Challenging Conversations: End of Life

Do we know how to handle death as we do life?

Most of us don’t think about the former; we’re so wrapped up in our busy lives that it doesn’t really enter our thoughts that often. We’re focused on getting the kids to school; meeting the next deadline at work; getting the family together for dinner.

Our culture is about doing everything we can to prolong life and live as long as we can, as it should be. Nothing reflects the American spirit more than the words “life, liberty and the pursuit of happiness.” From family to sports to education to the arts, we live hard.

We have a proud history of never giving up. We root for David and fight to the end, regardless of our chances. This driving nature has helped deliver a quality of life to several generations that other nations have sought to imitate.

Seeing this Firsthand

Due to advances in health and medicine, people over 65 are able to live longer than in any previous generation. They’re wearing Fitbits; taking healthy eating classes; and believe they’ll outlive their ancestors. More power to them.

I’ve seen how some of our own Medicare members who participate in Humana at Home, which now serves 600,000 people nationwide, have been able to enhance their quality of life – and avoid unnecessary hospitalizations – despite the multiple chronic conditions they live with. For example, Humana At Home members who had the highest risk for disease progression had a 15.9 percent greater survival rate than those not participating in the program.

But the story goes well beyond any number. These care managers take the time to get to know these members. They learn their stories, learn what motivates them, encourage them, help them set – and reach – goals that bring a better quality of life, a greater sense of well-being. The care managers may connect members with social workers or other community resources to help with finance, transportation or loneliness. The care plan is based on individual need and looks at mental, physical and social issues. It goes well beyond the clinical and mental facets; it’s about caring for a person like they are part of your family.

Many of these members are able to live longer with a higher quality of life, despite the chronic conditions that have inevitably shortened their lifespan. Yet, as we all know, death is a part of life. While we want to enjoy our time on earth, are we prepared for the moment when it ends? How do we want our passing to go? Do we want to trade more time for quality of life?

My Own Experience

As a former oncology company executive, and now the leader of a health and well-being company, the questions I raised are ones most people are not prepared for when it comes to cancer. While many of the Medicare Advantage members I discussed above stay with us for an average of over seven years, and have active lifestyles, sadly enough, we see many of them pass on.

Many of you reading this blog have lost a loved one (family, close friend) to cancer. Despite the advances made in chemotherapy, it’s still a treatment that can knock you to the floor and drain any energy you have left to fight. When it comes to cancer, everyone wants to save their loved one.

The most common example I’ve seen – between my time in oncology and now at Humana – is the 73-year-old female patient (Lucy) who is diagnosed with a terminal disease, such as lung cancer. Lucy decides to fight, receives the chemo treatments and has a great response. Unfortunately, her cancer recurs. With her physician she promptly starts a second round of chemo or radiation.

After four months, Lucy’s health is much weaker than before. She’s been hospitalized three times; has lost her hair; has been nauseated a lot of the time; and lost weight as a result. At this point, Lucy and her family finally begin to have a real discussion about her real wishes in terms of treatment.

The sad truth of this common example is that Lucy was nervous and had not had a real conversation with her family or her doctor about her own options. On the family side, they were equally worried because they didn’t want to upset mom so they didn’t discuss it either. Not infrequently, Lucy now questions whether she made the right choice and regrets not speaking with her family.

We all believe in self-determination and the right to pursue different types of treatments that are available and appropriate. But it’s also important to start the discussion among the patient, his or her family, their doctor and their clergy so they have a real expectation of the situation.

I’ve had friends from various age groups who have faced cancer, like many others. When everyone is clear on where things stand, it’s not just individuals like Lucy battling cancer. It’s a team.

The Conversation Must Take Place

Discussing end-of-life with loved ones is not an easy conversation. Our natural instinct is to do everything we can to help our loved ones when they get sick; death is not an option. We don’t want to see them go and will always feel it’s too soon.

Our compassion is our greatest strength, yet it’s important to remember that the patient fighting the battle may sometimes have a different view. There is sometimes a disconnect between treatment and health. The patient may choose an extra month of life due to chemo treatments over quality of life, or vice versa. His or her family may want more time. Either way, we all know it will be tough but it’s important to discuss now, no matter how difficult it will be.

When a person with a serious illness passes on, there are countless loved ones left behind who have had to pick up the pieces. They’ve gone from serving as caretakers for several months, sometimes years, and the person they have been fighting for is now gone.

We don’t want life to end and – many times – we don’t do what we can to prepare for it. While other cultures throughout the world view death as a part of life and address it long before it happens, we tend to put this off. As a society, we must come together to have an open, honest and transparent conversation about preparing for end of life. We need to help those closest to passing on think about how they want to live.

This is not an easy conversation to have at any stage in life, but taking more time to address it will help us all. The more you talk about death while you’re alive and enjoying all that life has to offer, the more you’ll be prepared to face it.