"I want to talk to my parents/husband/friend about end-of-life...but it's such a hard topic to bring up!"
One thing we hear again and again from our users is that they want to use Cake to start a conversation with their loved ones, especially their parents. We know it can be an awkward thing to bring up, so we have created a guide and free materials to help you get started.
In this three-part guide, we'll cover:
- Part I: Preparing for the talk
- Part 2: Starting the conversation -- with helpful tips from palliative care physicians
- Part 3: Sample conversations and email templates
Part I: Preparing for and end-of-life planning discussion with your loved ones
You might have already tried to bring this up with your loved one, or you might be guessing how your they will respond to any conversation related to preparing for end-of-life.
Common ways people deflect and respond to this topic:
- "I've done this already."
- "We can do it later."
- "Why do you want to talk about this now? Do you think I'm going to die soon?!”
- “I don’t care about what happens -- I’ll be dead.”
- “Planning will make it a reality.” (superstition)
If you had to choose, which response do you think they would have? Your knowledge of their personalities is an important factor in figuring out the best approach. Here are some factors to consider:
1. Determine their coping style
Cancer doctors sometimes think about people's coping styles broadly as "monitors" and "
- "Monitors" are people who cope by seeking out more information
Blunters" tend to prefer distraction and avoid practical planning
If your loved one is more of a "monitor" coping style, providing them with information about different options can be helpful, but they may also need more reassurance throughout the conversation. On the other hand, a "blunter" may prefer to keep it simple and will rely more on you to suggest what you think would be the best. You can emphasize that it's important to know what they want, not what you think they would want.
2. Determine their communication style
Consider how they usually deal with difficult conversation topics. Are they someone who likes to think carefully about what they say first? In that case, you might tell them about Cake’s end-of-life planning website (you’re on Cake’s blog right now) and allow them to explore it on their own before sharing their wishes.
Alternatively, do they prefer to think out loud? Then it might be more fruitful to talk about the questions in real-time, or even discuss your own end-of-life preferences to help get things started.
3. Frame your conversation to meet them where they are
Here are a few other helpful things to consider that will help you frame your conversation:
- How is their health?
Are they healthy or ill? Has anything happened in their lives recently that might bring this issue to the forefront? For someone who is sick, there's more urgency. This can make the conversation more challenging emotionally, but also provides an anchor to engage everyone in the family. Medical issues can provide starting points for the conversation, especially if they designate you as a healthcare proxy or they are deciding about
- What concerns do you have for them?
Sharing your #1 concern can help set priorities for the conversation. A big reason people decide to do end-of-life planning is to unburden their loved ones from making tough decisions for them, so it may help to express your primary concerns. Whether it's medical decisions or financial planning, are you particularly worried about one aspect of end-of-life?
- Consider their comfort and trust with technology
If they are older, are they comfortable using Facebook or LinkedIn? If so, Cake will be a very simple tool to use. If you worry they wouldn't want to use a website or technology to do end-of-life planning, it might be easier to talk in person, even if it means waiting until the next time you get together, or perhaps encourage a family member or close friend who lives nearby to do so.
Part 2: Starting an end-of-life planning conversation
Below you'll find 7 actionable tactics on how to start this conversation. You know your loved ones; let that knowledge guide you on which one or combination of these tactics makes the most sense for you and your family.
Tactic 1: Use Cake as an icebreaker
We designed the Cake to be the easiest way to talk about and do end-of-life planning.
If you sign up for your free Cake profile for yourself, then share your Cake plan with your loved ones, that might be a great way to start the conversation. See Part 3 for more concrete details on how to do this.
Tactic 2: Get personal
"Dad, I talked to a financial planner recently about how to get my affairs in order. It made me think that this might be important for you, too. Can I ask you about that?"
Sometimes a life event or something you learn about triggers you to think about mortality. Some examples:
- Reading the news
- Career changes
- Experiencing loss of a friend, family member, pet, or even a distant acquaintance
- Having a near-death experience
- Getting married or divorced
- Thinking about starting a family
- Knowing someone who becomes ill or injured
Sharing why the topic of end-of-life is on your mind can be a natural way to start.
Tactic 3: Entice with interesting content
"Mom/Friend, I thought this article was interesting and thought you might, too. Can we talk about it after you read it?"
Here is some suggested content that you can share as a launch-point for conversation:
For the podcast listener:
For the book reader:
- Being Mortal by Atul Gawande -- This is a Cake team favorite!
- Can't We Talk About Something More Pleasant? by Roz Chast
- Everybody Dies: A Children's Book for Grownups by Ken Tanaka
For the internet lover (videos/articles):
Tactic 4: Use an inspirational planning story
Give an example of good planning and how that affected this person and their families. You might already have some examples of people who faced their own mortality and by doing so, helped ease the transition for their loved ones, but if not, here are some:
- Joan Rivers' funeral requests, and accounts of her actual funeral, which honored and celebrated her life in a way that was true to who she was as a person
- Emily Debrayda Phillips wrote her own obituary, which is both funny and moving
- Jeffrey M. Piehler builds his own coffin
Tactic 5: Appeal to their practical side
Although we don't think fear is the best way to convince someone to act, sometimes illustrating the negative consequences of not preparing can be an effective way to get them to address this topic. It all depends on the temperament of your loved ones.
