Death Cafe as a formative strategy in speech and language and audiology in in palliative care

ABSTRACT

Speech therapy interventions may be influenced by how one thinks, feels, and talks about death and dying. The literature suggests that the (future) speech therapist should learn how to manage their emotional responses related to death and dying and broaden their perspectives to consider death and dying as part of the human experience through reflective formative strategies and experiential learning, resembling the characteristics of a Death Cafe. This makes its formative use potentially applicable in this context. The Death Cafe is a global social franchise with pre-established rules, where people gather to freely discuss death as a part of life, without predefined objectives or themes, distinguishing it from grief support, lectures, and the like. Studies discuss the benefits of students and healthcare professionals participating in Death Cafe, including transforming death into a naturalistic perspective, exploring the humanity of dying, reassessing how they approach and want to approach end-of-life care, managing emotions, and enhancing clinical judgment.

Keywords:
Palliative care; Attitudes to death; Death; Professional training; Speech, Language and hearing sciences

RESUMO

As intervenções fonoaudiológicas podem ser influenciadas pela forma como se pensa, sente e fala sobre a morte e o morrer. A literatura sugere que o (futuro) fonoaudiólogo deve aprender a administrar suas respostas emocionais relacionadas à morte e ao morrer e ampliar suas perspectivas para considerar a morte e o morrer como parte da experiência humana, por meio de estratégias formativas reflexivas e de aprendizagem experiencial, assemelhando-se às características de um Death Cafe, tornando seu uso formativo potencialmente aplicável neste contexto. O Death Cafe é uma franquia social global com regras preestabelecidas, em que as pessoas se reúnem para discutir livremente a morte como parte da vida, sem objetivos ou temas predefinidos, distinguindo-se do apoio ao luto, palestras e afins. Estudos discutem os benefícios da participação de estudantes e profissionais de saúde em Death Cafe, incluindo a transformação da morte numa perspectiva naturalista, a exploração da humanidade do morrer, a reavaliação de como abordam e querem abordar os cuidados de fim de vida, a gestão das emoções e a melhoria do julgamento clínico.

Palavras-chave:
Cuidados paliativos; Atitude frente à morte; Morte; Capacitação profissional; Fonoaudiologia

This letter aims to present Death Cafe (DC) as a training strategy in palliative speech therapy.

The COVID-19 pandemic has shed light on palliative care (PC)(¹) and multidisciplinary assistance for better quality of life for patients with life-threatening disease and their families by preventing and relieving suffering through accurate assessment and treatment of pain and other physical, social, psychological, and spiritual symptoms(²).

Individuals under PC are more prone to communication and/or swallowing difficulties(³,⁴). Palliative speech therapists are thus essential to help them face the disease and understand death as a natural part of life(⁵).

A Brazilian study(⁶) has raised the hypothesis that difficulties coping with the families of the patients reported by speech therapists in palliative care are associated with the lack of undergraduate training in the death process(⁷). A recent study has identified that the Brazilian speech therapy training on PC is insufficient(⁸). The topic is present in only 16.13% of undergraduate courses, 11 residency programs, and 18 paid specializations.

Another study has reported that the speech therapy training on life end is limited and proposed an evidence-based tutorial for the curricular inclusion of this content(⁹). The authors established that the (future) speech therapist must consider death and dying as components of human experience and learn how to manage their emotional responses to this(⁹) through reflexive training strategies and experiential learning, such as fishbowl and discussion forums outside the classroom(⁹), whose features are like those of the DC(¹⁰-¹³), thus allowing its educational application. Death Cafe is a worldwide social franchise with pre-established rules for people to discuss death freely as part of life, without predefined goals, thus differing from grieving support, and lectures, among others(¹⁰). The meetings are face-to-face or online, lasting approximately two hours, with the host(s) and facilitator(s) offering coffee, cake, and/or other food(10), thus requiring few resources to run.

As an academic training experience(¹⁴), DC emerged as a sociocultural activity for speech therapy students and graduates and became an extension project. Such a professional practice experience has allowed greater empathy, better communication skills, self-reflection, and person-centered care. Leaving “their coat at the door” allowed them to share, recognize, and legitimize the pain and fears related to the death of family members, friends, co-workers, and patients, as well as to “share their own pain”.

Some studies have discussed the benefits of students and health professionals participating in DC, allowing them to share experiences and shifting death into a naturalistic panorama, reducing communication barriers at work, and exploring the humanity of dying, without aiming for totalitarian answers(¹¹). It also allows them to reassess how they approach and wish to approach life-end care(¹²). DC has shown educational potential in the managing of emoticons and clinical evaluation of participants(¹³).

Therefore, there is evidence of the benefits of DC as an educational strategy in palliative speech therapy, during or after the undergraduate course, thus research is needed on this subject.

• Study carried out at Instituto de Saúde de Nova Friburgo - ISNF, Universidade Federal Fluminense - UFF - Nova Friburgo (RJ), Brasil.
• Funding: None.

