How TV Shows Can Prompt Real-Life End-of-Life Planning

Takeaways

• Television shows with end-of-life storylines can encourage viewers to engage in personal end-of-life planning.
• Despite the importance of end-of-life planning, many people avoid it because of emotional discomfort, lack of knowledge, or perceived time constraints, but these barriers can be overcome through practical steps and open conversations.

Thinking about the end of our lives can be so unappealing that many of us put it off. However, people are beginning to discuss the subject more readily, and some television shows may be helping to lead the way.

In a recent survey conducted by End Well in collaboration with the Norman Lear Center Media Impact Project at the University of Southern California, researchers found that watching thoughtfully crafted end-of-life storylines on television correlates with a higher likelihood of viewers taking concrete end-of-life planning steps.

For example, viewers of shows that openly depict dying, discussions about end-of-life preferences, and advance directives were significantly more likely to initiate conversations with loved ones about end-of-life topics, discuss preferences for end-of-life medical care, and draft or update advance directives.

The report, titled Changing the Channel on Death: How Television Can Lead the End-of-Life Revolution, describes how authentic portrayals of dying, marked by realism, humor, medical accuracy, and meaningful character arcs, help reduce fear and prompt viewers to think about how the situations in the shows could apply to them.

In short: stories we watch can reshape the way we live, and the way we prepare to die.

Why This Matters

Although about 90 percent of Americans say discussing end-of-life wishes is important, only around 27 percent report actually having done so. That gap is enormous and points to a real public-health and personal-wellness issue.

When people have had end-of-life planning conversations, they are more likely to receive care consistent with their values and their families suffer less stress. Together, media and health care providers can normalize end-of-life conversations, increase access to supportive care, and ensure dignity when we reach the end of our lives.

By spotlighting this issue through TV narratives, End Well and the Media Impact Project are showing how culture can shift behavior. If watching a show can trigger planning, maybe we should all be paying more attention and taking action.

Why People Avoid End-of-Life Planning

Though nudges from media may help people be less hesitant about end-of-life planning, many of us still avoid or delay this type of planning for any number of reasons:

• Emotional discomfort and avoidance. Some people may feel that delving into the topic of death means giving up hope or tempting fate or find the topic too sad, too final, or simply “too soon.”
• Uncertainty about what to plan or how to start. Even when someone wants to plan, they may not know where to begin or what legal documents to use.
• Lack of time. In clinical settings, as well as many personal settings, time can be limited. Though health care providers have these discussions with their patients, they report that a lack of time is the biggest barrier to the discussions when they don’t happen.
• Role confusion and system gaps. People may not know who should start the conversation: their doctor, a family member, an attorney, or them. The lack of clarity around who initiates the conversation, who documents it, and who follows up can be a barrier. Additionally, institutions may lack standard communication systems, leadership support, or routine workflows to embed end-of-life planning into their practices.
• Cultural, demographic, and health-literacy factors. Some populations are less likely to engage in end-of-life planning because of cultural or religious beliefs, lower health literacy, or mistrust of the health care system.
• Waiting until illness or health decline. Many people delay planning until they are sick or are nearing the end of their lives. However, by then the ability to make sound choices may be severely diminished.

How to Overcome These Barriers: Practical Steps

The good news is that many of the barriers are addressable. Here are strategies you or your loved ones can use to turn intention into action.

Start the Conversation Early and Keep It Simple

You don’t need to launch into complex paperwork. Start with questions like:

• “Have you ever thought about what kinds of medical treatments you’d want if you couldn’t speak for yourself?”
• “If something changed and you couldn’t make decisions, whom do you trust to talk to the doctors for you?”

These questions open the door and make the subject less abstract.

Use Media Moments as Springboards

If you and your family watch a TV show that features an end-of-life storyline, pause and ask: “If this were us, what would we want?” The End Well study shows that witnessing these storylines can push people toward real-life planning, turning passive watching into active reflection.

Break the Task Down into Manageable Parts

Advance care planning and end-of-life preparation don’t have to happen in one day. Consider a phased approach:

• Sit down and discuss your values, such as quality of life, comfort versus life-extension, location, and whom you would want around you.
• Choose a trusted person to be a medical decision-maker for you as your health care proxy.
• Draft or review your advance directive with an estate planning attorney and share it with your proxy, primary care physician, and pertinent family members.
• Store the documents where the relevant people can find them, such as your doctor’s office, a family folder, or on a cloud-based server.

Leverage Resources and Aids

Numerous guides and templates are available online, but make sure the ones you look at reflect the laws and practices in your state. You may also be able to find community workshops at hospitals, hospices, and aging-services organizations in your area or online.

Normalize the Conversation

Rather than letting this be “the scary talk,” try to integrate end-of-life topics into normal life. For example, mention at your next family gathering that you’re working on your estate plan documents and ask if your loved ones have done the same. Bring the topic to your primary care physician or a trusted clinician as well. Let them know about your interest in planning and ask for help or referrals.

Check In and Revisit

Life changes, such as marriages, births, illnesses, and changes in belief, can affect the types of care you want or don’t want. Revisit your plans as needed to keep your plan current and meaningful.

Why It’s Worth the Effort

Planning for end-of-life care may seem like an unpleasant hassle, but it can serve as a gift to yourself as well as those closest to you. Important reasons to take the time and put in the effort to make end-of-life plans include:

• Less burden on loved ones. When your wishes are clear and documented, your family doesn’t have to guess or deal with guilt, litigation, or lost time.
• Better alignment of care with your values. People who engage in advance planning are more likely to receive care that reflects their goals and less likely to undergo unwanted treatments.
• Peace of mind. Knowing you’ve done your part can ease anxiety for you and your loved ones in the face of life’s uncertainties.
• Planning is part of living well. Estate plans aren’t only about death; they are about ensuring your final chapter matches the life you’ve built.

The survey from End Well and the Norman Lear Center reminds us that stories matter: What we watch can influence what we do in our day-to-day lives. However, while watching a TV show can open a door, walking through it is up to us. Taking even a small step can make a difference.

Today might be a great day to start the conversation by talking to your doctor, an estate planning attorney, or a trusted friend or family member. Ultimately, planning for the end of life is planning for the rest of your life as well as for those you’ll leave behind.

Additional Reading

For additional reading on topics related to end-of-life planning, check out the following articles:

• Estate Planning With Dementia on the Rise
• When Should I Start My Estate Planning Journey?
• Why Should I Work With an Estate Planning Attorney?
• What Most People Don’t Know About Durable Powers of Attorney
• Make Sure Your Beneficiary Designations Match Your Estate Plan
• Benefits and Drawbacks of Do Not Resuscitate (DNR) Orders