Talking about dying can help someone with a terminal illness to express their concerns and fears, and help them to make plans for what’s important to them. It can bring up uncomfortable emotions for you and for the person who is dying, but there are things you can do to make the conversation easier and more meaningful.
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Key points
- Talking to someone with a terminal illness about dying can help them to express their concerns and fears, and make plans for what’s important to them.
- Talking about dying can be difficult but there are things you can do to help the conversation be more meaningful for your patient.
- If someone doesn’t want to talk about dying, don’t force them but let them know that they can talk to you later if they change their mind.
- Be honest if you don’t know something. You can try and find out and tell them later or ask a colleague for help.
- Talking about dying can be challenging for you. Find out where to get support if you need it.
Why is it important to talk about dying?
Talking about death or dying can bring up many uncomfortable thoughts and feelings, so wanting to avoid it is a common reaction. But talking about death with someone who has a terminal illness can be very helpful for them at any stage in their illness. It can help them to:
- express their concerns and fears – sharing these with another person can help to reduce distress and anxiety
- understand more about their illness and what’s going to happen to them – this might reduce anxiety and help them make decisions about their treatment and care
- make decisions about practical things including making a Will or making funeral plans – this can help them feel more in control and helps those important to them.
It’s OK not to talk about dying sometimes. Some people, and cultures, prefer not to talk about it. You can still let people know that you are ready to talk to them if they want to in the future.
Starting the conversation
It can be difficult to know how to start the conversation. It might be helpful to ask the person questions such as:
- If you were to become more unwell, what would be important to you?
- Have you thought about what you would want to happen at your funeral?
- If you were to become more unwell, who would you want to be around you?
The person might open up to you and start the conversation themselves. They might ask direct questions or they might start talking about death in a less obvious way. Be aware of more subtle cues that they might want to talk to you about dying. It may be something they mention once or repeatedly. For example, they might say things such as:
- Do you think there is a god?
- What happens when we die?
- I’m worried about leaving my daughter behind.
- How will my partner cope?
- I wish I could see my friend one last time.
- I’m not getting better, am I?
You could open up the conversation by saying: “You mentioned ‘X’, is that something that’s on your mind?”
Listening well
We communicate through our body language and tone of voice as well as the words we use. You can use your body language to make people feel more comfortable and show that you’re listening, for example:
- If possible, sit at the same level as the person. If they’re in bed, sit in a chair next to them, rather than standing above them.
- Remove any barriers between you. Don’t sit at opposite sides of a table.
- Use open postures, for example rest your hands on your thighs rather than crossing your arms.
- Give them your full attention.
- Nodding and leaning towards them can show that you’re listening.
- You can be warm and smile but remember that you are discussing serious things.
Listening well also involves making sure that you understand how the person is feeling. There are techniques you can use to help, including:
- Exploring cues – for example if someone says they feel worried, you could say ‘Can you tell me more about how that feels?’
- Check that you have understood what they’ve said – for example if they say: ‘I’m worried about what’s going to happen next.’ You could say: ‘You said you’re worried about what’s going to happen next, what kind of things are you worried about?’
- Summarising the conversation – at the end of the conversation sum up what you have understood and ask the person if you’ve missed anything.
Giving information
Usually information about the person’s illness and treatment will be given to them by their doctor, or specialist nurse. But, whatever your role, there will be times when you have to give information or explain something to a patient.
These techniques can help the person to understand what you’re telling them:
- Check what information the person knows already.
- Give small amounts of information at a time.
- Avoid using jargon.
- Avoid euphemisms as they can cause confusion – for example say ‘dying’ instead of ‘passing away’.
- Avoid explaining things in detail – unless the person asks to know more.
- Check how much they’ve understood.
- Check how they feel after having the conversation – for example you could say: ‘That was a lot of information, how are you feeling about it?’
Allow them to ask questions. Don’t worry if you don’t have all the answers. It’s better to admit you don’t know than try to make something up. You can try and find the answers to their questions and let them know later. Other professionals, such as doctors or specialist nurses, may be able to help. It might take different members of the team to answer all of the person’s questions.
It might be helpful to give them written information such as booklets or websites. This allows people to find extra information in their own time and gives them support when you’re not there.
Marie Curie has online information for people living with a terminal illness and carers on a wide range of topics as well as booklets that you can download or order printed copies.
You can also tell the person who they can contact when you're not there. If they have general questions or need emotional support, they can contact the Marie Curie Support Line.
Telling someone that they're going to die
When someone may be entering the last days of life, a healthcare professional should tell the patient that they’re dying (unless they don’t want to know). We have more information on telling someone that they're going to die.
The best person to speak to the person and their loved ones about this is a healthcare professional who is confident and experienced and has a good rapport with the person. This is often the person’s doctor.
Denial
Sometimes a person with a terminal illness will be in denial that they’re going to die. Denial is a normal reaction and can be an important part of them coming to terms with their illness. It’s important not to force them to accept that they’re going to die before they’re ready. Often, they will accept it in their own time. They might benefit from speaking to a counsellor or psychologist.
What other support is available?
If someone has questions about their illness that you can’t answer, it might be helpful for them to speak to their doctor or specialist nurse. If they’re distressed or anxious about dying, speaking with a psychologist or counsellor can help them to explore their thoughts and feelings and find ways to manage them. They might also wish to speak to a chaplain, spiritual advisor or faith leader to discuss spiritual issues. A social worker can help with practical issues such as finances as well as providing emotional support.
Taking care of yourself
Talking about dying can be challenging for you as well. It may trigger memories of people you have lost or care about in your personal life. This is normal but if your feelings are interfering with your work or personal life, it is a good idea to get some support. Talking to your manager or other colleagues about your experiences can be helpful. If you feel you need extra support, you could consider seeing a counsellor or psychologist.
Talking about dying is a skill that can be learned and improved. Reflect on your conversations and think about what went well and what you could do better next time. Ask your manager if there are any communication skills courses you could attend.