Talking About Dying

For patient you probably won’t see again, because they are dying, consider saying something to acknowledge the situation. It can be unexpectedly rewarding. Adapted from our paper in Annals.

Step	What you say
1. Choose an appropriate time & place	“I think we’ve covered everything today, and there is one more thing I wanted to say.”
2. Acknowledge the end of your routine contact	“Let’s make an appointment in 2 weeks, but if it is too hard to come to clinic, give us a call.”
3. Invite the patient to respond	“How does that sound?” This gives the patient a chance to weigh in, and enables you to assess their frame of mind.
4. Frame your goodbye as an appreciation	“If I don’t happen to see you in person again, I want to make sure that you know I’ve enjoyed working with you. I’ve admired your spirit.” Or “I’ll miss not seeing you in clinic, and hearing about your life.”
5. Allow space for the patient to reciprocate, and respond empathically	If the patient thanks you, be sure to say “You’re welcome.” Don’t say it was nothing—that could inadvertently diminish the work you have both done. “I realize this might seem awkward, but I wanted to make sure you knew how I felt.”
6. Articulate your commitment to the patient’s ongoing care	“Of course I am still available by phone.” “Your hospice nurse will be keeping me in the loop.”
7. Take a moment to reflect	Some clinicians think of this as a gratitude practice—where you stop to take in something that you appreciate.
	Copyright VitalTalk 2019