The use of humor and laughter in research about end-of-life discussions

Abstract

Humor is known to normalise sensitive issues and reduce stress and depression. By studying the spontaneous use of humor in research we aimed to discover its role and impact to inform future researchers and clinicians who engage with patients in discussions at the end-of-life. Semi-structured interviews with 51 patients with cancer who were being interviewed about end-of-life decision-making were taped and transcribed. Reading and rereading and a qualitative software package were employed to identify the sections of the interviews where speech was associated with laughter or humor. The interviewer typically used laughter at the beginning of the interview when issuing instructions to the relatives that the focus of the interview was on the patient’s views, during the interview when clarifying issues that a patient was having difficulty understanding, and at the end when affirming the value of the patient’s co-operation. Humor was also used as a personal response to the patient’s humor or embarrassment. Patients used humor or laughter most commonly when they were uncertain about an answer, when embarrassed at discussing personal or family issues or physical symptoms, or when making broad generalisations. Patients told amusing anecdotes or used colloquialisms for sensitive concepts like death, as well as laughing in response to the humor of the interviewer. The topics most associated with patients’ use of laughter were death, euthanasia, funerals (particularly their own), hope, religion, and when they described complementary and alternate therapies. Humor is appropriate for researchers, and thereby clinicians, to use to help humanise and enhance communication about sensitive issues at the end of life.