Final Conversations Research Articles

Embracing Endings: Unveiling the Connection Between Final Conversations, the Opportunity Model for Presence, and Coping With the Death of Our Parents.

This study examines adult children's loss of a parent through final conversations and communal coping. By looking at survivors' experiences through the lens of the opportunity model for presence (OMP) during the end-of-life (EOL) process, a model that provides a path of engagement leading to a good or bad death and consequent bereavement processes, we quantitatively test the relationships between two communication constructs before and after death of a parent. While final conversations as one construct did not lead to appraisal or action coping, results illustrate that final conversation topics of identity, instrumental, love, and everyday talk, were significantly related to shared appraisal. Instrumental talk and love were significantly related to joint action. Joint action and shared appraisal together led to participants engaging in all three types of coping. Final conversations as a whole, was important for bereavement outcomes, whereas communal coping's role in these relationships was convoluted.

Survivors’ perspectives on saying goodbye: Implications for end-of-life engagement across the lifespan and grieving process

Family members are often unaware of their loved ones’ final wishes and underestimate the need to talk about them before parents reach end-of-life (EOL). The benefits of engaging in EOL conversations alleviate needless suffering and can allow an opportunity to say goodbye in a meaningful way. We examined final conversations 13 adults recalled having with their aging parents through the lens of the opportunity model for presence (OMP) during the EOL process, a communication process model based on engagement in the dying process from diagnosis through bereavement, to understand the process from the survivor’s perspective, looking at content of conversations and where they occurred in the dying process. Findings illustrate final conversations that align with the socio-cultural space of the OMP before the knowledge that a parent was dying, and when entering imminent death engaging in the critical moments, have implications for the grief and bereavement.

Abiding in the Vine: A Relational Model of Spiritual Formation

In recognizing the significance of final conversations, the information Jesus shares in his Farewell Discourse (John 13–17) is considered especially important. During this conversation, in describing the new relationship he envisioned with his disciples following the events of his passion, he employs a vine and its branches as an analogy. Three core concepts seem critical to understanding this comparison—abiding in the vine, bearing fruit, and pruning. These concepts are explored within the context of Jesus’ Farewell Discourse and defined relationally in connection with the new commandment he had just introduced. This new command to love each other as he had loved them (John 13:34–35) was to be the identity marker of his disciples and the key to their new relationship. From this exploration a model of spiritual formation is proposed that equates fulfilling this new commandment to abiding in the vine, emphasizing how loving those with whom a special bond is shared opens disciples to the life of the vine, which is the Holy Spirit whom Jesus promised to send. In learning to love as Jesus loved (abiding), we grant his Spirit access and freedom to work deeply within our lives (branches) resulting in increased fruitfulness (formation) as reflected in healthy relationships and loving communities that last (John 15:16).

What we said and what I wish we said: Regret during final conversations

Research indicates that final conversations with dying loved ones are significant but challenging relational events for survivors. Using a qualitative theme analysis, the present study documented survivors’ (N = 44) retrospective reports of experiences of regret during final conversations. The analysis revealed experiences of validation regret, intersubjective regret, and encumbrance regret, and the use of regret management techniques. This knowledge is useful because it points to the impetus of regret experienced during final conversations and implicates communication patterns that could negatively impact bereavement.

When goodbyes matter: The conditional relationship between final conversations and symptoms of depression

An online survey of 528 people who lost someone close to them in the last 5 years was used to test associations between having final conversations (FCs) and depression. The direct effect was nonsignificant, but there were two significant moderation effects. Time since bereavement moderated the FC–depression relationship; there was a negative relationship between FCs and depression shortly following bereavement, but no relationship after more time had passed. The age of the deceased also moderated this relationship; there was a negative relationship between FCs and depression when the deceased was older, but no relationship when the deceased was younger.

Interdisciplinary simulation for nursing and medical students about final conversations: Catalyzing relationships at the end of life (CAREol)

Final conversations (FCs) go beyond how patients want to be cared for at the end of life (EOL) and focus on messages of love, identity specific, and unique to an individual and relationship that requires self-examination, everyday talk that normalizes a difficult situation, religious/spiritual messages, and if needed, difficult relationship talk to heal broken relationships. The purpose of the Catalyzing Relationships at the End of Life (CAREol) program was to provide interdisciplinary education to nursing and medical students and clinical faculty about facilitating FCs among patients and families. This two-part, quasi-experimental program consisted of a cognitive (online) and experiential (live simulation) curriculum experience. Program curriculum, including video vignettes, readings, and live simulation (utilizing actors), was developed by the study team. Reflective journaling and researcher designed pre- and post-tests were used to assess comfort, confidence, importance, and distress regarding FCs and collaboration with other disciplines. The pre-/post-test questions demonstrate statistical significance based on a paired t-test with effect sizes supporting the practical importance of the findings for effect size. Preliminary content and thematic analysis of qualitative responses describe categories of the mock team meeting experience and interaction with the actors to change patient and family outcomes. Early intervention with the CAREol program provides a framework to help students and clinical faculty facilitate FCs that may result in peace and comfort for patients and families during a difficult time.

