End of Life Conversations

Talking about dying when faced with end-of-life may be important for achieving optimal outcomes for young people and their families. This analogue study examined the role of attachment theory in conversations about dying. Experiment 1 assessed attachment security of 80 healthy young adults and randomised them to receive either an induction that raised awareness of one’s attachment figures or a neutral induction, and then primed them with an imagined scenario where they were diagnosed with an incurable illness. Participants then completed a self-report measure of their willingness to discuss end-of-life topics with family, friends, or a psychologist. The experimental attachment induction did not increase willingness to talk about end-of-life concepts. Experiment 2 extended this design and asked participants to describe these conversations and assessed the content of their imagined end-of-life conversations. Experiment 2 replicated the finding that enhancing individuals’ awareness of key attachment figures did not increase participants’ willingness to engage in end-of-life conversations. However, heightened attachment awareness led participants to talk more about their relationship with the person they were hypothetically talking with. Across both experiments, avoidant attachment tendencies reduced the likelihood that participants receiving the attachment prime would want to engage in end-of-life conversation. Overall, it seems there are important differences between individuals on willingness to talk about death, and this may be influenced by one’s attachment style. These results raise implications for the importance of attachment in the therapeutic relationship for healthcare professionals working with young people with life-limiting illnesses, such as cancer. Further research may shed light on how an individually tailored approach, taking into account attachment security, achieves the best outcomes for individuals who require end-of-life conversations.

直面临终阶段时谈论死亡，或许对青少年及其家属获得最优诊疗结局具有重要意义。本模拟研究（analogue study）探讨了依恋理论（attachment theory）在死亡话题对话中的作用。实验1招募了80名健康青少年，评估其依恋安全感（attachment security），并将其随机分配接受两种启动操作：一是唤醒个体对其依恋对象（attachment figures）关注度的依恋启动，二是中性启动；随后对所有被试进行假想场景启动，即假设自身被确诊为不治之症。随后，被试完成自我报告量表，以评估其与家人、朋友或心理学家谈论临终话题的意愿。实验结果显示，依恋启动并未提升被试谈论临终相关议题的意愿。实验2拓展了该实验设计，要求被试描述上述假想对话，并对其临终假想对话的内容进行编码分析。实验2重复验证了前述发现：提升个体对核心依恋对象的关注度，并未提升被试参与临终话题对话的意愿。但依恋唤醒程度更高的被试，会更多地谈论其与假想对话对象之间的关系。综合两项实验结果来看，回避型依恋倾向（avoidant attachment tendencies）会降低接受依恋启动的被试参与临终话题对话的意愿。总体而言，不同个体谈论死亡的意愿存在显著差异，而依恋风格（attachment style）或许是影响该意愿的重要因素。本研究结果提示，对于与罹患癌症等终末期疾病青少年打交道的医护人员而言，依恋在治疗关系中的重要性不容忽视。未来研究可进一步探索，如何结合依恋安全感制定个体化干预方案，以帮助需要开展临终话题对话的个体获得最优诊疗结局。