Death talk: gender differences in talking about one’s own impending death

BMC Palliative Care

Research Article

Arna Hauksdottir¹  Kozma Ahcic²  Asgeir R Helgason³  Bragi Skulason⁴ 

[1] Centre of Public Health Sciences, University of Iceland, Saemundargata 2, IS101, Reykjavik, Iceland;Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Vasagatan 33, 411 37, Gothenburg, Sweden;Sahlgrenska University Hospital SE, Per dubbsgatan 16, 413 45, Gothenburg, Sweden;Karolinska Institute, Departments of Public Health Sciences and Oncology-Pathology, & Centre for Epidemiology and Community Medicine, Stockholm County Council Health Services, SE171 77, Stockholm, Sweden;Karolinska Institute, Departments of Public Health Sciences and Oncology-Pathology, & Centre for Epidemiology and Community Medicine, Stockholm County Council Health Services, SE171 77, Stockholm, Sweden;Reykjavík University, Menntavegur 1, IS101, Reykjavik, Iceland;University of Iceland, Saemundargata 2, IS101, Reykjavik, Iceland;National University Hospital, Eiriksgata 29, IS101, Reykjavik, Iceland;Reykjavík University, Menntavegur 1, IS101, Reykjavik, Iceland;

关键词: Death;    Terminal care;    Communication;    Evocation;    Gender;   

DOI  :  10.1186/1472-684X-13-8

 received in 2013-10-08, accepted in 2014-02-25,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundAccording to common practice based on a generally agreed interpretation of Icelandic law on the rights of patients, health care professionals cannot discuss prognosis and treatment with a patient’s family without that patient’s consent. This limitation poses ethical problems, because research has shown that, in the absence of insight and communication regarding a patient’s impending death, patient’s significant others may subsequently experience long-term psychological distress. It is also reportedly important for most dying patients to know that health care personnel are comfortable with talking about death and dying. There is only very limited information concerning gender differences regarding death talk in terminal care patients.MethodsThis is a retrospective analysis of detailed prospective “field notes” from chaplain interviews of all patients aged 30–75 years receiving palliative care and/or with DNR (do not resuscitate) written on their charts who requested an interview with a hospital chaplain during a period of 3 years. After all study patients had died, these notes were analyzed to assess the prevalence of patient-initiated discussions regarding their own impending death and whether non-provocative evocation-type interventions had facilitated such communication.ResultsDuring the 3-year study period, 195 interviews (114 men, 81 women) were conducted. According to the field notes, 80% of women and 30% of men initiated death talk within the planned 30-minute interviews. After evoking interventions, 59% (67/114) of men and 91% (74/81) of women engaged in death talk. Even with these interventions, at the end of the first interview gender differences were still statistically significant (p = 0.001). By the end of the second interview gender difference was less, but still statistically significant (p = 0.001).ConclusionsGender differences in terminal care communication may be radically reduced by using simple evocation methods that are relatively unpretentious, but require considerable clinical training.Men in terminal care are more reluctant than women to enter into discussion regarding their own impending death in clinical settings. Intervention based on non-provocative evocation methods may increase death talk in both genders, the relative increase being higher for men.

【 授权许可】

CC BY   
© Skulason et al.; licensee BioMed Central Ltd. 2014