Talking with the Dying Patient
Source: raw/nsg210_wk09_TALKINGWITHTHEDYINGPATIENT.pdf (5 pages). “Talking with Patients about Life-Threatening Illness: Questions for Getting Started,” Susan D. Block, MD and J. Andrew Billings, MD, 2005.
A bank of open-ended questions grouped by topic. You do not ask all of them; pick what fits the patient. Openers if the patient does not start on their own: “Tell me about your illness” or “Tell me about yourself.”
Question Areas
| Area | Sample questions |
|---|---|
| Hearing bad news | How did you first find out? How were you told? How did you feel then? |
| Understanding and prognosis | What is your understanding of the illness? What have the doctors and your family said? What is likely to happen? What are your expectations or concerns about the future? |
| Physical and emotional effects | How has it affected you physically? Pain? How are you doing emotionally (nervous, angry, sad, isolated)? What has been hardest? What are your main worries? |
| Coping | Other hard times or losses you have faced, and what helped? How are you coping now? What do you look forward to? Could things get so bad you would consider ending your life? |
| Supports | How have family, friends, coworkers, doctors, nurses helped or disappointed you? Any formal services (visiting nurse, home health aide)? |
| Spirituality | Religious or spiritual practice? Community or clergy? How have beliefs helped or not? Doubt or anger at God? Prayer? Beliefs about death and afterward? What gives life meaning? What are you proudest of? |
| Facing terminal illness | Have you been thinking about dying? Plans made or changed? Will, property, burial or cremation, funeral? Health care proxy? Living will or advance directive? Talked to doctor and family about wishes? |
| Site of care | How do you feel about being at home, in the hospital, or elsewhere? |
| Family coping | How is your family affected? Do they understand how you feel? How are younger children affected and what do they understand? |
| Personhood | How has illness changed you, your roles, your body, your inner life? Can you still feel like yourself? What qualities do you value most in yourself? |
| Closure and saying good-bye | How do you want to be remembered? Relationships that need healing? Things left unsaid? Legacy (stories, values) to pass on? How would you like to say good-bye? |
Nursing Takeaways
- Open-ended questions let the patient lead and reveal priorities, fears, and goals of care
- Asking directly about suicidal thoughts is appropriate and does not plant the idea
- Spiritual assessment is part of holistic end-of-life care
- Asking about advance directives and a health care proxy ties to the slides on living wills and DNR (nsg210-dd-slides)
References in the Handout
Barnard (1995); Billings and Stoeckle (1999); Block and Billings (1994) on requests to hasten death; Byock, Dying Well (1997); Faulkner and Maguire; Quill (2000); Thiel.