Tag: listening

EOLPodcast

Ep. 517 Lessons the Dying Teach Us About Living with Diane Button

kwyattmd

Learn about a heartwarming book of end-of-life teaching stories about the “little things” that make life meaningful.

My guest Diane Button is an end-of-life doula, a founding partner of the Bay Area End-of-Life Doula Alliance in Northern California, and an instructor for the University of Vermont’s End-of-Life Doula Professional Certificate Program. She has been a NEDA board member and a hospice volunteer and is the author of the newly published book What Matters Most: Lessons the Dying Teach Us About Living. She discusses the book and the importance of storytelling and legacy projects. Learn more at her website:

dianebutton.com

Get the book here

Watch on YouTube

Listen here:

This episode includes:

  • What inspired Diane to write this book
  • Why storytelling is important as we help our society become more death aware
  • The Joy Counter and other stories from the book
  • The value of “the little things” of life to help us create meaning
  • Why legacy projects are helpful as we approach the end of life
  • How Diane helps people create their own legacy projects
  • What is the “Final Checklist”
  • Who can benefit from reading this book
  • How this work has impacted Diane’s life

Links mentioned in this episode:

If you enjoy this content please share it with others and consider leaving a review on iTunes. Thanks again to all supporters on my page at Patreon.com/eolu and thank you to everyone who bought me a coffee or made a donation on Paypal! Your contributions make all the difference and ensure this podcast stays ad-free.

EOLU Blog

What to Do When a Loved One Refuses Hospice Care

kwyattmd

by Karen Wyatt MD

When it was time for Doris, an 85-year old woman with biliary cancer, to be discharged from the hospital, her physician suggested to her and her family that she be admitted to hospice care. But Doris refused hospice care even though her family members strongly supported the doctor’s advice.

It’s not unusual for a patient to have concerns about signing on to a hospice for care and for families to get caught up in a struggle as they try to find the best care possible for their loved one. There are many reasons a patient like Doris might say no to hospice and it’s important for care providers and family members to try to understand her feelings. Here are some steps to take if you find yourself dealing with a loved one who refuses hospice care:

Listen without judgment.

Begin by calmly listening to whatever the patient needs to say. Don’t argue or try to persuade her to change her mind—just listen to see what you can learn about her feelings.

Ask why she is not comfortable with hospice.

If she hasn’t told you yet her reasons for saying no, ask her why. But again, don’t argue with her reasoning. Careful listening will help you understand her better and get a glimpse of how she views end-of-life care. She may have misconceptions about hospice or she may have had a traumatic experience with death in the past. Provide her with a safe space to express her feelings even if you don’t agree with them.

Validate her emotions.

Let her know that you understand why a decision to begin hospice care can be frightening and overwhelming. Don’t push or rush her to choose hospice but agree that she has the right to turn it down.

Gently provide reassuring facts.

Once you understand where her resistance is coming from you can gradually begin to provide additional factual information about hospice. Again, don’t argue—just mention some of the details about hospice and how it functions as a way of answering her fears. For example, many people fear that accepting hospice care means that death will come more quickly. In this situation you might explain that a study has shown that patients who receive hospice care actually live longer than patients with an identical diagnosis who do not receive hospice care.

Arrange for her to meet someone from hospice.

Invite a hospice staffer to meet her and answer questions. Connecting with a real person who represents the hospice team can go a long way toward reassuring the patient that hospice care is provided with compassion and empathy as well as expertise. During that face-to-face meeting you can bring up some of your loved one’s questions to show her that you are on her side and share her concerns.

Respect her wishes.

Let your loved one know that she has control over her own decisions and that you will honor her choices. She needs to feel supported or her resistance to hospice might increase if family members apply too much pressure.

Offer alternatives.

If palliative care is available in your area see if she might agree to accept that rather than hospice, since she will be able to continue curative treatments while receiving palliative care. Some patients may also agree to be admitted briefly to a home care service for evaluation of their potential for improvement. This temporary measure could buy some time while your loved one adjusts to the idea of hospice care.

Ultimately no one should be pressured into receiving hospice care if it doesn’t meet her preferences. But most patients who initially refuse care from hospice end up agreeing to it eventually and feeling good about their choice. We must allow patients the freedom to choose their own course with whatever timing is best for them. Showing respect for their right to make decisions for themselves is an important step to help patients embrace their own individual end-of-life process.

EOLPodcast

Ep. 424 Implicit Bias in End-of-Life Care with Kimberly Curseen MD

kwyattmd

Learn why cultural humility and awareness of hidden bias are essential in reducing racial disparities in care at the end of life.

