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CBecause death is inevitable does not make talking about it easy or natural. In a new study, researchers asked whether hospice workers — experts in end-of-life care — have lessons to teach the rest of us when it comes to talking with patients and their families about death.
Daniel Menchik, an associate professor of sociology at the University of Arizona who studies language use in various fields of medicine, spent eight months attending team meetings at a nursing facility that was also open to patients’ families. His goal was to study how both groups talked to each other about the patient’s impending death. His findings will be published in the journal Social sciences and medicineReinforce the importance of framing death as a process rather than an outcome when caring for frightened patients and loved ones. It’s a useful strategy he says everyone can use when facing loss.
“People don’t die until they die,” Menchik says. “And even then, they may not be experienced in this way by the people they associate with, especially if they have had a good time with that person.”
In the study, Menchik observed that nursing home workers used three different types of verbs in meetings with family members: predictive, subjunctive, and imperative. Predictive verbs are used to emphasize things about the future and include words like “will” and “going to.” Imperative verbs carry a similar fixity, but include a call to action; The most common thing Menchik encounters in medical settings is “should.” Modal verbs convey a kind of personal attitude when talking about the future. “Think,” “I feel,” “I want,” and many other expressive expressions fall into this category.
When a family begins caring for the elderly, “their ability to engage in intense conversations decreases.” [about death] “It’s usually very limited,” Menchik says. But he believes nursing home workers are helping to bridge this gap by reducing their use of imperative verbs. In the meetings he observed, imperative verbs made up only 17% of the verb phrases used by elder care professionals. This is somewhat uncommon in medicine. Menchik has also looked at how surgeons talk—an area in which questions about treatment courses and disease progression require quick, decisive answers—and found that they use imperative verbs more often, likely as a way to show that they are in control of outcomes.
The top priority in the hospice is emotional management. “With the language they use, they are there as guides, not as authorities,” says Dr. Maya Giaquinta, a pediatric resident at the Medical College of Wisconsin who worked with Menchik on the research. Speaking in their own capacity and not on behalf of the school). Using more predictive and conditional verbs allows hospice care professionals to direct care around current emotional needs, rather than future events.
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While predictive verbs were used most often in the meetings observed by Menchik and Giaquinta, at least half of the most frequently used verbs were words conveying uncertainty, such as “could,” “might,” and “might.” The researchers found that by refusing to talk about future events as defined, they were more able to redirect conversations to the present moment and focus on anxiety and emotions.
Hospice workers are not taught about care at the syntactic level in training, at least not explicitly, says Dr. Robert Gramling, MD, chief of palliative medicine at the University of Vermont, who was not involved in the study. He says research that describes and quantifies the skills experts acquire over time could be valuable for expanding the ability of the general public to think and talk about death.
Gramling has studied end-of-life conversations, which he says require “careful thought about the words we use and how they reach other people.” When you talk to a family or patient facing death, ask yourself: “Do I refer to this person as dying? Or do I refer to this person as alive?” suggests Gramling. Such thinking grounds the conversation firmly in the present. Another question to consider about your wording: “Is this framed in the language of the person experiencing it, or is it really my view of things?” In nursing homes, where patients face only one outcome, speaking compassionately and compassionately along the way to it is one thing people have control over.
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Discussing death and end-of-life care can be a difficult and uncomfortable topic for many people. However, using hospice language can help us become more comfortable and skilled at having these conversations. By familiarizing ourselves with this specialized language, we can better understand and navigate the complexities of end-of-life care, and provide more compassionate and effective support for those facing the end of their lives. In this way, hospice language can play a crucial role in improving our ability to discuss and cope with death and dying.