Death talk: gender differences in talking about one's own impending death.

BACKGROUND: According to common practice based on a generally agreed interpretation of Icelandic law on the rights of patients, health care professionals cannot discuss prognosis and treatment with a patient's family without that patient's consent. This limitation poses ethical problems, because research has shown that, in the absence of insight and communication regarding a patient's impending death, patient's significant others may subsequently experience long-term psychological distress. It is also reportedly important for most dying patients to know that health care personnel are comfortable with talking about death and dying. There is only very limited information concerning gender differences regarding death talk in terminal care patients. METHODS: This is a retrospective analysis of detailed prospective "field notes" from chaplain interviews of all patients aged 30-75 years receiving palliative care and/or with DNR (do not resuscitate) written on their charts who requested an interview with a hospital chaplain during a period of 3 years. After all study patients had died, these notes were analyzed to assess the prevalence of patient-initiated discussions regarding their own impending death and whether non-provocative evocation-type interventions had facilitated such communication. RESULTS: During the 3-year study period, 195 interviews (114 men, 81 women) were conducted. According to the field notes, 80% of women and 30% of men initiated death talk within the planned 30-minute interviews. After evoking interventions, 59% (67/114) of men and 91% (74/81) of women engaged in death talk. Even with these interventions, at the end of the first interview gender differences were still statistically significant (p = 0.001). By the end of the second interview gender difference was less, but still statistically significant (p = 0.001). CONCLUSIONS: Gender differences in terminal care communication may be radically reduced by using simple evocation methods that are relatively unpretentious, but require considerable clinical training.Men in terminal care are more reluctant than women to enter into discussion regarding their own impending death in clinical settings. Intervention based on non-provocative evocation methods may increase death talk in both genders, the relative increase being higher for men.

Assessing survival in widowers, and controls - a nationwide, six- to nine-year follow-up.

BACKGROUND: The aim of this study was to assess if widowers had an increased mortality rate during the first 6 to 9 years after the death of their wife, compared initially to an age-matched control group and also compared to the general population of Iceland. METHODS: The study base was comprised of all 371 men born in 1924-1969 who were widowed in Iceland in 1999-2001 and 357 controls, married men, who were matched by age and residence.The widowers and controls were followed through the years 2002-2007 using information from Statistics Iceland. Mortality rates were compared between the groups and also with the general population. The mortality rate comparisons were: study group vs. control group, on the one hand, and study group vs. general population on the other. Causes of death were also compared between widowers and their wives. RESULTS: A statistically significant increase in mortality in the widowers' group, compared to controls, was observed.Lifestyle-related factors could not be excluded as contributing to cause of death in these cases. CONCLUSIONS: Being a widower was related to an increased risk of death for at least 9 years after the death of their wife.

Identifying obstacles to participation in a questionnaire survey on widowers' grief.

BACKGROUND: The aim of this study was to determine if Icelandic widowers might foresee obstacles to responding to a questionnaire on bereavement. Also, we sought to compare the proportion of men reporting obstacles in a telephone interview to the actual response rate in the questionnaire survey. METHODS: The study was part of a nation-wide survey of widowers who lost their wives in 1999, 2000, and 2001. This included all widowers born in Iceland 1924-1969 (aged 30-75 years) who were alive, and residing in Iceland at the time of the study. A telephone poll was conducted prior to sending out a questionnaire to determine if the widowers would be interested in responding, or if they could see obstacles, which could affect their willingness to respond to a subsequent questionnaire survey. The telephone poll was repeated five years later with a random sample of the original study base to determine if views initially expressed towards the questionnaire survey, had changed over time. RESULTS: Of the 357 eligible widowers, 11 had died prior to the first telephone interview, yielding a study population of 346 widowers. Of those, 296 (86%) were reachable and all of these (100%) were willing to participate in the telephone survey. Of them, 55% identified obstacles to participation in the questionnaire survey. Men under 60 years were less likely to identify obstacles. Years from loss (second through fourth years) were not associated with reporting obstacles to participation. The response rate in the epidemiological questionnaire survey following the telephone interview was 62% (216/346).Of those who did identify obstacles 23%, did not did not identify any particular obstacle, but 33% stated that "they felt bad" or that it would be "a painful experience" or that they felt "uncomfortable" talking about their grief. About 18% stated their grief was "a private matter"; 6% stated that they did not want to be "stuck with their grief"; 9% said that it was "too late" to talk about their grief or that they "wanted to look towards their future". Additionally, 11% stated "other reasons", including responses like: "it's too early to talk about it", and "I have started another relationship - don't want complications." CONCLUSIONS: The willingness to participate in the telephone interview was high and indicates a strong interest in the subject. Also, exposure to the study appeared to increase willingness to participate, since many men who initially could see obstacles to participation, actually participated in the epidemiological questionnaire survey. However, approximately one third of the men who initially identified obstacles to participation remained negative toward participation throughout the study period.