Communication in Palliative Care
Good communication is essential for decision making throughout the course of an illness. As a disease progresses, new symptoms emerge, more specialists are consulted, and the emotional stresses of managing the illness mount. Adequate communication among the patient, family, primary care providers, multiple specialists, and health care professionals from various settings is necessary to coordinate care and decrease fragmentation. Information shared with patients and families must be honest, clear, and consistent to enhance understanding of the disease process and the patient’s overall health status, to guide decision making, to assist in setting realistic goals, and to prepare for the end of life.
Health care professionals often do not receive adequate training in communication (Back et al., 2005). This is especially true when it comes to giving bad or sad news to patients and families. Health care professionals also avoid these conversations because of fears of provoking emotional distress, lack of knowledge on how to handle the emotional reactions of patients and family members, concern about how health care professionals will handle their own emotions, and a desire to avoid confronting one’s own fear of death (Fallowfield, 2005).
• Use of medical terms that may be misinterpreted or not understood
• Concerns that discussing a poor prognosis will cause harm
• Difficulty in determining prognosis
• Attitudes held by both health care professionals and the public that death is a failure of medical interventions
These factors can lead to collusion to produce false optimism about recovery (The, Koeter, & van der Wal, 2000). This collusion is seen when, instead of clearly discussing the overall illness trajectory, both health care professionals and patients focus on available treatments and their associated side effects. Patients often interpret “treatment” as “can be cured,” whereas health care professionals often use the term treatment to mean “can be controlled.” The collusion of false optimism continues when prognosis is not discussed because both the health care professionals and the patients are waiting for the other person to bring up the subject.
KEYS FOR EFFECTIVE COMMUNICATION
Establishing Trust
The following strategies may assist health care providers to develop a trusting relationship with patients and family members (Back & Arnold, 2005; Tulksy, 2005):
• Let them know you are interested in knowing the person and the impact of the disease on the patient and family. Encourage patients and family members to talk so as to learn their understanding of the illness, what the patient’s life was like before the illness or hospitalization, and how the patient and family are coping with the current situation. Open-ended questions help to initiate discussion (e.g., “What do you understand about your illness at this time?”).
• Recognize the concerns of patients and family members. If these concerns involve not receiving adequate information or receiving conflicting information from other health care providers, validate that you understand this is a concern without contradicting other health care providers. Commit to clarifying any conflicting information the patient or family has heard.
• Acknowledge any errors or misunderstandings that may have occurred and establish a plan to avoid them in the future. Denial and defensiveness interfere with trust.
• Demonstrate respect for the patient and family at all times. Frame the situation as a mutual issue of concern that the health care team wants to work in collaboration with the patient and family to address.
• Do not force decisions. When decisions are needed, ensure that the patient and family understand the risks and benefits of all options, give them time to think about the information that has been presented, and set up a time for follow-up.
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