1. 2015-2016 UAB Geriatric Education Center Faculty Scholars Program End of Life Conversations November 6, 2015 Patricia Sawyer, PhD

2. 2 “It’s always too early, until it’s too late.” The Conversation Project, 2013

3. 3 Neurology Now: August/September 2015 - Volume 11 - Issue 4 - p 28–33

4. 4 Consider... 60% say “making sure their family is not burdened by tough decisions is “extremely important” 56% have not communicated their end of life wishes 82% say it’s “important to put their wishes in writing” 23% have actually done it 80% say that if “seriously ill, they would want to talk to their doctor about end of life care 7% said they had had an end of life conversation with their doctor California Health Care Foundation 2012

5. 5 Who, what, when, where, why When to have conversations General – early adulthood Later adulthood before crisis Facing a potentially terminal situation Why so difficult Cultural Considerations Who to include Ways to begin the conversation

6. 6 IOM “Life-cycle model of advance care planning” Milestones in life when an individual experiences either a change in personal risk and/or a major shift in responsibility Logical junctures when risks are mostly minimal Initial driver’s license, leaving for college, joining the military, getting married, becoming a parent, etc.

7. 7 IOM “Life-cycle model of advance care planning” At the diagnosis of any chronic illnesses or genetic conditions. At various turning points of a disease Final year of expected life. https://iom.nationalacademies.org/~/media/Files/Report% 20Files/2014/EOL/Report%20Brief.pdf

8. 8 Keep the Conversation Going From Let’s Talk http://www.n4a.org/files/Conversations.pdf

9. 9 Cultural Considerations (1) American norm reflects a lack of acceptance of one’s own mortality “Public’s expectation of a life that can be extended by extraordinary medical measures has been equally matched by a health care system that regards death as a failure” https://platform.atavist.com/view/excelsiorcollege/newconversationsaboutendoflife

10. 10 Cultural Considerations (2) Personal identity of patient and people around him/her Relationships between them Relative value and power of people in the care environment Rituals and Symbols Values that give meaning to life, and which may also give meaning to suffering and death http://www.uwmedicine.org/uw-medical-center/documents/Cultural-Issues- around-End-of-Life.pdf

11. 11 Cultural Considerations (3) Related to EOL, Studies show cultural differences in Truth telling Life-prolonging technology Decision-making styles End-of-life experiences, beliefs, and expectations are linked to cultural values https://www.osteopathic.org/.../Cultural-Traditions-in-the-EOL cf Tellez-Giron, 2007

12. 12 Cultural Considerations (4) http://www.honoringchoices.org/