Give an example of lack of planning and how that affected another person. You might have some examples that you know already, but if not, here are some:
- Top 5 regrets of the dying, written by a palliative care nurse
- Terri Schiavo and making sure caregivers know how much medical intervention you would want
Tactic 6: Share your worry
"Mom, after what Uncle John has gone through, I've been worrying a lot about what will happen if you or Dad get sick. Can we talk about it?"
There doesn't always need to be a specific event or reason you want to talk about end-of-life. One way to start is to start from a place of worry. Doctors use this type of language a lot. Saying, "I'm worried that..." feels warmer than
Find a piece of the broader topic that your parent is willing to discuss. You could be as open-ended as, "Is there anything you and Mom are worried about as you're planning for retirement?" If they ask, "What do you mean?", you can clarify: "Anything around medical issues, finances, or things that we as your kids should know about."
Tactic 7: Do it yourself first
"I've been doing some end-of-life planning myself. Do you want to hear what my preferences are?"
If you plan for end-of-life yourself, it takes away a lot of the stigma that it is only something that elderly people do. No one is exempt from death, and no one can control exactly when and how it goes down. It's better to be prepared. The bonus benefit of planning is that thinking about end-of-life actually makes you live better now, by giving you clarity on what's most important to you! End-of-life preferences are really just life preferences, with the added clarity of a zoomed-out perspective.
You can sign up for your free Cake profile to start your own planning today.
How are doctors trained to have difficult conversations?
All the examples above include a question and asking permission to talk about it. It's a technique oncologists often use in a communication program called VitalTalk, which teaches doctors how to talk about serious illnesses and end-of-life. Asking permission helps you know if someone is ready to talk about this topic. It also gives a sense of importance to it, and if they are ready, you can really engage.
Doctors are also trained to not talk too
With uncomfortable silences, we often feel compelled to keep talking, especially if this is a conversation you've been wanting to have for a long time. But it's really a conversation to learn what your parents have been thinking about.
Sitting with the emotions that arise and letting your loved one continue to talk can be a very revealing thing. Ask your parents if there's anything they specifically want to talk about.
What if they still don’t want to talk about it?
It may not hurt to ask why. You'll at least get a sense of where the anxiety comes from, indirectly.
"No worries, we don't need to talk about this now. Can you tell me what's the main reason you don't want to?"
Maybe they would feel more comfortable in a different time or place, or you'll realize that they'll accept talking about health but that finances are a sticking point. There's no need to cover everything at once--this can take time.
There are many online resources to help, including The Conversation Project, mentioned in our post on advance care conversations.
Part 3: Sample End-of-Life Planning Conversation Starters & Email Templates
In this part of the guide, we give you actual talking points and email templates that you can use right away.
This is especially helpful for those of us who live far away from the people they want to talk to. Distance can be one of the reasons that we delay or avoid having this conversation--but there is no rule that says this has to start as a face-to-face conversation! Let's be realistic: who would want to bring up death at Thanksgiving, especially if you only see your loved ones a couple times a year?
It might be easier to start with communication that is asynchronous (like email) or just a phone call.
Here is some sample language that can be personalized, whether you're calling or emailing:
- Hey Dad, before you go, there's something I've been thinking a lot about. Now that you and Mom are planning for
retirement / moving/ getting to spend more time with all of the grandkids, I've been wondering if there are things you think are important for me to know in case of an emergency.
- I recently found out about this online tool called Cake that helps you make an end-of-life plan and share it with other people who would need to know my preferences and important documents. I’ve tried it myself -- it has given me a lot of peace of mind to finally get my own affairs in order. Would you want to take a look?
- I think we should talk about what we should do as a family in case an emergency comes up. There is this online tool called Cake that can help us navigate all the different choices and it would be great if we could do it together.
Here is sample text for an email:
I recently found out about Cake, a website that makes it easier for people of all ages to discover their end-of-life preferences and share them with their loved ones. Having a better understanding of what's important to you in life, including your preferences at end-of-life, would really give me peace of mind...but I know it's an awkward thing to talk about!
I tried Cake myself, and it's really simple (and even a little bit fun). I wanted to share my Cake profile with you, so you could understand how it works and then see if we could do this together. You can go to joincake.com to read more about it and sign up for free, and then we can chat about what you think.
Thanks for being willing to start talking about it.
It’s not uncommon to meet resistance the first time you broach the topic of end-of-life planning with someone. In many ways, it can be harder to discuss the closer you are to that person.
Be persistent in your pursuit, but know when to back down and allow your loved one some breathing room. One of the most compelling ways to ease a resistant planner into end-of-life planning is to talk about your own preferences and explain why it’s important to you that they know your plans.