The Language of Hospice Can Help Us Get Better at Discussing Death

Just because death is inevitable doesn’t make it easy or natural to talk about. In a new study, researchers wondered if hospice workers—experts in end-of-life care—had lessons to teach the rest of us when it came to speaking with patients and families about death.

Daniel Menchik, an associate professor of sociology at the University of Arizona who studies the use of language in different fields of medicine, spent eight months sitting in on team meetings at a hospice care facility that were also open to patients’ families. His goal was to study how both groups talked to each other about the impending death of the patient. His findings, which will be published in the journal Social Science & Medicine, reinforce the importance of framing death as a process rather than an outcome when caring for frightened patients and loved ones. It’s a helpful strategy that he says everyone could use when facing loss.

“People aren't dead until they're dead,” Menchik says. “And even then, they may not be experienced that way by the people that they are connected to, especially if they’ve had quality time with that person.” 

In the study, Menchik noticed that hospice workers used three different types of verbs in meetings with family members: predictive, subjunctive, and imperative. Predictive verbs are used to assert things about the future and include words like “will” and “going to.” Imperative verbs carry a similar firmness, but include a call to action; the most common one Menchik encounters in medical settings is “should.” Subjunctive verbs convey some sort of personal stance when talking about the future. “Think,” “feel,” “want,” and many other expressive phrases fall in this category. 

When a family starts hospice care, “their capabilities to engage in intense conversations [about death] are usually pretty limited,” Menchik says. But he believes that hospice workers help bridge that gap by minimizing their use of imperative verbs. In meetings he observed, imperative verbs made up just 17% of the verb phrases used by hospice professionals. That’s fairly uncommon in medicine. Menchik has also researched how surgeons speak—a field where questions about courses of treatment and illness progression demand quick and conclusive answers—and found that they use imperative verbs much more often, likely as a way of projecting that they have control over outcomes.

A higher priority in hospice is emotional management. “With the language that they're using, they're there as guides, not as the authorities,” says Dr. Maya Giaquinta, a pediatric resident at the Medical College of Wisconsin who worked with Menchik on the paper (and emphasized that she’s speaking in her own capacity, and not on behalf of the school). Using more predictive and subjunctive verbs allows hospice experts to orient care around current emotional needs, rather than future events.

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While predictive verbs were used the most often in the meetings Menchik and Giaquinta observed, at least half of the verbs most frequently used were words that conveyed uncertainty, like “could,” “might,” and “may.” In declining to talk about future events as set in stone, the researchers found, professionals were better able to redirect conversations to the current moment and focus on anxieties and emotions. 

Hospice professionals aren’t taught about care at a grammatical level in training, at least not explicitly, says Dr. Robert Gramling, a physician and the chair of palliative medicine at the University of Vermont, who was not involved with the study. Research that describes and identifies the skills experts pick up over time can be valuable for expanding the general public’s ability to think and talk about death, he says.

Gramling has studied end-of-life conversations, which he says require “thinking granularly about the words we use and how they land with other people.” When speaking to a family or a patient facing death, ask yourself: “Am I referring to this person as dying? Or am I referring to this person as living?” Gramling suggests. Such reflection grounds the conversation firmly in the present. Another question to consider about your wording: “Is that framed in the language of the person who's experiencing it, or is it really my perspective of things?” In hospice, where patients face only one outcome, speaking with empathy and compassion along the path to it is one thing within people’s control.