DMA and Framing

Framing and re-framing are "shrinky" terms I use a lot in my work as a public speaker analyzing the experience of healthcare. A prime example of this comes from my work with advance care planning (end of life decision conversations and decision making). When teaching this material in our culture, a culture very adverse to discussing anything about our end, I can be assured my student's first response will be one of resistance. As a teacher, it becomes my job to then find a way to re-frame the messages in a way that become appealing so that they may open up their mind and heart to the ideas I am presenting.

The first step is always to examine the existing lenses or frames use to view end of life planning. For most red-blooded Americans, the topic is scary, distasteful or unnecessary. For some, it goes further into a superstitious attitude of "if we speak it, it will be." This framing makes productive conversations about advance care planning impossible. To begin the re-framing process, we must begin talking openly about where our prejudices and values come from and whether or not they are worth hanging on to.

Often, through our conversations, we begin to gather new information. This information comes from myself, as the teacher, peers with different experiences and from within. We learn the practical reasons within the context of healthcare. We learn that the standard way of approaching advance care planning is not usually the strategic way. Most importantly, we learn what it is that has "turned us off" and kept us from looking at this sooner.

More often than not, this gathering results in a creation. Creation of new thought, new perspectives and a new motivation for action. During the conversation, realizations are made on an intellectual level and an emotional one. Often people respond to the practical aspects of end of life decision making when it is re-framed as "advocating for yourself in the future." The greatest impact often comes from a more emotional place, however. This is when people make the connection that advance care planning is not a selfish act about themselves but, instead, a generous gift to family so that they can have more ease and peace when making decisions on behalf of their loved one. This realization is what brings about creative ideas on how to have the conversation, when to have it and who to have it with.

Reflection is a powerful tool in this particular example. Reflecting on what "quality of life" means to each individual. Reflecting on who you trust and love deeply. Reflecting on how you'd like to spend your final months/days/hours. All of these deep ponderings open the mind to making the practical choices that have to be made while re-framing the purpose and spirit of advance care planning. Here we have evidence of the challenge cycle and the potential it has to influence lasting and meaningful change.