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So we all die – at some stage. But the truth is few of us discuss living in the final stages of dying.

Conversations That Count Day – a national day – reminds us people need to talk about their end of life care.

Waikato District Health Board emergency department physician Dr Ruth Large said having these conversations can be hard, but waiting till someone is critically unwell makes it even harder.

“The saddest thing for me is to have a very elderly person arrive in the ED critically unwell, never having had the opportunity to have the conversations with their loved ones about what they want,” she said.

“They are then potentially subjected to painful procedures or treatment that they may have never wanted. I find this extremely difficult and only wish that we were all brave enough to have conversations about dying whilst we are well.”

Dr Large explains that often patients surprise her with what their wishes are, and she has learnt over the years to never assume, which she says often families end up doing.

“Everyone will die, it is a consequence of being born and yet conversations as to what is important to individuals at the end of their life is often put off due to feelings of awkwardness. I find that when I address these questions to elderly folk it is often the first time anyone has asked them what is really important to them at this time. “

Dealing with end of life is part of Waikato DHB’s older person’s clinical nurse specialist Julie Daltrey’s job, something she approaches by finding out what patients know first.

“Often patients and families have been told about their health issues, but they haven’t always heard what has been said.”

“This can be for multiple reasons, we know once bad news is given people don’t absorb much more information, if they are acutely unwell they often don’t remember information, at times we use language that doesn’t make sense to them, or we can be inadvertently vague and gentle,” she said.

Julie admits often the conversation about dying can be harder for adult children than older adults themselves and making sure the family is also prepared is critical to executing the end of life plan.

“We are as a society still focused on the fix-it approach and it can take a while for people to realise that fixing-it is no longer possible.  I think our language is important when talking about death, it is good to tell people what we can do before what we can’t.”

“It helps people understand that end of curative treatment is not end of care.”

Understanding your patients and them as a person means you have to be prepared for when their needs surprise you and be flexible enough to see them through, said Daltrey.

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