpkin pie aside and let's talk about that. So, you know, I think that people should really think about these conversations as more of a process than an event.

It's not something that you should think about doing once and then it's over with, but these are conversations and issues that people should become comfortable talking about so that they can have maybe small conversations, break it down into bite-sized pieces, over a longer period of time. And why do you recommend that? One reason is that people's opinions and attitudes and beliefs might change over time. So if you have this kind of conversation at one point in your life, and then something meaningful happens to you or your loved ones, there's a divorce or change in your marital status or someone else in your family or someone you're close to has something serious

happen to them, or some major story in the news happens, and you see how a person's end of life played out, that can change your opinions about how you want to be treated. So even if you've had the conversation, it's important to go back and revisit these issues when people experience important changes in their life. Now, you've been doing some research to try and develop tools for families,

aiding them in these types of decisions and online tools. Can you talk about that research, what you found? Our goal, originally our goal was to try to figure out how we can help people know their preferences, know their family members' preferences for the things we've been talking about better. Because when you survey family members and ask them to predict how an older mother or older father would want to be taken care of, family members are notoriously bad at being able to predict those things with any accuracy. In fact, some of our research suggests that you might be just as accurate picking a person at random off the

street and asking them to guess what your mom or dad would want at the end of his or her life. So our first goal was to try to figure out, could we educate people and help them become more knowledgeable? And so that's one aim of this research. The second aim, though, and I think it's become a more important goal for me, is simply to get people who feel more comfortable talking about these things. As you said at the beginning, these are difficult things for people to bring up. They're not sure how to do it. But we know it's important for them to plan. and to think ahead. So we want to give people a sense of confidence and competence that they know how to bring up these topics and they can have a conversation and it can turn into some product or

output that's going to be helpful for them down the road. What about older adults who are struggling to even come to terms with aging or even death? Do you find it gets easier as they get older or more difficult? Everybody's different. So I think for some people, as they approach, the end of their life, there's some natural reflection about what their life has meant, a kind of attempt to make sense of what their life has been about. And with that can bring some trepidation, some worry that their life is coming to a close, maybe focus on some regrets that they might have, things they might have wished that they'd done differently, things that they might wish that they had said to people or not said to people, as the case may be. So for some people, I think,

the approach at the end of life can be worrisome. For other people, not so much. They've found a way to live a life that's been satisfying to them. They realize that it's going to come to an end. It does for everyone. And if people can feel some sense of peace and understanding and kind of integration of their life, those people don't necessarily fear death or even talking about death. In fact, when I started doing some clinical work in this area, I was surprised at how receptive people were to talking about these things because they'd been wanting to talk about these issues, but nobody around them wanted to do it. So when you ask a person to talk about the end of their life, in my experience, many of them are anxious and welcome the opportunity to do so. It gives them an opportunity to express their feelings on it.

I kind of am curious because you're a psychologist, a lot of the issues that you're talking about, advanced directives, medical care. I mean, those are the purview of an attorney, a physician who's working in gerontology or any other kind of profession like that. Why is talking about end-of-life issues, a psychological issue? Well, as you know, the end of life is an experience that doesn't unfold for any one particular health profession. that there, of course, are nurses and medical doctors involved in carrying somebody at the end of their life. There are also social workers, occupational therapists, spiritual and faith leaders, and psychologists who are important, have things to share at the end of life because the end of your life is a kind of culmination of physical and biological development, but also psychological and social development.

And psychology has a lot to add in terms of what we know about how, people make decisions, how they manage their emotions, what can lead to successful social relationships at the end of life, how we understand cultural diversity and how that plays out in important ways as a person is approaching the end of their life. So psychology really has lots of different things to add at this very, very important part of an individual's life. How do you deal with, and I know you do some clinical work, but when you're confronted with, let's say, someone who has a very different idea of how they think their loved one should

die versus how that own person thinks they should die. I mean, I imagine that's a difficult conversation to have. Nevertheless, how does it bore out usually? It can be very, very challenging for families, and I think the key there is that this needs to be conversations, is plural, you know, that you're not going to probably change somebody's mind by sitting down and talking to them for five or ten minutes about how things are playing out. that the goal is to try to help people understand where each other is coming from, you know, why they believe the things that they believe, and helping those individuals reach some sort of consensus and understanding

about what's going to be helpful for that group as a unit, that family as a unit or that care system as a unit, because people have different needs at the end of their life. And some patients want to be aware and sensitive of the people around them and how they're dying is affecting those people. And those care partners also want to try to respect what the person who is dying is going through as well. Well, Dr. Carpenter, thank you so much for joining us. It's been very interesting.

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You can find those podcasts on iTunes, Stitcher, or wherever you get your podcasts. You can also go to our website, speaking of psychology.org, to listen to even more episodes and gather more resources on the topics we discussed. Thanks for joining us. I'm Audrey Hamilton with the American Psychological Association, and this is Speaking of Psychology.