"The “Amfora conversation”: reflecting on life and death when the end is near. An innovative practice empowering patients".

Abstract

Death is part of life. Yet, few people are prepared for it. Many of those who are old or seriously ill, have the need to reflect on the past life, the nearing end and the things that matter. Talking about and sharing those deeper feelings and thoughts can be deeply liberating. It can create a closer connection between the ill or old person, the loved ones and the health care professionals. End-of-life conversations can stimulate the person to think about future care and, this way, contribute to advance care planning. And for loved ones it can have a preventive effect in the sense that it increases the chances of healthy grieving.
 Who am I, where do I find strength, which meaning do I give to death? How do I look back on my life? What are my fears and my hopes? What do I wish to leave for those staying behind? Thinking and talking about these questions is not easy. The non-profit organization Amfora helps people to find language and create a tangible memory for loved ones, by means of an “Amfora conversation” resulting in a precious, carefully written end-of-life story. Amfora provides training to health care professionals and volunteers from various settings (hospitals, palliative care networks, facilities for people with disabilities and elderly care), so they can integrate the practice in their daily work.  
 Integrated care reflects the whole of a person’s health needs. It means we focus on the totality of the person and his full context, beyond the disease or chronic condition. This is particularly important in palliative care and end-of-life care, where consensus exists about the four pillars of care: physical, psychological, social and spiritual/existential. This last pillar – which goes far beyond religion – is the most intimate and hidden dimension of care, yet it’s crucial because of its close connection to each of the other dimensions.
 However, it remains a challenge for many palliative care professionals how to implement this non-medical, existential pillar in practice. This is where the Amfora conversation comes in: it has proven to be an accessible and effective way to empower people in having their spiritual/existential needs fulfilled. The Amfora concept is innovative because it is based on the journalistic interview method. The interviewer captures the essence of the person and gives it back in another form, so it can be passed on. End-of-life conversations are a form of care and should therefore be fully integrated in palliative care.