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.