If you need to have a discussion about end-of-life decisions.

You may be nervous about discussing end-of-life decisions with a contemplator. However, of all the communication types, a contemplator is the one most likely to have already planned for many of the decisions. After all, advanced planning for difficult situations is practically a recreational pastime for this personality type. If you ask the question and let the contemplator lead the discussion, you may find that the conversation is easier than you expected. Even when the contemplator doesn’t have a specific plan outlined, he’s probably identified the issues and started working on ideas.

Brianna was nervous about discussing end-of-life plans with her mother. It was a very emotional topic for her, and she assumed her mother would be similarly overwhelmed by it. So, one afternoon, over coffee, she gathered her thoughts and asked, “Mom, have you given any thought to end-of-life arrangements? Do you have a living will? What if you need hospice someday? Do you have funeral plans?”

“I have a living will and a DNR order on file with my doctor and the University hospital. Do you want a copy? I’ve been planning to give you medical power of attorney, but I didn’t want to worry you. Can we do that this week? One of my friends volunteers with the local hospice, and we’ve talked about it before.

“My insurance policy is in the top drawer of the file cabinet in the folder marked ‘Burial Insurance.’ I haven’t purchased a plot yet, but I’d like one in Piney Hill Cemetery near my mother’s grave. I should call them Monday. In the folder labeled ‘Funeral’, I’ve listed the dress I want to wear and the hymns I want sung.”

The conversation Brianna dreaded quickly turned into her mother’s opportunity to outline all the plans she’d already made and to make a note of places where she still had work to do. Brianna left the conversation amazed by her mother’s ability to calmly plan for contingencies and to tackle difficult topics head on.

If they are in denial or ashamed of their condition.

When contemplators are in denial or ashamed, it’s often because they feel that they’ve failed to live up to their own standards and plans. When you communicate with them about their condition, be sensitive to their possible shame and guilt. Help them see that they’re not at fault and that they can make a new plan to tackle the current problem.

Adia suspected her mother was having an issue with urinary incontinence. Several times when they were out shopping, her mother returned from the bathroom smelling of urine and demanded that they go home immediately. When Adia tried to bring up the subject of disposable briefs, her mother burst into tears and said that she’d never be able to live a normal life again.

“Mom, this is totally normal. You had four kids. This happens to everyone,” Adia said as she attempted to give her mother a bigger picture view of the situation. “No, it’s my fault,” her mother replied. “I never did the Kegels like the doctor told me to, and now I can’t even go out in public.” “I know this is really embarrassing for you,” Adia said, “But you’re an important part of this community and you can’t just stay at home. We need you. Lots of women have this problem. That’s why they make so many kinds of disposable briefs.” Once she’d had a chance to share her worries and the source of her shame, Adia’s mother was ready to think more logically about the problem. After she had some time and privacy to work through the issue, she agreed to try briefs.

If you think they need to see a specialist.

Because contemplators tend to focus on the details and keep worries to themselves, they may miss signs that point to the need for a specialist when you take all of the symptoms together as part of a big picture. It’s important to acknowledge their symptoms as important, empathize with their suffering, and give them the perspective they need to book an appointment with a specialist.

Aska was worried about her mom’s heart health. “I just get short of breath sometimes, like when I’m pushing a vacuum or bending over. I probably just need to lose weight.” “Well, sure, my feet and legs swell, but I’m probably eating too much salt or sitting too much.” “This cough? It’s just allergies.” “I like sleeping in a recliner. It’s more comfortable.” Her mom saw a list of symptoms that were just signs of aging. Aska, a big-picture person, saw symptoms that added up to possible heart failure and the need for a cardiologist appointment.

Aska started the conversation about a cardiologist by expressing concern for her mother’s suffering. “Mom, you do so much for us all, and I hate to see you struggling. Don’t you wish there was something we could do about all of these symptoms?” She followed up with a bit of perspective. “We really need you in our lives. The kids especially. And these symptoms can all be signs of early heart failure. Can you make a cardiologist appointment?” After a little back and forth, Aska’s mother asked her doctor for a referral to the cardiologist based on her symptoms.

If you think they’re having problems with their medications.

If your loved one suddenly has new medications to take or a new schedule to follow for his medications, you may worry about side effects, whether he remembers to take them, or drug interactions. On one hand, you can trust a contemplator to notice symptoms and side effects. However, you may have to persuade these self-sufficient problem solvers to talk to a pharmacist or doctor about what they’re experiencing.

