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Open Access Highly Accessed Research article

Death talk: gender differences in talking about one’s own impending death

Bragi Skulason127*, Arna Hauksdottir345, Kozma Ahcic6 and Asgeir R Helgason67

Author Affiliations

1 University of Iceland, Saemundargata 2, Reykjavik IS101, Iceland

2 National University Hospital, Eiriksgata 29, Reykjavik IS101, Iceland

3 Centre of Public Health Sciences, University of Iceland, Saemundargata 2, Reykjavik IS101, Iceland

4 Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Vasagatan 33, 411 37 Gothenburg, Sweden

5 Sahlgrenska University Hospital SE, Per dubbsgatan 16, 413 45 Gothenburg, Sweden

6 Karolinska Institute, Departments of Public Health Sciences and Oncology-Pathology, & Centre for Epidemiology and Community Medicine, Stockholm County Council Health Services, Stockholm SE171 77, Sweden

7 Reykjavík University, Menntavegur 1, Reykjavik IS101, Iceland

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BMC Palliative Care 2014, 13:8  doi:10.1186/1472-684X-13-8

Published: 11 March 2014

Abstract

Background

According to common practice based on a generally agreed interpretation of Icelandic law on the rights of patients, health care professionals cannot discuss prognosis and treatment with a patient’s family without that patient’s consent. This limitation poses ethical problems, because research has shown that, in the absence of insight and communication regarding a patient’s impending death, patient’s significant others may subsequently experience long-term psychological distress. It is also reportedly important for most dying patients to know that health care personnel are comfortable with talking about death and dying. There is only very limited information concerning gender differences regarding death talk in terminal care patients.

Methods

This is a retrospective analysis of detailed prospective “field notes” from chaplain interviews of all patients aged 30–75 years receiving palliative care and/or with DNR (do not resuscitate) written on their charts who requested an interview with a hospital chaplain during a period of 3 years. After all study patients had died, these notes were analyzed to assess the prevalence of patient-initiated discussions regarding their own impending death and whether non-provocative evocation-type interventions had facilitated such communication.

Results

During the 3-year study period, 195 interviews (114 men, 81 women) were conducted. According to the field notes, 80% of women and 30% of men initiated death talk within the planned 30-minute interviews. After evoking interventions, 59% (67/114) of men and 91% (74/81) of women engaged in death talk. Even with these interventions, at the end of the first interview gender differences were still statistically significant (p = 0.001). By the end of the second interview gender difference was less, but still statistically significant (p = 0.001).

Conclusions

Gender differences in terminal care communication may be radically reduced by using simple evocation methods that are relatively unpretentious, but require considerable clinical training.

Men in terminal care are more reluctant than women to enter into discussion regarding their own impending death in clinical settings. Intervention based on non-provocative evocation methods may increase death talk in both genders, the relative increase being higher for men.

Keywords:
Death; Terminal care; Communication; Evocation; Gender