When it comes to terminal illness, conversations can be difficult, whether they are with physicians or family members.

"It is sad. It's a time of intense emotion," said Linda Logue, coordinator of Sharon Regional Health System's hospice program. "But it's also a time when people can grow, learn how much the people around them care about them."

Jodie Moroco, bereavement counselor with Sharon Regional's hospice program, said conversations about death vary according to the age and relationship of the dying person's relatives.

"Obviously, you're not going to talk to a 3-year-old the same way you talk to a 15-year-old," she said. "We encourage the family to talk to them as much as possible."

Ms. Moroco works with children before and after their family member dies. She said they talk about the concept of burial, do artwork that reveals their feelings and read stories that address death through metaphor.

When a family member, such as a parent or grandparent dies, children often face issues of security and abandonment. They may be afraid that everyone is going to leave them or that they might die also.

Ms. Moroco said it is important for parents to talk to their children about death.

"We as counselors never lie to them, and we encourage parents not to lie," she said. "Most don't. They may say, 'I don't know if this is going to get better.' "

While conversations with family members about impending death are difficult, physicians who had been treating the terminally ill also find these conversations tough.

"For oncologists, it's often a very hard thing to go from actively treating patients and repeatedly giving chemotherapy to talking with the patients and families and saying there may not be much more we can do," said Dr. George Garrow, medical director for medical oncology at Sharon Regional's Cancer Care Center.

Garrow said having a previous relationship with the patients and their families before their illness is deemed terminal makes conversations about death easier.

"The hardest thing I do is when I have to have this discussion with a patient and not have a pre-existing relationship," he said. "It's easier if you're treating them from the time of diagnosis."

Surprisingly, Garrow said, patients usually welcome discussions about death. It's their families who don't want to give up hope.

"I usually find that is the biggest challenge," Garrow said. "Patients often have an inner sense or knowledge of what's happening to their bodies. Often it's the family that struggles, seeing someone they love at the end of their life."

It's at this time Garrow discusses going from aggressive treatment to palliative care, which does not treat a patient's symptoms to make them comfortable but does nothing to either lengthen or shorten life.

He also emphasizes that he will still be there to support the patients and their families.

"I say, don't feel I'm going to walk away. I'm still going to be with you," Garrow said.

Ms. Logue said conversations with dying loved ones can help improve the quality of their lives at the end, as well as wrap up any unresolved issues. The hospice center offers a booklet called "How to Say Good-bye," which deals with making a dying patient comfortable both physically and spiritually.

Ms. Logue said a hospice nurse made a list of the five things that should be said before a loved one dies:

Forgive me.

I forgive you.

Thank you.

I love you.

Goodbye.

"Continue to talk to them, continue to tell them you care," Ms. Logue said. "We tell people, if you're able to say good-bye to them, it's very freeing ... if they never can, we don't say they have to."