RESEARCH Life and death conversations Research focuses on young patients and their readiness to talk about serious illness. By Chris Williams The teenage and emerging adult years are associated with beginnings — fi rst dates, driver’s licenses, prom, graduation and career. They are a time to look to the future and dream big. They are not thought of as a time for adolescents and young adults to consider the end of their lives. Yet, for young patients with cancer and other terminal illnesses, that’s often the reality. While their peers are getting ready for prom, they’re enduring chemotherapy. Instead of college applications, they’re having diffi cult conversations with doctors and loved ones. Rather than looking ahead to career, marriage and parenthood, they’re worried about making it through the next month. Understanding adolescents’ and young adults’ acceptance of their situation and willingness to discuss it is important, both for caregivers and for family members who are often unsure of the emotional support their loved ones need. Research conducted by the Wayne State University College of Nursing could help caregivers and families understand when adolescents and young adults with advanced or terminal cancer are ready to talk about their situation. The research is a collaboration between WSU assistant professors Cynthia Bell, Ph.D., research scientist, and Jessica Spruit, D.N.P., an acute-care nurse practitioner specializing in pediatric oncology. “When I worked with pediatric oncology patients before going back to school, what bothered me the most were when patients were processing the fact that they were going to die and didn’t have someone to talk to and were afraid to burden their family,” Bell said. “They’re trying to protect each other from the emotional pain of death and separation.” Moved by these discussions, Bell focused her dissertation on understanding how young patients engage in end-of-life conversations and whether those discussions help improve quality of life. Her conclusion? The conversations were not readily happening and to foster these diffi cult conversations, it was necessary to understand when patients were ready to discuss their illness, treatment, fears and other concerns. “They go in and out of this open-and-closed awareness. When they are openly acknowledging their incurable disease, then they will process more emotional conversations. And when they’re in closed awareness, they want to talk more about their hopes, dreams and future and what they want to do with their life,” explained Bell. 20 Wayne State University College of Nursing