Beatrice’s uncle had recently visited the cardiologist, pulmonologist, and endocrinologist in quick succession, and ended up with a plethora of new prescription medicines. After a few weeks on the drugs, she noticed that he’d developed a tremor. However, Uncle Henry refused to talk to the pharmacist about possible interactions. “I looked it up online,” he told her. “I’m just cutting one of the pills and taking half in the morning and half at night. I’ll see if it helps before I bother anyone.”

“I really appreciate how you do your own research,” Bea replied once she’d had time to think, “And I think it’s good that you’re trying to stay in control of your health. But I think your pharmacist would still want to know what you’re experiencing. After all, it may be something that should be reported to the drug companies.” Uncle Henry felt loved and valued by her affirmation. Since she framed his tremors as something that should be reported in order to solve the drug company’s problems, he was more willing to talk to his pharmacist and work out a safe, effective solution.

If you think they don’t understand their diagnosis or aren’t following doctors’ instructions.

Contemplators are usually good about following a doctor’s orders, or at least what they assume their doctor ordered. However, sometimes you may see your contemplator doing things that seem to contradict what their doctor has told them. In these situations, it’s important to determine whether your contemplator misunderstood a key bit of information, or whether she’s simply given up because she wasn’t able to comply perfectly with the doctor’s advice.

When Julie’s older sister was diagnosed with Type II diabetes, Julie went along to the dietitian’s appointment. Mariah took copious notes and asked detailed questions during the appointment, and Julie felt like she really understood her situation and her new dietary needs. However, a month later at a family party, Julie watched in horror as Mariah consumed three pieces of cake and a large scoop of ice cream. When she challenged her sister, Mariah replied, “They say it’s all right if you only have a little bit and only splurge occasionally.”

Julie diffused the situation with humor. “And once you cut it, all the carbs fall out, right?” Once her sister was more relaxed, she drew her attention back to the big picture. “You know, everyone has trouble sticking to a new diet,” Julie said. “Sometimes it takes a few tries to develop new habits.” Her gentle opening gave her sister a chance to refocus her thoughts on the problem of the new diet rather than on her failure to stick to it.

If you think they’re not taking proper care of themselves.

Contemplators are usually extremely detail oriented and dedicated to their routines. That can make conversations about proper self-care especially difficult. If you feel like a contemplator isn’t following doctor’s orders, keeping up with hygiene, or getting enough rest, you need to be gentle in your conversation. Chances are that your contemplator is already berating himself for his failure to live up to his plans.

Marcus noticed that his father seemed to be struggling with self-care. His beard, which had always been impeccably groomed, was slowly growing scraggly and dirty. His breath smelled and his hair was uncombed. Instead of pointing out everything that was wrong, Marcus opened with a question. “Dad, are you feeling OK? Has anything been getting harder for you recently?”

His dad unleashed a torrent of worry on Marcus. His hands had been hurting so badly, he couldn’t hold a toothbrush or a razor. He had done and internet search for his symptoms, and there was a chance it was metastatic cancer. He guessed he’d just have to live with the pain, but not for long. Marcus responded with a deep breath and a sincere “Wow, that must be really scary for you. Thank you for letting me know.” After letting his father let out all the pain and worry, he suggested a doctor appointment. His father received a new medication for his arthritis, and was able to resume his familiar routine.

When you think they need extra help.

Because contemplators are detail-oriented problem solvers, they tend to live by a philosophy of “If you want something done right, you have to do it yourself.” That makes accepting extra help especially difficult for them. When you first suggest bringing in extra help to deal with health concerns, expect a list of objections. Your contemplator will need time to work through the situation and accept the solution you’ve offered.

After Natchaya’s mom had surgery, the doctor suggested that she have a physical therapist and a home health aide come to her house several times a week. Natchaya thought the suggestion made sense, since it would allow her mother to receive necessary care without having to leave the house and fight with rainy weather. Her mother, however, promptly registered a long list of objections, including, “What if they break something? What if they steal from me? How do I know these home health people are any good? If there’s bad weather, will they still come? Who will pay for them? Will I have to keep extra equipment in my living room?”

Instead of trying to immediately answer her mother’s objections, Natchaya gave her mom time to think, plan, and research the home health company the doctor suggested. After a few days, her mother was ready to accede to the doctor’s wishes. While she still had concerns, she’d also come up with solutions like “I’ll lock my jewelry up before they come,” and “I will ask them about their inclement weather policies.” Natchaya’s mother was able to solve the problem presented by home health once she had time and space to tackle it in her own way.