Communication issues at the end of life: reports from hospice volunteers.

The central goal of this study was to inventory and understand difficult communication issues or dilemmas that arise among hospice volunteers, patients, and their families. Hospice volunteers reported, based on their observations and experience, that denial was the most common communication issue or dilemma for patients, family, and caregivers, followed by negative feelings and family conflicts. Volunteers reported that for themselves, the most common problem was patient impairments such as Alzheimer's or Parkinson's disease that made conversation difficult. Powerful and wide-ranging emotions were also challenging for dying patients and their caregivers. Problematic integration theory and terror management theory could be developed further by expanding the role of emotions, and trauma management theories could be enhanced by developing deeper understanding of how the loss of social bonds may be as traumatic as the loss of life.