Communication Techniques in

Palliative Care
Frema Osei-Tutu (RGN,BSN,MPH,PCNS)
 Learning Objectives

o Understand the concept and components of

effective communication in P/C.
o Understand communication difficulties in
P/C.
o Learn communication techniques to help in
difficulties faced in P/C.
o Be aware of the barriers in communicating
with patients.
Introduction
o Effective
communication is a
core clinical skill and
the foundation to
excellent and
successful p/care.
Dahlin and Gasiracusa,
2006.
 Introduction
o Truth is one of the most powerful therapeutic agents, but
we still need to develop a proper understanding of its
clinical pharmacology and to recognize optimum timing
and dosage in its use.

o Communication of painful truth does not equal

to destruction of HOPE.
 Goals of
o
communication
Share information.
o Reduce uncertainty.
o Build trust between the patient and caregiver.
o Explore patient’s worries.
o Help patients make decisions about their care.
o Improves patient and family satisfaction with
care.
 Basic
o Theories
Introduce yourself - even when previously
done.
o Address the patient/s by name.
o Establish who the other person/s are.
o Establish what they already know.
o Use simple language- avoid jargon.
o Think about how you appear.
o Be professional – Boundaries.
Qualities of a Good Communicator
o Knowledge- need to know the facts.
o Clear with information.
o Confidentiality.
o Sincere and non-judgmental.
o Sensitive.
o Empathetic.
o Listener.
o Non-verbal cues.
6 Key Point in a
Toolkit :
1) Comfort - a simple question like “Are you
comfortable”?

2) Question style - the more open the question

the more information you are likely to gather.

Questions should be prefaced with phrases like

“..Please, may I, or could you kindly share with me……”
3) Language - understandable by
patient.

4) Reflection - pick up the key

words, words associated with
feelings.

5) Summarizing - fantastic tool if

you feel stuck in a consultation.
6). Listen Actively ;
include SILENCE.

o Even if they decide

not to speak, they are
still saying
something.

o Do not interrupt!!

o Empathize.
 === 80:20 RULE===
Listen 80% of the consultation time and talk
20%.
Patient to talk 80% of the time.

This is vise vasa!!

Verbal & Non-verbal
Communication:
o Studies show that;

7% of the message is verbally communicated by

words . 93% Non- verbal;
i.e.38% vocal tones
55% facial expression, posture and gestures.
Ref.psychologist Albert Mehrabian popularized the “7-38-55 rule” to emphasize
Albert Mehrabian Model.

Lesson from Alberts

research is that
we
need to pay
attention
to far more than just
the words from our
patients.
 What are the
difficulties?
1) Breaking bad news.

2) Difficulty questions.

3) Denial - a valid coping mechanism for those

who are unable or not ready to cope with the
reality.
o Denial is like a wall of
a stony house.
4) Emotional
reactions.
5) Collusion - Generally an act of love and care.
“We don't want mummy to know her diagnosis….we know her!”.

Ethical principals can guide you handle this:

1. Respect for autonomy; does mummy want to be
told regardless of what the family want?
2. Beneficence; would it help mummy to know her
diagnosis?
3. Non - maleficence; would it harm mummy to know
her diagnosis?
BREAKING BAD NEWS
 What is bad
Definition:
news?
“Any information that drastically and negatively alters
the patients view of his/her future”. (Buckman 1984)
 Who is responsible?

o Any health care worker can break bad news as

long as you are competent and feel comfortable
with it.
o In 2000, Walter Baile and
colleagues set up a six –
step protocol for breaking
bad news using the
acronym SPIKES.
Setting up the
session.
Getting started
o Are you set for the task – read file,
deal with your own issues, finish
up with pressing work etc.

o Environment Setting – arrange for

privacy and adequate space.

o Patient comfort- key.

 Setting
o
Cont;significant others.
Involve

o It is helpful to start with a

question like, "How are you
feeling right now?" to indicate
to the patient that this
conversation will be a two-
way affair.

o Be aware of non-verbal
communication, yours and the
patient.
 Perception
;
 Finding out how much the patient knows.

o
Before you tell, ASK. It is important to gauge the
patients understanding of their situation.

“Would you kindly share with me all what you have been told by your
doctor about your condition Mr P?

o This helps to determining the patients capacity and if

they are in denial.
 Obtaining patients’
HowInvitation.
much information is the patient willing to know?
o For instance, you can say;
"Some patients want me to cover every medical detail, but other patients want only
the
big picture--what would you prefer yourself?"

This establishes that there is no right answer, and that

different patients have different styles.

o Most patients wish to know about their diagnosis

and prognosis of their illness.
 Knowledg
e
Share the information
o Pause, assess and present information.
o Always give a warning shot.
o Present bad news in small chunks and
stop in between to check that they
understand….Your report has come and its
not good”….Check back…Yes its not good” .
…you have Lung cancer”…pause, How
are they feeling?
 Knowledge
o Cont;
Use proper words; cancer…not spots, not carcinoma.
o Repeat the information.
o Do not over burden the patient with a lot of
information.
o Avoid telling the patient that…. “nothing can be done”.
o Even if the disease has advanced for curative treatment,
patient should be reassured that support will be
provided to improve his quality of life.
 Emotions &
Empathy
Respond to patient's feelings.

o If you don't understand patient's reaction, you will leave a

lot of unfinished business, and you will miss an
opportunity to be a caring expert.
o Stop talking when they are showing strong
emotions; crying, anger.
o Allow silence or pause.
o Observe and identify the reason for emotion.
Emotions &
Empathy denial to fear, anger, sadness,
o Phases of emotions range from

self- pity, dependency and

hopelessness.
o Explore and respond to
the patients emotions.
o Give patient uninterrupted time to
express his emotions and let him
know that you are connecting to
his feelings…”This must be very difficulty
for you.. Mr P ….I can imagine.”
 Emotions &
Empathy
Remember you are not responsible for their emotions.
o Take care of yourself, ensure safety.
o Take a deep breath and allow anger to wash over
you, it will stop.
o Silence….Use communication enhancers..Mmm,
mm,
o Don’t interrupt or argue.
 Emotions &
Empathy.
o Listen, Listen, Listen.

o Once the anger is dissipated, cautiously respond

by reflecting back to what you heard about the
major parts of anger.
 Strategy &
Plan andSummary
follow-through.
o Find out if the patient is ready for
further discussion.
o Outline a step-by-step immediate and long term
plan.
o Explain and contract about the next step.
o Should the patient have unrealistic expectations, it
may be useful to ask him to summarize what he
has understood.
o
This usually reveals fears, concerns and
other emotions.
 Strategy &
o
Summary
Offer your recommendations.
o Help patient to Identify support network.
(family, friends, pastor, etc)
o Ask if there are any questions or concerns.
o Arrange for an appointment, follow up.
o Document the discussion in the file.
Communicating Effectively
with Children
Communicating Effectively
with Children
 Barriers to Effective Communication:
o Physical barriers - staff shortage,
o Ambiguity of words - words sounding the same but
different in meaning.
o Patients barriers – cultural, not aware of their right to
information.
o Physiological barriers - individuals personal discomfort due
to ill health, poor vision, hearing and speech difficulties.
o Presentation of information – presented by clinician who
lacks skills, presented too complex and fast to understand.
Communication
during COVID 19
Pandemic!

Not easy and fairly

effective
Conclusion