1. Talking about death: Living life to the fullest Lucia D. Wocial, PhD, RN Woltman Inter-professional Communication Scholars Program IU School of Nursing

2. Objectives Identify barriers to having conversations about end-of-life planning. Demonstrate essential skills for initiating and participating in discussions about of end-of-life planning. Identify resources for clients to assist them in having these conversations with the important people in their lives. Discuss why having these conversations matters. 2

3. A Tale of Two Parents 3

4. What keeps us from talking? 4

5. Death: What we wish it could be 5

6. Death: How it is 6

7. <50 % of the severely or terminally ill patients have an AD in the medical record. Only 12 % of patients received input from their physician in its development. Low rates of AD 7

8. Between 65 and 76 % of physicians whose patients had an advance directive were not aware that it existed. Until fairly recently, conversations about end of life planning was not part of training for physicians. Inadequate training 8

9. General public predicts 54% survival to discharge for in-hospital CPR Overall, survival for victims of cardiac arrest to hospital discharge has been estimated between 0% and 10%. Marco & Larkin, 2008 Enamored with technology 9

10. Talk about what people need to know, not just what they want to hear 10

11. Why conversations matter 11

13. The Four Things That Matter Most Please forgive me. I forgive you. Thank you. I love you. The Four Things That Matter Most A Book About Living by Ira Byock, M. D. 7/2/201513

14. identify values choose surrogates wisely decide whether to grant flexibility inform others of your wishes McMahan, Knight, Fried, and Sudore, 2013 Beyond Advance Directives 14

15. Patients who had advance planning discussions with their physicians continued to discuss and talk about these concerns with their families. Such discussions enabled patients and families to reconcile their differences about end-of-life care. AHRQ Report Patients value discussions 15

17. You have a good chance at recovery. 30% Six months in a skilled nursing facility Will not return to independent living What would you want? 17

18. 7/2/201518 http://www.nhdd.org/

19. Imagine… 19 An Opportunity

20. The Question “Have you and your loved ones ever talked about what you would want if things don’t go the way you hope?”

21. L L earn about your options, choices and decisions I I mplement your advance directive plans V V oice your end-of-life wishes E E ngage others to talk about their wishes It is about LIVING 21

22. The Other Objective Change the way you talk to your clients. Make time for these conversations, personally and professionally. Enthusiastically assist clients when they want to discuss advance care planning.

23. Motivation 2.5 million people die each year. 80% who die in hospitals have no decision making capacity. >30 % of these patients are on life support. Decision making falls to surrogates, usually family members.

24. 24 Karen Ann Quinlan Nancy Beth Cruzan Terri Schiavo

25. The New Culture 25

26. If people think you care they will trust you This is the most caring conversation you will have It cannot be the last slide in your presentation Reframing your challenge 26

27. 27 You matter because you are and you matter to the last moment of your life Cicely Saunders