In Palliative Care, Discussions About Death Are Essential


Families and even health care workers need to get used to talking about death more to make it easier, a palliative care specialist in Wales has said.

Hospice consultant nurse Dinah Hickish said demystifying fears could help make dying feel like a “normal process”.

Ms Hickish, based at St Kentigern Hospice, St Asaph, Denbighshire, spoke out to mark Dying Matters Awareness Week.

In Pembrokeshire, a festival called Pushing up the Daisies included a public tour of a crematorium.

Ms Hickish said: “People, following the loss of a loved one, can be extremely isolated because [other] people find it so difficult to know what to say.

“Talking about death demystifies fears. It helps people to get their houses in order.”

She said she had seen “numerous examples where, if people had had the conversations, a catalogue of distress could have been avoided”.

Ms Hickish highlighted a “typical” scenario where a family accompany their loved one to the hospice and, during an initial assessment, tell her nurse “‘he doesn’t know he’s dying, please don’t tell him'”.

“Immediately, I know things will just get more complicated for the loved ones and that basic decisions, such as whether he wanted to be cremated or buried, will not have been discussed,” she said.

A series of events have been held in Wales over the past seven days to mark Dying Matters Awareness Week.

In Pembrokeshire, there was a flower arranging workshop for memorial arrangements organised by the Paul Sartori Foundation, a hospice-at-home charity in the county.

Other events included a public tour of Parc Gwyn crematorium at Narberth.

“It’s not for everybody but I think things like this are important,” said James Allen, crematorium superintendent registrar.

Ms Hickish, who has worked at the hospice for more than a decade, said: “For us here at the hospice, we sometimes have an extremely limited time to try and gently support people into discussing some of these choices, and generally we are able to do this but sometimes it just is not possible.

“And then you know that people will have not said their goodbyes… and that their grieving process will be so much harder.”

Ms Hickish became Wales’ first consultant nurse in palliative care this year at St Kentigern Hospice, a charity which provides specialist care for adults in the Conwy, Denbighshire and Flintshire area.

She said some health care professionals who work outside palliative and hospice care can also find it difficult to discuss death and dying.

“In a health culture where death is seen as a failure, discussing it seems to admit to that failure,” she said.

“If we are all comfortable talking about death than that actually makes communication between healthcare professionals and patients much more meaningful and true.”