Professor Rod MacLeod from Hospice NZ, and one of Violet's clinical committee members, shares a sensitive deep-dive into the final days of a human's life. And what you might expect.
Prof. Macleod is a member of Violet's clinical committee. We recently asked him a few questions about the difficulty may clinicians have in communicating with patients around end of life.
Violet: Hello Rod, thanks for chatting with us. Can you explain how end of life conversations are approached in a clinical setting?
Rod Macleod: Well, in some ways, approaching it in a clinical setting, depends on how much you feel that the family are aware of the situation. Now, sometimes if you read the literature around this, it's the family who are the last people to know, because they haven't been told by the health professionals that this last stage of life is upon them. But sometimes the family will be well aware that this is happening and using gentle language, like, um, rather than saying, well, of course, you know, so-and-so's going to die soon, which is not a helpful way to put things you can suggest perhaps that, um, that their loved one is sick enough, that they might die soon. You can suggest that the, the bodily functions are telling you that their life is winding down and very rarely will that come as a surprise.
Violet: Why do you think we find it so difficult to open last stage of life conversations?
Rod Macleod: I think we find it difficult to open the conversation because we're fearful of the emotion that might be unleashed. I remember doing some work with medical students who were always reluctant to have these sort of conversations with people near the end of life. And the fear for them was that some emotion, anger, or sadness would be unleashed on them and they wouldn't know how to deal with it. And I think that's true for a number of health professionals as well. I think what we know about palliative care is that palliative care professionals are not frightened to have those conversations because they have them down after day, week after week, month after month, it doesn't make them any less challenging. But I think we're not frightened of the emotions that may come with these conversations
Professor Rod Macleod has published over 200 articles on palliative care in national and international journals and over 20 book chapters. He is one of the authors of The Palliative Care Handbook which has become a freely available standard text for healthcare professionals in New Zealand and more recently New South Wales. He is also co-editor in chief of the Textbook of Palliative Care recently published by Springer Publishing.