My guest Dr. Kimberly Curseen is board-certified in Internal Medicine, Geriatrics and Palliative Care. She is the director of Supportive and Palliative Care Outpatient Services for Emory Healthcare and helps provide physical, emotional, and spiritual care for patients with cancer at any point in their disease process. She has helped educate physicians on implicit bias in healthcare and has written research articles for the Journal of Palliative Medicine and the Journal of Pain Symptom Management on structural racism and bias in palliative care. We discuss specific issues leading to racial inequities in healthcare and what we need to do to make changes and improve care at the end of life. Learn more about Dr. Curseen’s work:

med.emory.edu

Follow Dr. Curseen

Watch on YouTube

Listen here:

This episode includes:

  • How Dr. Curseen became interested in hospice and palliative medicine
  • What is “implicit bias” and how we can recognize it
  • Her work in rural Arkansas to educate community members and healthcare providers on implicit bias
  • Why we need “cultural humility” along with cultural competency training
  • How implicit stereotypes and biases contribute to racial inequities in healthcare
  • The current problem of racial disparities in pain management
  • Why improving racial disparities in advance care planning and hospice utilization must begin with our own personal work on hidden biases
  • How end-of-life care providers can develop cultural humility and a person-centered approach in their work
  • Why we need to change what we offer in end-of-life care to fit the patients that need care, rather than trying to force patients to fit into our existing model

Links mentioned in this episode:

If you enjoy this content please share it with others and consider leaving a review on iTunes. Thanks again to all supporters on my page at Patreon.com/eolu especially my newest donors Lacy Buynak and Grace Lawrence and to Robin Blanche and Sandy Jane Stacy for increasing your pledge.Thank you to my newest donors on PayPal Erin Collins, Debora Schauss, Kathleen Lynch, and Janice Wildrick! Also many thanks to Ann Hyland and Jerry for buying me coffees! Your contributions make all the difference and ensure this podcast stays ad-free.

EOLU Blog

Don’t Focus on Regrets at the End of Life

kwyattmd

Why it’s not helpful to ask dying people what they regret about their lives and what to do instead.

“Don’t waste your time in anger, regrets, worries, and grudges. Life is too short to be unhappy.” 

Roy T. Bennett

For some reason there’s been a buzz in the last few years about finding out what people on their deathbeds regret most about their lives. We hear this often: “they regret what they didn’t do more than things they did.” That’s fine to say and tends to be good advice for those of us who aren’t facing our last days. We can learn from their mistakes and pledge to live our own lives differently from now on.

In fact, research on regret as an emotional state has shown that it may be helpful for young people as a reminder to reconsider their current path and make better choices for the future. But when regret occurs in situations where there is no chance to change the current circumstances or make things better, it can cause chronic stress and do both physical and emotional harm. Individuals who feel they have no path forward can experience guilt, self-blame, disappointment and depression as a result of spending their time focusing on their regrets.

Regret sells

However as a society we are drawn to learning about the regrets of other people because we fear making mistakes or missing out on opportunities. We are eager to benefit from someone else’s suffering if it means we can avoid the same path for ourselves. Advertisers rely on our fears by using regret as a motivator to sell products, such as “this person didn’t buy from us and paid more money for worse service.” We don’t want to be the foolish person who regrets their choice so we pay attention to messages like that and we buy products, books and courses that teach us how to avoid these costly mistakes.

Not helpful at the end

There’s nothing really wrong with this tactic except when it applies to people who are nearing the end of life. Because they may not have time to repair the past or forge a new direction in the future, they have no opportunity to truly learn from their regrets. Placing their attention on the mistakes of their lives may lead them to despair and a feeling of worthlessness as they prepare for the end, especially if you are unable to guide them beyond their self-blame.

Do this instead

Instead of asking “what regrets do you have from the past” we would be better advised to ask “what are you grateful for in your life” or even “are there things left undone that you would still like to address.” If the person wants to talk about regrets it’s fine to go there, but it’s not helpful to introduce the topic to them if they’re not already thinking about it. Viewing life as a series of mistakes or regretful events is painful and creates a spiral of negativity. But we can help people avoid that downward spiral and lessen their distress by asking better questions.

Listen and find meaning

People at the end of life generally benefit greatly from doing a life review and being able to tell their stories in a safe setting. The art of being a good listener includes helping them find meaning, connection and resolution through their own stories without judgment or shame. To truly help a person find peace at the end of life focus on forgiveness, gratitude for what life has offered, self-compassion and letting go of self-blame. But don’t ask about regrets unless you know you can lead them out of that dark place to a higher, more healing perspective.

End of Life, EOLPodcast, Spirituality

Ep. 225 How to Make Difficult Times Better as a Death-Aware Person

kwyattmd

Learn what it takes to bring your compassionate presence more fully to others in challenging circumstances.

