What Matters Most? Making Room for Conversations We Keep Putting Off
National Hospice and Palliative Care Month
“I don’t want to upset her.”
“We’ll talk about it when we need to.”
“I wouldn’t even know how to start.”
When someone we love is aging or living with a serious illness, conversations about their wishes can feel overwhelming. We may worry that asking about comfort, future care, or the end of life will take away hope. Sometimes, we keep waiting for the right moment.
November’s National Hospice and Palliative Care Month offers a gentle invitation to begin. A conversation can start with something as simple as:
“What matters most to you right now?”
Quality of Life Is Personal
We often talk about quality of life as though everyone understands it the same way. Yet what makes a day meaningful can look very different from one person to another. For someone you love, it might mean sitting outside, attending a religious service, spending time with grandchildren, or being comfortable enough to enjoy a conversation. Someone else may place the greatest importance on privacy, independence, familiar surroundings, or remaining involved in decisions.
Rather than assuming we know, we can ask:
“What makes a day feel like a good day to you?”
“What are you hoping you’ll still be able to do?”
“What worries you most about your health or care?”
“Are there cultural, spiritual, or personal wishes you want us to understand?”
“Who would you trust to speak for you if you couldn’t speak for yourself?”
The answers may surprise us. They may also change over time. What matters is making room to hear them.
Understanding Palliative Care and Hospice
These terms can bring uncertainty, especially when families first hear them during a difficult time.
Palliative care supports people living with serious illness by addressing symptoms, stress, and quality of life. It can begin early and be provided alongside treatment for the illness. It also helps people and families understand care options and discuss their goals.
Hospice care focuses on comfort and support as someone approaches the end of life, when care goals shift away from trying to cure the terminal illness. It includes support for the person and their loved ones. A healthcare team can explain whether hospice is appropriate and what services are available.
Asking about either service creates an opportunity to learn. Families do not need to arrive with every answer.
Start Small and Leave Room to Pause
You do not have to cover every concern in one conversation. Choose a quiet time when the person feels comfortable, and ask whether they are open to talking.
You might say:
“I care about you, and I want to understand what feels most important to you. Would it be okay if we talked a little about that?”
Or:
“If your health changes, I want to support you in ways that reflect your wishes. What would you want me to know?”
If they are not ready, respect that. You can let them know the invitation remains open.
There may be tears, silence, humor, or uncertainty. Resist the urge to fill every pause or immediately reassure someone that everything will be fine. Sometimes the most caring response is:
“Thank you for telling me. I’m listening.”
Listen Before Trying to Solve
Hearing a loved one’s wishes can stir up our own fears. We may want more time, different choices, or reassurance that they will keep pursuing every available treatment. Their priorities may differ from ours.
Try reflecting back what you hear: “It sounds like being comfortable enough to spend time with family is especially important to you.” Then ask whether you understood correctly.
If someone says, “I don’t want to be a burden,” gently explore what that means. Are they worried about money, needing help with personal care, or exhausting a family member? Understanding the concern can help guide a more useful conversation.
When questions about treatment arise, bring them to the healthcare team. A helpful question is: “How would this option affect the things that matter most to them?”
Give Wishes Somewhere to Go
A meaningful conversation deserves follow-through. With your loved one’s permission, write down important priorities and share them with the people involved in their care. Ask the healthcare team how to document wishes, identify a healthcare decision-maker, and complete or review advance care planning documents. These conversations can help connect future care with the person’s values. Return to the discussion as circumstances change. A person may feel differently after a new diagnosis, a hospital stay, or changes in daily life.
Resources to Help Put Your Wishes in Writing
You do not have to start with a blank page. These resources can help you explore what matters, begin conversations, and document your healthcare wishes:
The Conversation Project offers free conversation guides to help you talk about your values, care preferences, and who you would want involved in decisions.
PREPARE for Your Care provides step-by-step guidance and easy-to-read, state-specific advance directive forms in English and Spanish.
CaringInfo offers information about advance care planning and free advance directive forms by state, including Missouri.
Five Wishes helps people document personal, emotional, spiritual, and medical preferences, along with who should speak for them if needed. Some materials have a fee.
An advance directive records healthcare preferences and may also name a healthcare decision-maker. A durable power of attorney for healthcare names someone to make healthcare decisions when you cannot. Follow the instructions for your state, including any witnessing or notarization requirements.
Once completed, share copies with your healthcare decision-maker and healthcare providers. Keep a copy somewhere accessible, and tell trusted people where to find it. Review your wishes periodically, especially after changes in health or relationships.
The paperwork matters—but so does helping the people who care for you understand the wishes behind it.
Caregivers Need Space, Too
Supporting these conversations can be emotionally demanding. You can respect someone’s wishes while also feeling sadness, fear, exhaustion, or uncertainty. You may need help preparing questions, understanding resources, or talking through your own feelings. You may also need an honest conversation about what care you can realistically provide and where additional support is needed. Your needs deserve attention throughout the process.
Finding Your True North Through Difficult Conversations
At True North Wellness Services, LLC, we recognize how deeply personal these moments can be. Through caregiver support, care navigation, education, and resource connections, we help individuals and families prepare questions, explore concerns, and navigate next steps with compassion. You do not need perfect words to begin. You need a willingness to ask, listen, and return to the conversation with care.
“I love you. I want to understand what matters most to you.” That can be enough for today.
True North Wellness Services, LLCGuiding You Toward Balance, Purpose, and Well-Being.
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