The Human Connection of Palliative Care: Ten Steps for What To Say and Do

Summary

This transcript highlights the importance of training healthcare professionals in having complex conversations with seriously ill patients and their families. It emphasizes that these discussions are as critical as medical procedures, requiring preparation, communication, and empathy. The speaker outlines strategies for creating a supportive environment, ensuring clarity, and guiding patients through difficult information. Key techniques include the 'ask-tell-ask' approach and providing written summaries for reassurance. The goal is to empower patients as active participants in their care and to enhance the communication skills of healthcare professionals for the future.

Takeaways

• 🧠 Complex medical conversations, like surgical procedures, require training, practice, and supervision.
• 📊 It's important to fully understand a patient's medical situation, prognosis, and treatment options before engaging in these discussions.
• 👥 Ensuring the right people are present in the room and establishing a respectful communication environment are key steps for these conversations.
• 🗣 Non-verbal communication makes up 70% of human interaction, so body language, facial expressions, and the physical setting are crucial.
• 🏠 A quiet, private space with comfortable seating arrangements and items like water and tissues help facilitate emotional processing during difficult conversations.
• 🛑 In the 'ask-tell-ask' method, listening to what the patient and family know, giving the medical update, and then confirming their understanding are essential.
• 🧑‍⚕️ Delivering bad news should be brief and followed by a pause, allowing time for the patient and family to process the information emotionally.
• 😢 It's important to acknowledge the emotional impact of the news and provide support, while using tools like water or tissues to help the family cope.
• ✍️ Writing down key points from the discussion and providing contact information helps patients feel supported and included in their treatment decisions.
• 🎓 There's a push for future medical education to include training on having sensitive conversations with seriously ill patients, ensuring a more holistic approach to care.

Q & A

Why is having conversations with patients and families about serious illness compared to a medical procedure?

These conversations are considered complex and require training, practice, and supervision, just like a medical procedure. They involve making critical decisions in a serious illness context and require thoughtful communication skills.

What should a doctor understand before starting a conversation with a patient and their family?

A doctor should first understand the patient's medical situation, prognosis, treatment options, and the pros and cons of those options.

Why is nonverbal communication emphasized during these conversations?

Nonverbal communication accounts for 70% of human interaction, so a doctor's facial expression, body language, and the setup of the room play an important role in making patients and families feel comfortable and understood.

How should a room be prepared for a difficult conversation with a patient and their family?

The room should have a door that can close to provide privacy, be quiet, and chairs should be arranged in a circle so everyone faces each other. A pitcher of water and tissues should be available as the conversation may evoke emotional responses.

What is the 'ask-tell-ask' method in these conversations?

The 'ask-tell-ask' method involves first asking the patient how they prefer to receive information, then telling them important information (e.g., medical updates), and finally asking them to explain back what they understood to ensure clarity.

Why is it important to pause after delivering difficult news, like a diagnosis of cancer progression?

After delivering difficult news, patients need time to process the information. Anything said immediately after may not be heard because they are emotionally absorbing what they feared hearing.

How should doctors respond when asked, 'Am I going to die of this disease?'

Doctors should answer honestly, acknowledging that, barring any unexpected events, the disease is what will cause the patient’s death. This validation provides patients and families with clarity on what they already fear.

What should be done to ensure that patients and families retain important information from the conversation?

Doctors should write down the key points from the conversation, including the next steps, when they will next meet, and how they can be reached. This written note becomes a 'transitional object,' reminding patients that the doctor is there for them.

How does giving a written note help patients during a difficult time?

The written note helps patients feel they are active participants in their care, rather than passive recipients. It reassures them that their doctor is available to guide them through the treatment process.

What change does the speaker hope to see in medical and nursing education in the future?

The speaker hopes that, within the next 10 years, medical and nursing education will include training to ensure that every healthcare professional can effectively have challenging conversations about serious illnesses with patients and families.

