living your best to the end

Comfort: How important is it to you at life’s end?

For many – perhaps most – suffering is the biggest worry about life’s end. Suffering doesn’t start and end with pain management. It includes peace of mind and comfort – both of which are highly individual, and can hold the keys to perception of and requirements for a ‘good death’: What comforts you, or what brings you comfort? What are your small pleasures, or what gives you pleasure?  What brings you peace of mind? Comfort and feeling good about herself is the gift a palliative doctor gave to a terminally ill patient who wanted no further medical treatment. He simply asked: “What would make this a good day for you?” “If I could sing” The patient, Dolly Baker (nee Thelma Botelho), was once a renowned songstress.  And sing she did. I have sat in countless meetings, workshops, think tanks, round-tables where everything but the word, comfort is used to help us on the way to as good a death as possible. Amongst the questions commonly asked: What are your values? What are your beliefs? What’s important to you? What are your goals of care? These may may all play into what makes us feel good,  and brings comfort, but these approaches often then require further probing and questioning which takes so much more of that precious thing that’s often in short supply: health care professionals time. Revealing answers, reveal simple solutions Answers about comfort reveal solutions that: often have nothing to do with medical interventions; can bring comfort and joy to attending healthcare professionals; can help family and friends support more purposefully and meaningfully; As a ‘layperson’ whose focus...

BestEndings Chat: end-of-life discussion video’d

Inaugural BestEndings Chat topic: Why is it so hard to talk about dying.   Insights, Revelations. Confessions and Spirited Debate amongst 6 friends from diverse backgrounds. Together, we represented Hindu, Athiest, Christian, North American Catholic, Mexican Catholic and Muslim. Left to right: Mike, Sudhir, Ruth, Kathy, Colleen, Gina, Majid Mike Houlahan, Healthcare Executive; Sudhir and Ruth Handa, Businessman, Colleen Young, plain language writer and founder of Canada’s national tweet chat for healthcare and social media: #hcsmca, Gina Camacho Ibarra and Majid web developers, BestEndings. The video will be uploaded soon, but in advance – a taste of what’s to come (funny bits saved for the video) Mike: I’m involved in healthcare, I’m engaged with BestEndings and still – when my father had a health scare, I was too scared to talk to him. Sudhir: I guess because of my upbringing, I am not afraid of dying – I just want to be fully prepared. Ruth: I don’t think you can say any one religion offers more comfort than another. Gina: In Mexico, we celebrate death: we visit our relatives and have Day of the Dead. Majid: I love talking to you every day: it’s a great opportunity to talk about living – that’s really what you’re talking about. Colleen: So often, when someone is ‘going’ you want to do something. My mother’s given me something to do in the event she can’t speak: she’s asked me to read to her. I feel very comforted by...

Communicating Prognosis at the End of Life

How to tell patients they’re likely to die Health care professionals often have difficulty facilitating hope and coping strategies when managing end-of-life issues.  Advising a limited life expectancy has an obvious impact on the patients, caregivers and their networks ability to remain optimistic. To overcome this health care professionals can offer to answer questions, discuss promising new treatments, treat the patient as a “whole person”, discuss the limitations of end-of-life estimates, present information about palliative care and advice on other alternative treatments. Often this information will need to be staggered to avoid overwhelming the patient. If a patient’s health is deteriorating a time will come in which discussing death and dying becomes important. In the terminal phase the patient and their caregivers may hold unnecessary or misplaced misconceptions about the process of dying. This discussion can do much to alleviate anxiety. Patients’ information needs differ with context, prognostic stage and distribution rates. Though most patients will prefer being kept highly informed and appraised of treatment options this need will differ in relation to the context of their own health and their stage in the prognostic cycle. Further, whilst some patients may prefer an “all-at-once” approach to information, others will prefer it to be dispersed across a series of touch points in a more “piecemeal” approach. Discussing prognosis and end-of-life issues has been identified as an important component of care by patients with progressive life-limiting illnesses, and their families.1,2 Being adequately informed is essential for such patients and their caregivers to participate in decisions about their treatment and care, to set goals and priorities, and to prepare for death. Clinicians...