The Human Connection of Palliative Care: Ten Steps for What To Say and Do
Summary
TLDRThis 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
🩺 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.
🌟 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.
Mindmap
Keywords
💡Training and Supervision
💡Prognosis
💡Nonverbal Communication
💡Ask-Tell-Ask
💡Emotional Support
💡Patient-Centered Care
💡Difficult Conversations
💡Validation
💡Transitional Object
💡Transformation of Medical Education
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
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