Outlines

00:00

🩺 Conducting Complex Medical Conversations

This paragraph discusses the importance of training and practice in conducting serious medical conversations with patients and their families. The speaker emphasizes that, similar to complex surgical procedures, these discussions require a structured approach. The process involves understanding the patient's medical situation, communicating effectively, and ensuring a comfortable setting for the conversation. The speaker also highlights the significance of nonverbal communication and the need to allow everyone to speak without interruption. The 'ask-tell-ask' method is introduced as a way to understand how patients prefer to receive information and to ensure they understand the medical details shared with them. The paragraph concludes with the speaker's hope for improved medical education that includes training in these critical communication skills.

05:01

🌟 The Privilege of Helping Seriously Ill Patients

In this paragraph, the speaker expresses the privilege of being able to help patients and their families during serious illness. The focus is on having difficult conversations that matter most to the patients, such as understanding what gives their life meaning and how healthcare professionals can assist in achieving that. The speaker hopes that medical and nursing education will evolve to ensure that all healthcare professionals are equipped with the skills to conduct these challenging conversations. The paragraph ends with a hopeful note about restoring joy and pride in healthcare professions through this approach.

Keywords

💡Training and Supervision

The video emphasizes that conversations around complex medical decisions, especially in the context of serious illness, require extensive training and supervision, much like surgical procedures. This underscores the idea that healthcare professionals must be prepared and practiced in communication to handle sensitive patient discussions.

💡Prognosis

Prognosis refers to the predicted outcome or course of a disease. In the video, it highlights the importance of doctors understanding a patient's prognosis before discussing treatment options. This ensures that families are well-informed about the seriousness of the illness and the likely future scenarios.

💡Nonverbal Communication

Nonverbal communication accounts for 70% of human interaction, according to the video. The setting of a conversation (e.g., a quiet room, body language, facial expressions) is critical in conveying empathy and understanding, which is especially important during emotionally charged medical discussions.

💡Ask-Tell-Ask

This is a communication method doctors use to ensure clarity during difficult conversations. It involves asking patients how they prefer to receive information, telling them the necessary details in a concise way, and then asking them to explain back what they understood. This approach empowers patients and families, ensuring they comprehend the medical information shared.

💡Emotional Support

The video illustrates how providing emotional support is an integral part of difficult medical conversations. Examples include offering tissues for tears, water to drink, and creating a supportive atmosphere where the family can process distressing news. This reflects a caring and empathetic approach to handling sensitive topics.

💡Patient-Centered Care

This concept is highlighted as the practice of involving patients in their own medical decisions and care. The video advocates for making patients 'captains of their own medical ship,' meaning doctors should empower them by providing clear information and involving them actively in decision-making processes.

💡Difficult Conversations

Difficult conversations refer to the discussions around serious or terminal illnesses, where doctors must deliver bad news to patients and their families. The video underscores the importance of preparing for these conversations, offering support, and guiding families through their fears and next steps.

💡Validation

In response to the question, 'Am I going to die from this disease?' the video stresses the importance of validation. Doctors need to confirm what patients and families may already suspect. Validating these fears allows for open, honest dialogue, which is critical to trust and understanding in healthcare settings.

💡Transitional Object

A transitional object, in this context, refers to a tangible item (like a piece of paper with written information) that provides reassurance to the patient. The video mentions how giving patients something physical to take home, such as a note of their next steps or contact information, can symbolize continued support and connection to their doctor.

💡Transformation of Medical Education

The speaker expresses hope for a transformation in medical education, where communication skills are treated as a core component of training. The goal is for future healthcare professionals to be proficient in handling emotionally difficult conversations with patients and their families, ultimately enhancing the quality of care.

Highlights

Complex medical decisions require training, practice, and supervision.

Approach conversations by understanding the patient's medical situation.

Ensure the right people are present for important conversations.

70% of human communication is nonverbal.

Arrange a quiet, private space for conversations.

Arrange chairs in a circle to facilitate face-to-face interaction.

Provide water and tissues to manage emotional responses.

Ensure everyone has a chance to speak without interruptions.

Ask patients what they have been told by other doctors.

Use 'ask-tell-ask' to guide the conversation.

Allow patients to control the exchange of information.

Give patients time to process bad news.

Ask patients to repeat information to ensure understanding.

Prepare to answer difficult questions about life expectancy.

