Communication

KEYPOINTS

  • Communication is a cornerstone of palliative care, affecting both quality of care and quality of life
  • Communication affects the interpersonal relationships within and between health care teams, patients, and family/caregivers
  • Communication can influence: symptom control, understanding of information, decision-making, abilities to cope
  • Effective communication reduces uncertainty, helps people feel understood, helps people maintain a sense of control, gives people a direction in which to move, gives people sense of hope
  • Specific communication skills can facilitate supportive conversations and help people get their needs met
  • Communication of information, difficult or otherwise, is an ongoing process
  • Personal beliefs, values and assumptions impact the way we relate to and understand the experiences and needs of patients and family/caregivers

CONSIDERATIONS

Communication: Patients and Family/Caregivers

  • What information about the patient and their family/ caregivers would be helpful?
  • How do patients and family/caregivers want to be involved in information sharing and decision-making?
  • How does the patient understand their situation? What information is known and what do they want to know or not know?
  • How does the family/caregiver understand the situation? What information is known and what is being shared or not shared between patient and family/caregivers?
  • What opportunities and challenges exist within the patient and family relationship?
  • What tools or resources may be helpful when sharing information, e.g., visual aids, written information, interpreters, presence of a loved one?

Communication: Health Care Team

  • What information gets shared between the team and how is this communicated and/or documented?
  • What information do patients and family/caregivers want people to know or not know?
  • Good communication within a team can improve patient care and satisfaction
  • Dealing with conflict and differences in a team can often be challenging and requires time and commitment to developing a process
  • How do teams approach conflict or differences with patients and family/caregivers?

STRATEGIES

Effective Communication

Active listening

Active listening is a powerful therapeutic intervention. It involves ways of listening, giving full attention, expressing empathy, and responding to another person that improves mutual understanding. People’s way of thinking, seeing, hearing, and interpreting the world is influenced by their beliefs, values, fears, and social and cultural backgrounds. Active listening is best done without interpretation or evaluation.

Facilitating Conversation
Open-ended questions

  • Open-ended questions allow people the opportunity to describe and express their feelings, thoughts, and concerns more fully.
  • Examples:
    • “How are you feeling today?”
    • “What has been worrying you most?”
    • “How have you been coping with these experiences?”
    • “I understand that you have some questions and concerns about your care. Can you tell me more about that?”
    • “How do you see things going from here?”

Clarifying responses

  • Clarifying responses help to understand the facts and people’s feelings, attitudes, beliefs and values.
  • Examples:
    • “Can you give me an example of what you are talking about?”
    • “Tell me more about …”
    • “As you were talking I noticed … in your body language. I am wondering if you are feeling/experiencing …?”

Paraphrasing and summarizing

  • Paraphrasing and summarizing let’s people know that they are being listened to and their experiences are understood.
  • It also provides an opportunity to get further clarification.
  • Examples:
    • “What I hear you saying is that you have been experiencing … which has been making you feel … Have I understood that correctly?”
    • “What would be most helpful? Is there anything else you need?”

Non verbal communication

How people communicate is rooted in cultural and social traditions, values and beliefs. Observing people’s body language, posture, gestures and facial expressions can provide clues to people’s feelings, emotions and capacities for coping. It is important to attend to the complex ways people communicate non-verbally and carefully and respectfully explore with the individual what information they may be communicating and are unable to verbalize. It is equally important to attend to our own non-verbal communication, and how this may impact our attempts to convey respect, compassion and understanding.

SOURCES/REFERENCES

  1. Bruera E, De Lima L, Wenk R, Farr W, editors. Palliative care in the developing world: principles and practice. 1st ed. Houston (TX): International Association for Hospice and Palliative Care; 2004.
  2. Cairns M, Thompson M, Wainwright W. Transitions in dying and bereavement: A psychosocial guide for hospice and palliative care. Victoria (BC): Victoria Hospice Society; 2003.
  3. Downing GM, Wainwright W, editors. Medical care of the dying. 4th ed. Victoria (BC): Victoria Hospice Society; 2006.
  4. Doyle D, Hanks G, Cherny N, Calman K, editors. Oxford textbook of palliative medicine. 3rd ed. Oxford: Oxford University Press; 2005.
  5. Emanuel L, von Gunten C, Ferris, F. Education for physicians on end-of-life care (EPEC) curriculum. Princeton (NJ): Robert Wood Johnson Foundation; 1999
  6. Librach L, Gifford-Jones W. Ian Anderson continuing education program in end-of-life care. Module 5: communication with patients and families. [Online]. Available from: URL:http://www.cme.utoronto.ca/ENDOFLIFE/Modules/COMMUNICATIONS%20MODULE.pdf
  7. Storey P, Knight CF. UNIPAC Two: Alleviating psychological and spiritual pain in the terminally ill. Gainesville (FL): American Academy of Hospice and Palliative Medicine; 1997.
  8. Watson M, Lucas C, Hoy A, Back I. Oxford handbook of palliative care. Oxford: Oxford University Press; 2005.
  9. Werth J, Blevins D, editors. Psychosocial issues near the end of life: a resource for professional care providers. Washington (DC); American Psychological Association; 2006.

Back to top of page Next page Previous page

Unless otherwise stated, the content of this page is licensed under Creative Commons Attribution-ShareAlike 3.0 License