1. What On Earth Do I Say by Sue Spencer
Talk about the book
Morphed into a finer existence

2. Palliative Care
Palliative care is the active holistic total care of patients whose disease is not responsive to curative treatment.
Palliative care aims to:
Offer a support system to help both the family and patient cope during the patient’s illness and in their own bereavement by providing:
Relief from pain and other distressing symptoms.
Psychological support
Social support
Spiritual support
Affirm their life and regard death as a normal process.
Not just cancer, Parkins disease, MND MS, heart failure, COPD

4. Establishes a team comprising of the dying person, family, friends, volunteers, religious leaders and health care professionals who communicate with one another irrespective of the place of care.
Home, hospital or hospice, Care Home

5. There are over 200 Euphemisms for the word death
Kicked the bucket
Popped their clogs
Pegged it
Turned up their toes
Fallen off their perch
Given up the ghost
Pushing up daisies
Deceased
Departed, Passed away
Gone to a better place, six feet under, Brown Bread
. Death denying society, don’t talk about it and it won’t happen

6. Visiting The Dying An important role Share concerns or fears
Be sensitive
Be flexible
Dying can be a lonely and isolating experience
The gift we can bring is friendship, making them feel valued, wanting to validate their lives.
Share concerns, worries that they can’t with family or friends, be a mediator :
Fatigue can be a problem, finding it hard to concentrate. Give them the permission to ask you to leave:
Don’t go with a set agenda, let them set it. Be a good listener.
My first patient in Dartmouth

7. Levels of Conversation
External environment/outside world Knowledge Thoughts and feelings Hopes and desires Meaning
Weather etc
What you know about them or find out about family etc
What are their thoughts or feelings
never take hope or desires away, explore with them
Never promote false hope
What does their life mean to them, Validation? Most popular topic of conversation
of their life

8. Listening Skills Listening is a skill
Try and create a listening environment
Body language
Touch
Silence
Listen for cues
That can be learnt
Practise listening sensitively and pastorally.
In the right environment they will say things that they haven’t said before. If truly listening they will trust you: Turn the TV off.
Being in their own home puts them in charge, more likely to open up. Talk about seeing Drs etc.
Relaxed body, eye contact, smile,
Touch is important communicates that you are listening and that you care
Silence is a very important tool,

9. We miss the cues that patients give us

10. Communicating With The Dying
Starting a difficult discussion:
Being asked difficult questions or saying the “right” or “wrong” thing
Upsetting patients/relatives
Exploring concerns
These are a list of concerns that you may have. Anxious about visiting, what to say etc. I could introduce myself by saying what I was there for, harder for you.
Start with the weather etc. Flowers on the table, photograph
Don’t worry about the difficult questions, there isn’t always an answer, John’s challenge.
You may have upset them because they have had to face the truth. Lots of tears.
Door step

11. Blocking Questions Questions that only require a yes or no answer
Multiple questions
Leading questions
Jollying along
Normalising
Don’t fill silences
Silence is a very important tool

12. “Is there anything you want us/me to know?”
Questions
“What would you like to talk about?”
“How do you feel about your situation at the moment?”
“I know these are difficult things to talk about”
“How do you feel you’re progressing?”
“What do you hope for in the next few weeks?”
“Is there anything you want us/me to know?”

13. Spiritual Distress Why me, what I have done to deserve this?
Am I going to die?
Is there a God and does he care about me?
How will I be remembered?
Do you believe in life after death?
My husband wasn’t a Christian, will I see him again?
Not going to answer the questions for you, but be aware that this can cause Spiritual pain which can cause physical pain

14. Reflective Questions/Clarification Closing
“Can I just check that I have understood what you have just said?”
“How you are feeling?
“What is upsetting you?”
“It sounds like….”
Acknowledge that this conversation has been difficult.
Offer to return
Touch them as you leave
Check their facial expression.
You may not have the answers for them but just talking about their problems helps. Touch very powerful but do be careful

15. “ “I Would rather make mistakes in kindness and compassion than work miracles in unkindness and hardness” Mother Teresa, A Gift For God: Prayers for Meditation (San Francisco, Harper 1996)
How we are with the dying person is as important if not more important than what we say. I still made mistakes.
Visit with Treena

16. Holding Cross
Giving a gift such as a prayer card or holding cross The use of a wooden Holding cross, deliberately uneven in order to fit in the hand between the fingers.

18. www.dyingmatters.org www.ncpc.org.uk

19. Remember
“You matter because you are you. You matter to the last moment of your life.”