Validate patients' fears and provide clear information.

Document the conversation and provide contact information.

Help patients transition from passive to active participants in their care.

Aim for a transformation in medical education to include communication skills.

Healthcare professionals should help patients find meaning and achieve their goals.

The privilege of helping people during serious illness.

Transcripts

just as you wouldn't send a young

physician in to do a surgical procedure

without a lot of training and practice

and supervision having conversations

with persons and their families about

very complex medical decisions in the

context of a serious illness is a

procedure and it requires training and

practice and supervision just as any

other complex medical procedure

requires

I typically approach these things first

of all by making sure I understand this

patient's medical situation their

prognosis their treatment options and

the pros and cons next I make sure that

I communicate with the patient and their

family that this is going to be an

important conversation at the and that

the right people need to be in the room

we have to remember that 70% of human

communication is nonverbal so it's both

the space around the family and the

doctor as well as the doctor's own

facial expression and Body Language so

the first thing is to find a room which

has a door that closes and is quiet then

you arrange the chairs in a circle so

people are facing each other I always

get a picture of ice water in some cups

and some kleenex because there's often

tears and it helps people to be able to

deal with that everyone will go around

the room and introduce themselves and

say what their relationship is to the

patient and secondly I want to assure

everyone that everyone will have a

chance to speak and no one will be

interrupted The Next Step then is to ask

them exactly what the other doctors have

told them and this is where you get the

opportunity to hear that they've heard a

lot of different things that actually

don't align very well which is

unfortunately very often the case in

modern medicine this is the stage where

you remember the three words ask tell

ask and the first ask is finding out how

people like to get information and what

that does is in the 90% of say yeah I

want all the details they have given you

permission to tell them so you have

essentially place the power and the

control over the exchange of information

in the hands of the person and their

family the tell part which we doctors

think should take up the entire meeting

and we spend a lot of time feeling

anxious about is actually the shortest

part the tell part is where you say for

example I'm sorry to have to tell you

this Mrs Jones but the Pet Scan has

shown progression of your

cancer and then you stop

talking because nothing you say after

that is going to be heard it was exactly

what they were afraid of hearing you've

said it you've got to give them a couple

minutes to process it and that will be a

motion this may be when you need the

kleenex or the water um and when you've

spent enough time hearing their reaction

and saying I'm I'm sure this is really

upsetting to hear is not what you hope

to hear you then ask them to tell you

back so that's the ask tell ask Mrs

Jones sometimes I tend to use big words

or language that is medical and and I

just want to be sure that I've been

clear can you explain back to me what

you understood from what I

said and then people will kind of take a

few minutes and then they'll pull

themselves together and then you'll ask

them to explain back and then they'll

ask you what's the next step doc there

are a couple of really difficult

questions that doctors dread and the

first one is Doc am I going to die of

this disease and the right answer to

that question is barrowing some

unexpected

accident yes this disease is what you

are going to die

of you have to understand this is not

going to come as a surprise to your

patient or their family they just need

validation of what they already fear and

know deep inside

themselves and that's when your

preparation that you did before the

meeting is comes in handy because you

will be able to explain the

options and their pros and cons and how

you're going to help them figure out

what the best path for them is in

whatever time they have remaining a very

important step that I think is often

missed by busy doctors is to write down

what we said and also when you are next

going to see them and how they can reach

you what number and hand them the piece

of paper that piece of paper is you

they're going to take that home it's a

transitional object it's a reminder that

you're there for them because again what

that does is it takes the patient out of

the role of being a cog in the disease

treatment machine and puts them in the

role of an active participant and

essentially captain of their own medical

Ship My Hope Is that we'll see a

transformation of medical education

Nursing education other health

professional education in the next 10

years so that no one escapes from

medical school or nursing school without

being able to demonstrate highly skilled

ability to

conduct difficult and challenging

conversations with seriously ill

patients and their families about what

matters the most to them what gives

their life meaning how can we help them

achieve what gives their life meaning

that's what makes this work such a

privilege because we can help people at

times like this I I hope it will restore

the joy and pride in being a healthc

care

[Music]

professional