Abstract
Richard P. McQuellon and Michael A. Cowan. New York: Oxford University Press, 2010, 144 pages, $15.95.
“Dying is part of living and needs to be talkable.” Although hospice and palliative medicine professionals agree with this statement, many health care providers, patients, and their families and friends lack the skills to comfortably talk about dying.
The Art of Conversation Through Serious Illness: Lessons for Caregivers is written to encourage frank, life-affirming conversations with those facing the prospect of death. Written by two psychologists who work closely with cancer patients and their families, this book is especially relevant to hospice and palliative medicine professionals who often witness missed opportunities when families, caregivers, or patients are afraid to talk about dying. The authors provide a guide for patients, families, and caregivers (both professional and nonprofessional) who want to discuss serious topics but are unsure how to do it.
The first of three sections explores the personal experience of patients and caregivers confronting life-limiting illness and the role of meaning at this time. The authors coin the phrase “mortal time” to describe the time when human beings are confronting the prospect of death and therefore are acutely aware of their mortality. The authors discuss how hope and meaning can be maintained during this time, and they explore common existential questions often asked by people in mortal time such as “Where did I come from?”; “What is my purpose?”; and “What is my destiny?”
The second section lays the groundwork for helping caregivers guide patients and families through mortal time with compassion and honesty. It contains a helpful discussion about maintaining hope, even in the face of progressive illness and referral to hospice. The authors suggest that maintaining hope is not a task for the individual, but rather something that people do together in relationships. This section also includes a thoughtful discussion of important elements of effective and healing communication, noting that words cannot change the reality of a situation but they can decisively shape how it is experienced. They emphasize the role of empathy and give guidance for conveying empathy effectively. They also give practical advice about a range of communication topics, including everyday conversation with friends, using platitudes appropriately, and the role of spontaneity and light chatter. This section also includes discussion about healthy denial and its impact on conversations with health care professionals. Throughout the book the authors give suggestions for effective phrases for caregivers to comfort and support patients. They also give examples of inappropriate conversations and discuss how caregiver and recipient intentions can be misconstrued.
In the third section, the authors look at the various types of caregivers a patient with advanced illness might have, including family, friends, and professional staff. The authors discuss the many intrinsic rewards of caregiving as well as some of the psychological burdens, including compassion fatigue and a concept of “empathy shift,” when caregivers experience a change in their ability to empathize with the normal and expected small wounds of everyday life. They discuss important caregiver virtues that are needed by patients who are in mortal time and close with the idea that conversations at the time of serious illness provide important opportunities for patients to consider their lives, to make amends where possible, and to say what is in their hearts to family, friends, and associates. The authors offer their view that for any of us to finish our lives with deliberateness and a measure of closure, we must turn toward death together, in shared conversation.
Many people think that the term caregiver refers only to family members, friends, or paid caregivers. This book is unique in that it includes health care professionals in the category of caregivers. Clinicians are not only having these conversations with their patients but are also advising and guiding family and friends who may feel uncomfortable and inexperienced with these important conversations. This book is an excellent resource not only for family and friend caregivers, but also for hospice and palliative medicine professionals and other medical colleagues.