Discussing end-of-life choices with family members in a way that pays attention to how they perceive themselves and maintains your relationship with them may be more important than actually reaching decisions, according to a study recently published in Communication Monographs, a journal of the National Communication Association.
The reason is that reassuring people about shared commitment to a relationship increases their feelings of satisfaction about the conversation. And that satisfaction may have a positive impact on the health choices that are made later, in part because the person's positive emotional response to the conversation helps them better process and remember information.
"The way an end-of-life discussion is negotiated has the potential to strengthen or undermine relationships," says Allison M. Scott, Assistant Professor in the Department of Communication at the University of Kentucky and lead author of the study. "Family communication holds a great deal of potential for improving end-of-life health care, but this potential lies in the quality of the discussions."
At the heart of the new study is the idea that people may have more than one purpose for a conversation, including task, identity, and relational goals. In an end-of-life conversation with a parent, for example, the primary task may be to share information on options, the identity goal may be to preserve the parent's feeling of independence, and the relational goal may be to maintain a high level of trust.
Achieving an end-of-life conversation's goals can minimize the hurt feelings and relationship damage that can result from talking about such an emotionally charged topic. When people have positive communication experiences and negative outcomes are avoided, they're more likely to engage in subsequent conversations about a topic.
"A common refrain among end-of-life researchers and practitioners is that families should 'be open,'" said John P. Caughlin, Acting Head of the Department of Communication at the University of Illinois at Urbana-Champaign and one of the study's authors. "But our findings demonstrate that having a successful end-of-life discussion is not just about being open, and that some ways of being open are better than others."
Openness when discussing specific health care options is beneficial, as is working to achieve other conversational goals in addition to simply sharing information. At the same time, being so open that the other person's feelings are hurt is counter-productive.
- Allison M. Scott, John P. Caughlin. Enacted Goal Attention in Family Conversations about End-of-life Health Decisions. Communication Monographs, 2014; 81 (3): 261 DOI: 10.1080/03637751.2014.925568
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