From coping with life to coping with death: Problematic integration for the seriously ill elderly

Decisions made by and for elderly patients nearing death frequently perpetu ate unwanted suffering and dependence. This article extends the argument th at Babrow's (1992, 1995) problematic integration theory can provide insight s into why communication fails to produce desired outcomes for such patient s. Open-ended responses obtained in face-to-face interviews with 142 elderl y dialysis patients and mailed surveys of 393 dialysis unit nurses were exa mined to better understand how patients and nurses reconciled incompatible probabilistic and evaluative judgments. Results indicate that patients seek information that will enable them to cope with debilitating dialysis treat ments rather than information nurses believe is necessary for them to make informed choices about whether to undergo such treatments. The tension betw een the information patients want to successfully cope with life and the in formation they need to decide intelligently about treatments that forestall death constitutes a key reason why communication about end-of-life issues is frequently flawed. Our analysis of these communication flaws leads to sp ecific recommendations for how this tension can be eased, which in turn may better prepare patients to make the transition from coping with life to co ping with death.