REFERÊNCIAS

• ¹
  Wynne KJ, Petrova M, Coghlan R. Dying individuals and suffering populations: applying a population-level bioethics lens to palliative care in humanitarian contexts: before, during and after the COVID-19 pandemic. J Med Ethics. 2020 Ago;46(8):514-25. http://dx.doi.org/10.1136/medethics-2019-105943 PMid:32561660.
  » http://dx.doi.org/10.1136/medethics-2019-105943
• ²
  Brasil. Ministério da Saúde. Gabinete do Ministro. Comissão Intergestores Tripartite. Resolução no 41, de outubro de 2018. Dispõe sobre as diretrizes para a organização dos cuidados paliativos, à luz dos cuidados continuados integrados, no âmbito Sistema Único de Saúde (SUS). Diário Oficial da União [Internet]. 2018 [citado em 2023 Jul 22]. Disponível em: https://www.in.gov.br/web/guest/materia/-/asset_publisher/Kujrw0TZC2Mb/content/id/51520746/do1-2018-11-23-resolucao-n-41-de-31-de-outubro-de-2018-51520710f
  » https://www.in.gov.br/web/guest/materia/-/asset_publisher/Kujrw0TZC2Mb/content/id/51520746/do1-2018-11-23-resolucao-n-41-de-31-de-outubro-de-2018-51520710f
• ³
  Kelly K, Cumming S, Corry A, Gilsenan K, Tamone C, Vella K, et al. The role of speech-language pathologists in palliative care: where are we now? A review of the literature. Prog. Palliat. 2016;24(6):315-23. http://dx.doi.org/10.1080/09699260.2016.1141745
  » http://dx.doi.org/10.1080/09699260.2016.1141745
• ⁴
  Pascoe A, Breen LJ, Cocks N. What is needed to prepare speech pathologists to work in adult palliative care? Int J Lang Commun Disord. 2018;53(3):542-9. http://dx.doi.org/10.1111/1460-6984.12367 PMid:29327799.
  » http://dx.doi.org/10.1111/1460-6984.12367
• ⁵
  Brasil. Entidades de Fiscalização do Exercício das Profissões Liberais. Conselho Federal de Fonoaudiologia. Resolução n. 633, de 02 de setembro de 2021. Dispõe sobre a atuação do fonoaudiólogo em cuidados paliativos. Diário Oficial da União [Internet]. 2021 [citado em 2023 Jul 22]. Disponível em: https://www.in.gov.br/en/web/dou/-/resolucao-cffa-n-633-de-2-de-setembro-de-2021-347062872
  » https://www.in.gov.br/en/web/dou/-/resolucao-cffa-n-633-de-2-de-setembro-de-2021-347062872
• ⁶
  Mendes BNN, Christmann MK, Schmidt JB, Abreu ES. Percepção de fonoaudiólogos sobre a atuação na área de cuidados paliativos em um hospital público de Santa Catarina. Audiol Commun Res. 2022;27:e2565. http://dx.doi.org/10.1590/2317-6431r-2021-2565
  » http://dx.doi.org/10.1590/2317-6431r-2021-2565
• ⁷
  Noureddine N, Hagge D, Kashkouli P. Student-reported attitudes during an interprofessional palliative care learning experience: implications for dual-professional identity, interdisciplinary bias, and patient outcomes. Palliat Med Rep. 2020;1(1):307-13. http://dx.doi.org/10.1089/pmr.2020.0096 PMid:34223490.
  » http://dx.doi.org/10.1089/pmr.2020.0096
• ⁸
  Edom BS, Starosky P, de Carvalho RT, Roque FP. Cuidados paliativos na graduação em Fonoaudiologia e residência para fonoaudiólogos no Brasil. In: 31º Congresso Brasileiro de Fonoaudiologia, 12º Congresso Internacional de Fonoaudiologia; 2023, Out 6-10; Rio de Janeiro, RJ. São Paulo: Sociedade Brasileira de Fonoaudiologia; 2023.
• ⁹
  Stead A, Haynie S, Vinson M. Teaching end-of-life care in speech-language pathology: a tutorial. Teaching and Learning in Communication Sciences & Disorders [Internet]. 2023[citado em 2022 Maio 15];7(1):1-17. Disponível em: https://ir.library.illinoisstate.edu/tlcsd/vol7/iss1/4
  » https://ir.library.illinoisstate.edu/tlcsd/vol7/iss1/4
• ¹⁰
  Death Cafe [Internet]. Death Cafe Guide. 2015 [citado em 2022 Maio 15]. Disponível em: https://deathcafe.com/site_media/files/guide.pdf
  » https://deathcafe.com/site_media/files/guide.pdf
• ¹¹
  Nelson KE, Wright R, Abshire M, Davidson PM. All things death and dying: health professional students participating in the Death Cafe´ model. J Palliat Med. 2018;21(6):850-2. http://dx.doi.org/10.1089/jpm.2017.0440 PMid:29393728.
  » http://dx.doi.org/10.1089/jpm.2017.0440
• ¹²
  Adler S, Remer R, Coulter YZ, Miller BJ. Death cafes: a tool for teaching about end of life in both academic and community settings (FR469-E). J Pain Symptom Manage. 2015;49(2):386-7. http://dx.doi.org/10.1016/j.jpainsymman.2014.11.141
  » http://dx.doi.org/10.1016/j.jpainsymman.2014.11.141
• ¹³
  Howorth K, Thomson R, Paes P. Can the ‘Death Café’ concept be adapted for use in healthcare professional learning and development? Support Palliat Care (Online). 2018;8(Suppl 1):A15-6. http://dx.doi.org/10.1136/bmjspcare-2018-ASPabstracts.40
  » http://dx.doi.org/10.1136/bmjspcare-2018-ASPabstracts.40
• ¹⁴
  Moraes TR, Jevaux LN, Portella LC, Silva BVD, Alves BT, Starosky P, et al. Vivências de estudantes e profissionais da saúde em um Death Cafe e sua relação com a prática e o saber profissionais. In: X Exposição de Trabalhos Acadêmicos da Região Serrana, ETARSERRA; 2022 out 21; Nova Friburgo, Brasil. Nova Friburgo: Instituto de Saúde de Nova Friburgo/Universidade Federal Fluminense; 2022.

Publication Dates

• Publication in this collection
  04 Dec 2023
• Date of issue
  2023

History

• Received
  25 July 2023
• Accepted
  16 Oct 2023