Why We Shouldn't Be Scared to Death to Have "That" Conversation

Why We Shouldn't Be Scared to Death to Have "That" Conversation
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We have all faced those conversations. The ones that we feel are 'impossible'. A trip to the dentist for a root canal sounds more enticing. The most frequent rationale against initiating such a discussion is "I already 'know' how the person will react so it is pointless."

However, we rarely consider how our own discomfort may be preventing us from starting a difficult conversation. Rather than deal with or accept that we are avoiding our own potentially unpleasant experience, we project our own challenges onto the other person. In other words, we tell ourselves that we would be able to handle the conversation, but the other person cannot or will not be able to deal with it, so best to just avoid it altogether. Powerful research that deals with literal end-of-life conversations provides a compelling story as to why we may want to reconsider our biased perspective.

A study conducted at Massachusetts General Hospital involved 150 patients who had terminal lung cancer. Half of the group were randomly assigned to receive traditional treatment. The other half received standard care along with visits to the hospital's outpatient palliative care service.

Among other things, the group receiving palliative care was asked how they would like their treatment to be modified if their physical health changed. Families may be reluctant to have this conversation, as they may be uncomfortable discussing the possibility of their loved one's condition worsening. However, these possibilities are real and such discussions empower patients to talk about their preferred care rather than leaving it to the medical personnel or family members to make that decision.

The preliminary results were quite promising. First, significantly more patients receiving palliative care had their resuscitation preferences documented in their medical records than those receiving standard care; an important area to ensure patient wishes are followed at the end of life. Palliative care patients used less aggressive end-of-life care, which included less frequent chemotherapy as well as longer hospice care. These less aggressive treatments resulted in lower costs, which benefited the patients, their families, and the hospital.

Perhaps the most fascinating results related to their psychological and physical well-being. Specifically, the palliative care group was less depressed three months after their initial visit, experienced less pain, and reported a higher quality of life than those who received standard treatment alone.

In addition to the psychological benefits, these palliative care discussions also impacted the lifespan of the patients. Researchers found that although patients receiving palliative care chose "less aggressive end-of-life care'" these patients lived significantly longer; by an average of 25%.

The only difference between the two groups was the opportunity to have palliative care discussions, which focused on the realities of their disease and the patients' desires for how they wanted they wanted to live their lives at this terminal stage. Despite the gravity of the situation, opening the door to these difficult and deeply personal conversations yielded an opportunity to discuss what mattered most.

The above results suggest that the benefits of such difficult conversations far outweigh the discomfort we may feel when engaging in them. However, we may feel overwhelmed by the implications of these discussions and find ways to avoid it. While promoting his latest book, Being Mortal, Dr. Atul Gawande poignantly observed that this research points to the fact that "we are making bad decisions out of our anxiety about having these conversations."

This observation about how our personal discomfort prevents us from having crucial conversations also applies within a leadership or professional context. In many cases, this anxiety we experience about having a difficult conversation with someone can be used to rationalize its avoidance.

One such example is performance discussions. Many employees often complain they operate with very little performance-related feedback. Managers downplay negative feedback and leave out crucial specific information when employees do not achieve their targets. In many cases, the employee is ultimately let go when the situation does not change, and are left feeling blindsided by this drastic action.

The above research suggests that we should embrace rather than sidestep constructive feedback, as it can represent an opportunity to clarify a performance issue, and determine how best to move forward. For example, when candidly discussing the issue, the employee may decide to voluntarily exit the organization. This can minimize or eliminate feelings of resentment, as well as reduce potential legal costs. It may also leave a positive feeling from the employee about the organization when discussing their experience in their own networks and communities.

Furthermore, these transparent discussions can allow the employees to feel a part of crafting their destiny. They can also contribute to determining their performance goals and highlight the desired metrics. If these are not met, there is a clear strategy for moving forward, as well as mutually agreed consequences for not achieving specific objectives. The organization is then in a better position to act on a plan that is transparent and co-created with the employee.


Dealing with end-of-life matters is one of the most challenging and uncomfortable conversations to have. Yet, when done properly, it can empower and engage the individuals who need it most, resulting in improved physical and emotional well-being.

This provides an invaluable leadership lesson. When leaders have the courage to embrace difficult conversations in an authentic and transparent way, they maximize opportunities for more positive outcomes.

Although we may feel 'scared to death' of having certain conversations, leaders can draw inspiration from the above research, which persuasively demonstrates the importance of these discussions. By acknowledging the discomfort of the situation but engaging in it anyway, leaders can capitalize on the opportunity to bring crucial insight to the situation - thereby yielding profound benefits to the people they serve.

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