Call Me Gloria

Call Me Gloria

Does Talking at the End of Life Matter?: Exploring the Associations between Final Conversations (Fcs) and Coping Strategies

ABSTRACT The purpose of this investigation was to quantitatively examine associations between retrospectively recalled final conversations (FCs) with the outcome of coping strategies. Two-hundred thirty-six individuals participated in an online survey. Correlations revealed significant, positive associations between the FCs factors with coping strategies. Moreover, multiple regressions revealed the following: messages of identity significantly predicted positive reappraisal and cognitive monitoring; difficult relationship talk significantly predicted self and other distancing; and, messages of spirituality significantly predicted the use of faith as a coping tool. Overall, results suggest that retrospectively recalled engagement in FCs are associated with coping strategies after the death of a relational partner. Theoretical and practical implications, limitations, and future directions are discussed.

COVID-19 Bereavement: Considerations for Families, Psychologists, and Student Trainees

During the peak of COVID-19, inflicted individuals died unexpectedly and in isolation. These circumstances deprived families of opportunities to say goodbye or memorialize the death of their loved one in alignment with their values and cultural heritage (e.g., wakes/vigils, funerals, shiva, washing, shrouding, military honors). Unable to hold hands, have final conversations, or develop treatment plans with providers, bereaved families experienced compounded losses. Concurrent quarantine hindered their engagement in coping strategies. COVID-19 bereavement increases the risk for complicated grief, which escalates the risk of physical and mental health problems, suicide, drug abuse, and family discord (Shear, 2015, 2020). While death, grief, and mourning are normal life experiences, traumatic and sudden death during a global pandemic is a new domain and the voices of those left behind are under-represented in social discourse. Simultaneously, psychologists and trainees quickly became last responders. COVID-19 presented a constellation of clinical challenges. Practitioners provided care during a time of political and racial tension, civil unrest, school closures, health and financial insecurity, and a collective loss of normalcy. Additionally, COVID-19 cast a spotlight on ageist attitudes and critical need for increased representation of older adults in training curricula. These issues echo the call to embrace aging as a valued aspect of diversity, and to strengthen psychology’s workforce in the areas of training, practice, research and advocacy for aging adults (Hoge, et al., 2015). This poster will explore the impact of COVID-19 bereavement on families and practitioners, promote advocacy efforts, and offer tangible training recommendations for psychology programs.

From Ferrari to Citroneta. Sustaining student teachers’ stories

ABSTRACT ‘Son, the only thing that I want is to tell you is that I need you to be aware that you are getting out of a Ferrari and into a Citroneta.’ This is what David’s father said to him when he left engineering to enter physical education. In his new career, a teacher educator asked him, ‘Why didn’t you study something more difficult?’ David’s intellectual curiosity increased, so three years later, he also started to study pedagogy in philosophy in parallel. When he told another teacher educator that he had begun this new pedagogical program, that teacher said, ‘You will be two times poor!’ We think, write, and rewrite together these stories, analyzing the role of teacher educators in support of teacher education experiences. This research was conducted using the three-dimensional spaces of an autobiographical narrative inquiry. The narrative analysis was a thorough rereading of the final text and conversations between the participant/first author and the second author (teacher educator). Stories lead people to think about sustaining teachers to assist them in experiencing more desirable educational processes. We asked questions about helping teachers to preserve motivation and persistence across the difficulties associated with teaching tasks.

Exploring the Connection Between End-of-Life Relational Communication and Personal Growth After the Death of a Loved One.

The purpose of the current investigation was to examine associations between final conversations (FCs; i.e., relational communication with a terminally ill individual from the moment of terminal diagnosis to death) with the outcome of personal growth (PG). A total of 236 individuals who had previously engaged in FCs with a deceased loved one participated in an online survey. Analyses revealed significant, positive associations between the six FCs factors (i.e., messages of love, messages of spirituality/religion, messages of identity, everyday talk and routine interactions, difficult relationship talk, and instrumental death talk) with the PG factors. Implications are discussed along with limitations and future directions.

The Last Word.

The Last Word.

Oncologists' and Patients' Perceptions of Initial, Intermediate, and Final Goals of Care Conversations

ContextAlthough recommendations are for goals of care (GoC) conversations to happen early and often, their timing and content over the disease course remain unclear. ObjectivesTo describe perceptions of the timing and content of GoC conversations among oncologists and patients with advanced cancer. MethodsSemi-structured interviews with oncologists and patients at four hospitals in New York and Connecticut. We analyzed data using interpretive description. ResultsOncologists (n = 21) were 67% male, averaged 46 years old (range 34–68 years), and had a mean 20 years (range 8–42 years) in practice. Advanced cancer patients (n = 39) were 59% female with a mean age of 58 years (range 26–88 years). Oncologists and patients viewed GoC conversations along an initial, intermediate, and final continuum. Oncologists reported having initial GoC conversations to build rapport, provide disease information, and clarify and consider treatment intent and options. Intermediate conversations focused on changes in treatment and side effects. Final conversations occurred when patients were hospice-eligible and covered the shift to comfort care, a treatment summary, and advance directives. Timing and content were influenced by cancer type, disease status, and emotional state. Patients supported beginning GoC conversations early, but had different preferences for content of initial conversations. Some wanted complete information; others found this overwhelming. Patients felt intermediate GoC conversations should occur at decision points with time for processing. Content of intermediate and final conversations was dependent on patients' prognosis, questions, and treatment decisions. ConclusionAlthough GoC conversations should follow individual patient preferences, our findings offer structure for their timing and content.

