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FOR EXPERT COMMENT: End-of-Life Decisions Should be Discussed Earlier, MU Expert Says

April 14th, 2014

Story Contact: Jesslyn Chew,

The views and opinions expressed in this “for expert comment” release are based on research and/or opinions of the researcher(s) and/or faculty member(s) and do not reflect the University’s official stance.

By Diamond Dixon

COLUMBIA, Mo. – Advance directives are legal documents in which individuals communicate their end-of-life treatment preferences before they are faced with serious accidents or illnesses. However, most adults are hesitant to talk about death and typically wait until after life-threatening medical episodes have occurred to begin discussions. A University of Missouri social work expert says conversations about death and end-of-life wishes should happen sooner, during calmer times of individuals’ lives.

“So many times conversations about advance directives happen after serious, life-threatening medical episodes or accidents when individuals are transferring from one health care facility to another,” said Colleen Galambos, professor and director of the graduate certificate in gerontological social work at MU. “These are times when stress levels are high and everyone is anxious about the current situation. Individuals should not wait to have these conversations and should discuss preferences earlier during calmer times so the issues can be discussed in depth.”

Galambos recognizes that starting conversations about advance directives with loved ones can be difficult. She says individuals must get comfortable with the end-of-life treatment wishes by thinking about how they want to spend their final hours or days.

“A good way to begin conversations about advance directives with loved ones is to ask them what matters most at the end of their lives,” Galambos said. “Being able to give your loved ones control over the final aspects of their lives can bring peace to families.”

Galambos recommends that parents and adult children begin discussions about their wishes for life-sustaining treatment with each other. By the age of 21, individuals should start to formalize these wishes by completing the proper documents, she said.

“By 21, adult children legally are in a position to begin to put their financial and legal choices in place and should designate their wishes and preferences for end-of-life care,” Galambos said. “This should be a two-way process between parents and their children. Parents also should discuss their own advance directives with their adult children and significant others.”

Galambos also encourages parents or adult children to check with each other periodically about their advance directives because wishes may change over time. She says having routine conversations about end-of-life care will help normalize these conversations.

“People don’t like to think about death or becoming chronically ill,” Galambos said. “If individuals begin to view death as a normal and universal experience like birth, individuals can start having discussions about dying and death before they are faced with it.”

In 2012, a team of University of Missouri Sinclair School of Nursing researchers, led by Curators’ Professor of Nursing Marilyn Rantz and including Galambos, received a $14.8 million grant from the U.S. Department of Health and Human Services Centers for Medicare and Medicaid Services (CMS) to reduce the re-hospitalizations of nursing home residents. One goal of the grant is to develop communication systems at nursing homes to assure that consistent communication of residents’ decisions about advance directives can take place.

Galambos is a professor in the School of Social Work, which is within the MU College of Human Environmental Sciences.