Death and the Doctor: Students Practice the End-of-Life Talk

May 23, 2014

Nursing student Jennifer McClennon (left) speaks with two actors playing the role of patients in a new program at UT that gets health care workers to ask questions about end of life issues.

A new program at UT Health Science Center encourages students to bring up the touchy subject of "what happens if." 

In an examination room at the University of Tennessee Health Science Center, an aspiring nurse puts a question to a patient named "Jay."

“Consider a situation where there’s a car accident or a sudden illness that would leave you unable to communicate," she begins. "The doctors believe there is little chance you will ever recover.  In your own words, Jay, tell me what that situation would mean to you and would you want to continue life sustaining treatment?”

Jay and his wife "Julie," a middle aged couple, exchange glances. He’s had some heart problems.  

“I don’t want to be a burden on my family. I want them to enjoy me, and me to enjoy them and when that’s not fulfillable, then I don’t need to be around,” he says.

This is the beginning of a polite conversation – about death -- that educators at UT hope will become more common in medical facilities. In a national teaching program called “Respecting Choices,” students get to practice broaching an issue usually not associated with a visit to the doctor.

“We don’t really ask people if something happens to you, what do you want us to do and why do you want us to do that,” says Teresa Britt, director of professional education and clinical simulation at UT Health Science Center.

“It is a hard conversation," she says. "And maybe we might think and be comfortable doing that with people we know really well like our family, but to go up to someone I met or someone I’m taking care of as a patient, that’s a harder thing to get into."

It's an effort to encourage more patients to look into an "advance directive," which can be as simple as a power of attorney – naming someone to make decisions for you if you can’t. Or it can be a living will, establishing what kinds of procedures you want – or don’t want – at the end of life.

One study found that less than half of terminally ill patients have advance directives. And of the people who do have them, between 65 and 76 percent of their doctors don’t know about them. This could pose problems for both families and physicians.

“You don’t want the people taking care of you at the 11th hour to be making those decisions," Britt says. "Those are things that need to be known before you’re rushing through the folding doors and going into the I.C.U. surgery area.”

At UT’s Health Science Center, the students are real, but the patients are not. They’re actors trained to bring up concerns that real people have when making end-of-life decisions. Students in the program visit different rooms where each of the actors use a different script. Their medical histories and questions are based on real-life circumstances.

In one room Daneen Haba, a student physical therapist, listens to a woman and her son who worry that another family member might interfere with her end-of-life choices. In another room, Haba is asked about CPR, which Britt says only works with about 17 percent of patients, usually those who are young and fairly healthy.

One problem is that many people don’t understand how effective certain procedures are.

“If you look at our state forms, it has boxes on there for 'Do you want CPR?', 'Do you want a tube feeding?'," Britt says. "And people are marking things without any definition or explanation of what that actually is.

Britt says that the UT program “Respecting Choices” isn’t about persuading people to make decisions recommended by doctors, but to just encourage health care workers to bring up the matter of dying before it's too late.