Talking Points

CUREFall 2007
Volume 6
Issue 5

Caregivers can encourage the patient to take an active role in decision making at the end of life with these six suggestions.

Caregivers can encourage the patient to take an active role in decision making at the end of life, but you have to know the limits of the patient. “By and large I don’t break into people’s denial,” says psychiatrist Jimmie Holland, MD, of Memorial Sloan-Kettering Cancer Center. “If they don’t want to talk about it, I respect it.”

If a patient is up for discussion, here are some of the subjects you might want to broach.

The will, power of attorney, and related matters. When a patient isn’t eager to discuss an urgent matter, Dr. Holland recommends this opening: “As much as we don’t like to, we all need to have plans made, so let’s talk about it.” Many of the documents you’ll need can be found at, a website run by the National Hospice and Palliative Care Organization.

Stories you want to hear. Instead of asking the patient about his or her current state of mind, ask for stories from their life when they were going through a time when they were fearful or under great pressure. Then ask them what helped them cope during that experience.

Hospice care. Hospice offers end-of-life medical care, including symptom relief and emotional support. Find details on the Hospice Foundation of America’s website at

Funeral plans. Led Zeppelin was blasting at Steve Neifert’s funeral. That’s what he told his wife he wanted, and Joyce was glad she could oblige.

A last letter/videotape/audiotape. Some dying people like to leave something concrete for family members: a message to a son on his wedding day or to a daughter on her high school graduation.

Last wishes. You can ask or the patient might just volunteer them, from a day at Disneyland to a trip to their hometown to die. But the caregiver isn’t a fairy godmother: The fact is that not every wish can be fulfilled.