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

Abstract

BackgroundAccording 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.MethodsThis 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.ResultsDuring 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).ConclusionsGender 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.

Male‐female patient differences in the association between end‐of‐life discussions and receipt of intensive care near death

“…In this way, men may benefit even more from explicit physician discussions about EoL care, particularly because they are less likely than women to initiate discussions about death and dying. 32 In agreement with findings from prior studies, we also found that women were more likely than men to prefer palliative care at the EoL and to have a DNR order. 21,22 Not surprisingly, patients who preferred palliative care at the EoL were also less likely than those who did not to receive ICU care at the EoL.…”

“…In this way, men may benefit even more from explicit physician discussion about EoL care, particularly because they are less likely than women to initiate discussion about death and dying. 32 …”

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“…Research using Templer Death Anxiety Scale showed, females have significantly higher level of death anxiety (Chuin & Choo, 2009). Other studies also support this result, where females in youth population report significantly higher death anxiety (John et al, 2007) and in dying patients' population females initiate death talk on greater level as compared to males (Skulason et al, 2014). Early studies conducted by the author of DAP-R revealed that females were more accepting of death (although it was on the dimension of AA and EA) (Wong, Reker, Gesser, 1994).…”