Talking about end-of-life during what should be the happiest time of the year may seem like a hyper-specific topic of conversation, but studies have shown that adults have a greater chance of dying during the holidays, including adults with cancer.1 Coping with the death of a loved one is often most difficult this time of year, and although it has been written about extensively, it can be underdiscussed.
Before discussing counseling methods, I want to quickly address a key to preventing death during this particular time: Reduce barriers to care. No one really knows why deaths spike during the holidays, but a leading theory is that people in need of medical attention will put off seeking medical care in favor of spending time with their loved ones.1 In regards to hospice care, any changes in schedule due to the holidays should be relayed to patients and their caregiver(s) as early as possible. Patients tend to be more comfortable disclosing medical information to providers they trust.2 If you care for a patient with cancer who is not receiving services in the home, encourage your patient to seek necessary medical care at any time it is needed, even if it’s during holiday activities.
Consoling the Patient
End-of-life is a very challenging time for the person who is ill, and also for the person’s loved ones. The patient may be experiencing feelings of regret, sadness, and anger, and questioning his/her spiritual beliefs. Conversations can oftentimes feel uncomfortable both for loved ones and for the patient. Nurses are well positioned to help open this discussion and to role model how it can play out with loved ones. Not uncommonly, patients use tester questions or statements to see if their loved ones are open to engage. As a nurse, if you are asked to weigh in on an end-of-life concern, responding compassionately will facilitate a more in-depth and honest conversation.
Religion is talked about more often around the holidays, with 95% of Americans celebrating at least one holiday in December.3 Although holiday celebrations often appear to have less emphasis on religion than in the past, the end-of-life process tends to lead the dying person to examine these beliefs more carefully in a search for meaning.4 The most important thing a member of the health care team can do in these moments is to be respectful, honest, and engaged.5 There is no right or wrong thing to say to someone who is at the end of his/her life so long as you show genuine interest in what they have to say.
Patients may be concerned about burdening others. This feeling is heightened during a time meant to be celebratory and may lead to additional remorse. Your intervention at this moment, however long or short, can foster difficult discussions with family without having a negative impact on the hopefulness of the season. Giving a patient the space to be heard in a way that won’t invoke these myriad feelings is often very significant for the patient with the potential for healing across the family system.