Final Conversations: Overview and Practical Implications for Patients, Families, and Healthcare Workers.

The current paper presents a summary of a 12-year body of research on final conversations, which will be useful for healthcare providers who work with patients and family nearing the end-of-life, as well as for patients and their family members. Final conversations encompass any and all conversations that occur between individuals with a terminal diagnosis and their family members (all participants are aware that their loved one is in the midst of the death journey). Final conversations take the family member’s perspective and highlights what are their memorable messages with the terminally ill loved one. In this paper the authors highlight the message themes present at the end-of-life for both adults and children, the functions each message theme serves for family members, and lastly, the communicative challenges of final conversations. Additionally, the authors discuss the current nature and future of final conversations research, with special attention paid to practical implications for healthcare providers, patients, and family members; also, scholarly challenges and future research endeavors are explored.

Wished for and avoided conversations with terminally ill individuals during final conversations

ABSTRACTThe current investigation examines retrospectively wished for and avoided conversations during the end of life with a deceased relational partner. Participants reported on conversations they wished they had engaged in and conversations that they intentionally avoided, as well as reasons why they did not engage in the conversations. Analyses revealed the following wished for and avoided conversations: negative relationship characteristics; death and dying; postdeath arrangements; and personal information. Furthermore, participants indicated the following reasons for not discussing the aforementioned topics during final conversations: emotional protection, relational differences, and condition of the dying. Theoretical and practical implications for end-of-life communication are discussed.

The Challenges of Final Conversations: Dialectical Tensions During End-of-Life Family Communication

This study examines how participants recall the challenges they encountered during final conversations they had with a family member who has since died. We use relational dialectics as a theoretical framework to interpret participants’ responses. The dialectical tensions evident in these conversations are influenced primarily by a chronemic pressure: the impending death. The overarching tensions discovered were acceptance–denial and openness–closedness (including expression of emotion–concealment of emotion). Practical and theoretical implications are discussed.

Creating the Final Conversations Scale: A Measure of End-of-Life Relational Communication with Terminally Ill Individuals

Final conversations (FCs) are defined as the communicative interactions, both verbal and nonverbal, that occur between terminally ill patients and relational partners. In this study, the “Final Conversations Scale” was developed and tested. A total of 152 participants that had engaged in final conversations with individuals that were terminally ill completed the newly developed instrument. Factor analysis produced a five-factor structure, including: messages of spirituality/religion; expressions of love; proactive difficult relationship talk; everyday communication; and talk about illness/death. Participants' perceptions of the relational closeness and difficulty with the deceased significantly influenced the individuals' recalled frequency of FCs messages. Practical and scholarly implications focus on the needs of the family members regarding their communication with terminally ill individuals, as well as directions for future research with the FCs Scale.

Exploring Children/Adolescents’ Final Conversations with Dying Family Members

In the current study, the authors expanded on a program of qualitative inquiry exploring final conversations (FCs) to the understudied population of children/adolescents. Participants were 61 children/adolescents aged 5–18, who participated in semi-structured interviews regarding their FCs with a dying family member. Inductive coding analysis led the authors to discover four overarching themes of children/adolescents’ FCs messages, in order of descending prominence, are: everyday communication, messages of love, messages of individual identity, and messages related to religion/spirituality. The authors applied Functional Theory to further delineate how participants used, and continue to use, the messages from each theme within their FCs. Discussion of results, including limitations and directions for further research, is outlined.

Advice From Children and Adolescents on Final Conversations With Dying Loved Ones

To understand more about final conversations (communication between loved ones from the point of terminal diagnosis until death), 49 children/adolescents provided final conversation advice for other youth and for the dying person. Advice for fellow youth included (a) confirming the relationship with the dying person, (b) remaining positive throughout the death process, and (c) using external support networks. Advice for the dying person included (a) confirming the relationship with the youth, (b) engaging in open, honest communication with youth, and (c) confirming the identities of the youth. The main implication is that youth should be included in the death process.

The convergence of measurement science and computer science: A scientific conversation

This short paper is based on the first named author’s final scientific conversations with Ludwik Finkelstein, it forms part of what was an on-going discussion whose aim was to bring together our work and perhaps to contribute to the further development of systems engineering. The paper argues for the creation of a new design discipline founded upon the convergence of measurement science and computer science. The convergence of these disciplines proceeds from both an improved appreciation of the fundamental relationships between the disciplines and from the technological developments that have brought measurement and computing ever closer together. The paper points to the underlying relationships between measurement science and computer science and suggests that these relationships can form a principled basis for tackling the design challenges that technological convergence presents. The paper concludes by setting out an initial agenda for the new discipline.