In this solo episode I discuss how to be a person who makes every situation better simply by being there. Scientific studies have shown that by cultivating greater coherence in the heart’s energy field we can make a positive impact on the people around us who are going through difficulties. I share some tasks to focus on to help develop your own ability to be fully present with a compassionate heart for the good of everyone in our society.

Listen here:

This episode includes:

  • The heart’s electromagnetic field is the most powerful in the body according to the HeartMath Institute
  • Coherence occurs when there is harmony between body, mind, spirit, and emotions
  • Coherent energy from one person helps create calmer energy for other people
  • End-of-life workers can make a big difference for patients and families by increasing the coherence of their own heart energy
  • 5 tasks to make difficult times better:
    • Be willing to show up when things fall apart
    • Be a safe container
    • Be a deep listener
    • Be a truth-teller
    • Be a way-shower

Heart coherence serves as a facilitator, adding strength and effectiveness to your care, compassion, intentions and actions to help the world.

Heartmath Institute

Links mentioned in this episode:

If you enjoy this content please share it with others and consider leaving a review on iTunes! Thanks again to all supporters on my page at Patreon.com/eolu, especially my newest Patrons: Raquel Wiltbank-Mateo and Karen Coupe; your contributions make all the difference!

End of Life, EOLPodcast, Hospice, Spirituality

Ep. 82: How to Provide Spiritual Care for the “Non-Spiritual” Patient

kwyattmd

What can you do when a hospice patient refuses spiritual care? Here’s how to meet the need for a spiritual approach to dying for every patient.

PodcastSpiritual

Wyatt18smallIn this episode I’ll share the story of a hospice patient who refused spiritual care because he was a non-believer and how we discovered what really mattered to him at the end of life.

 

ANNOUNCEMENT:

The online course Step-by-Step Roadmap for End-of-Life Planning is still available. Learn more about it at www.eoluniversity.com/roadmap.

supportonpatreon-e1412764908776You can help support this podcast and the End-of-Life University Interview Series by making a small monthly donation at www.Patreon.com/eolu. To thank you for your donation I’ll promote your end-of-life related website, business, or organization on this podcast. Thank you to all of our current patrons – you make this podcast possible!

SPIRITUAL CARE FOR NON-SPIRITUAL PATIENTS:

This episode was inspired by my recent attendance at the Accompanying the Dying Residential Retreat hosted by Deanna Cochran of Quality of Life Care and led by Kirsten DeLeo and Dr. Ann Allegre of the Spiritual Care Program. This retreat provided a deep dive into the task of providing spiritual care to our patients at the end of life and offered an amazing opportunity to explore our own depths of spiritual practice and presence.

In my work in hospice I have long thought about those patients who refuse all spiritual care because they are “not religious” or just not interested. But everyone has a spiritual aspect, whether or not they are aware of it or develop that part of themselves. And every dying patient is entitled to receive the presence and compassion of a spiritual care provider. But how can this care be offered without offending or intruding upon the patient’s own beliefs?

Theologian Paul Tillich has defined spirituality as one’s “ultimate concern” meaning that whatever really matters to a person at the very end of life is the expression of that person’s spiritual nature. So for some individuals the ultimate concern might be a religion or a particular practice, but for others it could be anything … even baseball.

In this episode I tell the story of a hospice patient whose “ultimate concern” was baseball and how we eventually recognized that instead of trying to get him to talk about the meaning of life or his regrets, we just needed to let him talk about baseball. Listening to his stories about his favorite team was the path that ultimately helped him heal some of old regrets and unfinished business.

This story illustrates the need for the following conditions whenever we provide spiritual care to a patient who doesn’t identify as having spiritual needs:

  • Listen. The importance of allowing the patient to talk about the topics of his or her choice cannot be over emphasized. Deep listening with a compassionate heart is essential for honoring the perspective of the patient.
  • Discover the “ultimate concern.” When patients are allowed to guide the conversation they will naturally reveal what really matters to them.
  • Honor the patient’s wisdom and experience. Listen with reverence as the patient talks about his or her values and priorities. Recognize what is sacred to the patient even if it seems ordinary to you.
  • Connect patients to their own feelings of peace and joy. The “ultimate concern” is usually the source of positive feelings and experiences for patients. Help them recall those moments of being connected with something greater by listening to stories or guiding them to re-imagine a previous happy occasion.

In the podcast you will hear how Warren’s story came to a close as an example of finding a path to healing by going through the ultimate concern of baseball. Enjoy listening!

Remember to tune in every Monday for a new episode. Until then:

Face Your Fears.               BE Ready.                   Love Your Life.

karen-signature