By Daryl Buchanan | News & Views

Discussing death and end-of-life planning with patients can be an especially difficult conversation for medical professionals. These talks often stir the emotions and thoughts of patients and their families. However, Julia O'Shea, BA, RRT, and Alex Worl, BS, RTT, led a session at the 40th AACVPR Annual Meeting in September that offered insights for medical professionals seeking ways to make these conversations easier for patients and clinicians.  

O'Shea, with the University of Vermont Medical Center, says the need to shed light on this sensitive topic arose after working with patients suffering from pulmonary disease and the complex circumstances surrounding their treatment. “Some of them go on to live very long, fulfilling lives. But others may also get sick and pass away quickly because of an exacerbation. Seeing that in my world on a day-to-day basis drove home the need to have an open and honest discussion,” says O’Shea. 

Julia O'Shea, BA, RRT

She recognized the Annual Meeting as an excellent opportunity to share her insights with a group of like-minded individuals. O’Shea explains, “We’re all trained to improve patient quality of life, to help them exercise, and to breathe better. But dying is part of this process, right? It just may happen sooner for some than others.”  

“This Annual Meeting was an opportunity to help empower and support other professionals to open up these questions and engage in these conversations. I think this is a conversation the audience will [take back and] share with their patients,” she adds.  

Despite the difficulty of talking about end-of-life planning, O’Shea says these discussions can be approached as a means of offering comfort and clarity to an ailing patient. Explaining what certain medications do, preparing documents for families, and even giving them choices of where they would like to spend their final moments can ease some of the anxiety and fear patients may have.  

“Research has shown that engaging in these conversations not only helps patients be prepared and have an “easier transition,” but it also helps their families and loved ones during the grieving process,” states O’Shea.  

She continues, “One thing I think is unique to pulmonary rehab is that we get a lot of time with our patients because they’re with us sometimes two or three days a week. So, we get to know them really well. We develop an intimate relationship with some of them. That opens up a space of vulnerability. That connection can be really powerful when helping these patients face challenging situations and decisions.”  

As respiratory therapists, both O’Shea and Worl relied on years of professional experience to facilitate their session. They both spent time working at the University of Colorado Hospital, where they gained invaluable experience.  

Alex Worl, BS, RTT

“Respiratory therapists are around a lot of death because of our job responsibilities. So, there would be days where we’d be doing end-of-life on multiple people and taking them off ventilators. So, she and I share that same kind of thread of familiarity with death,” O’Shea adds.  

However, both presenters also included their personal experiences as part of their session. O’Shea notes that she and Worl come from families that viewed death and dying very differently. Worl grew up in a family where her grandmother was very open when talking about death. In contrast, O’Shea comes from a family where death wasn’t talked about as easily.  

“I think putting our brains together, both from her side of being more comfortable and my side of not being very comfortable, gives us the ability to relate to the audience. We can say we’re not palliative care experts — we’re pulmonary rehab professionals who have a background in understanding death. However, we can help to engage and open up these conversations,” adds O’Shea. “It’s okay to feel uncomfortable or to not want to talk about it. But there are different tips and strategies that can help people understand that planning is super-important for overall outcomes for everybody involved.”   

For pulmonary professionals that attended the session, O’Shea believes they obtained valuable knowledge that can benefit patients, families, and clinicians. She says the audience seemed very engaged and many attendees shared their own personal experiences in managing conversations about end-of-life planning.  

“For those interested in engaging in more meaningful conversations or improving their comfort level, they walked away with some tools to help identify how to fit these conversations into their pulmonary rehab programs,” adds O’Shea. “The goal was to learn from each other, which I think we accomplished.”  

If you were unable to attend O’Shea and Worl’s presentation, “Let’s Talk About Death,” you can still access it — and all of the recorded sessions and presentations from the Annual Meeting — through AACVPR’s On-Demand Access Pass. If you purchase the pass by February 1, 2026, you can unlock the education anytime between November 3, 2025, and February 26, 2026, and receive continuing education credit, as applicable.