["We are Heading Towards that Now" - A Qualitative Analysis of the Perspectives of Healthy Older Adults on Conditions, Difficulties and Benefits of Early End-of-Life Conversations]. / "Wir sind jetzt auch auf dem Weg dahin" ­ Qualitative Untersuchung zu den Perspektiven älterer gesunder Erwachsener über Voraussetzungen, Schwierigkeiten und Nutzen von Gesprächen über das Lebensende.

ABSTRACT

OBJECTIVE: Early conversations about the end of life can contribute to patient-centered care at the end of life. Too often, however, these conversations do not take place or if they do, they are too late. The aim of this qualitative research was to identify the prerequisites, difficulties and usefulness of such conversations from the point of view of healthy older adults. The findings might be of use in primary health care to provide early and open end-of-life discussions. METHODS: The interviews stem from an experimental study concerning the readiness of end-of-life conversations with healthy adults. Six transcripts (2 male and 4 female participants, 65-78 years) were evaluated by using the thematic analysis by Braun and Clarke. RESULTS: Conditions for the initiation of conversations were thematically separated into beliefs and attitudes, intrinsic motivation, experience, family communication and practical realization. Difficulties were found in the areas of cognitive barriers, practical realization, emotional barriers, relational factors and environmental conditions. Participants saw the usefulness of such conversations in the areas of relationship quality, organizational profit, values, as well as cognitive and emotional areas. DISCUSSION: The results are in agreement with past research. From the perspective of older healthy people, family conversations about the end of life can be "too late". However, it also appears that there are specific barriers to early discussions. The findings on helpful conditions and barriers can be used for the development of interventions to increase readiness for such discussions. CONCLUSION: Early conversations about the end of life should be offered in the sense of preventive care in a low-threshold way. Providers of primary health care can identify a "need to talk", reduce communication barriers and encourage confrontation with one's own mortality. Adequate information should be provided if necessary, and a structured communication approach should be employed.