Talking about dying

Talking intimately about a person’s death is a poignant conversation. The intensity of this is reduced by locating the discussion within a review of the goals of care and inviting consideration of natural forms of dying. A sequence of well-rehearsed strategies informed by patient-centredness and compassionate support serves the effective accomplishment of this task. Family support is an important related task, often calling for a family meeting to optimize outcomes. Withdrawal of life-prolonging therapies, handling requests for hastened death or futile care, and responding to misunderstanding and family conflict are common predicaments. The use of educational videos about end-of-life decision-making has improved understanding. Clinicians need to be able to comfortably discuss any potential mode of dying and assure the patient and their family of their continuing and committed care. Communication skills training with simulated patients helps optimize the ease with which clinicians can talk about death and dying.