When we have identified that a patient needs palliative care, we should introduce the approach to the patient, and to their family and carers, in a clear and sensitive way.
When introducing and providing palliative care, good communication is critical.
Communication occurs in many forms with the person, family member and between team members and other care providers. It can be verbal, non-verbal and written.
The key principles of communication are:
- Individualise communication
- Check and clarify
- Maintain dignity.
Communication needs to be individualised by considering:
- The person’s culture
- Their emotional state
- The diagnosis
- Current conditions
- Disabilities and impairments such as vision, speech and cognitive impairment.
It also needs to involve family members as appropriate.
Greet the person by name, use eye contact and position yourself at their eye level.
Consider non-verbal language such as movements, posture, gestures, facial expression and eye contact.
Ask open questions.
Avoid providing lengthy explanations early in your interaction and take time to hear issues from the person’s perspective.
Use facilitative statements such as “tell me about that”.
And maintain a person’s dignity at all times by:
- Greeting the person and calling them by name
- Treating the person as an adult
- Giving them privacy
- Finding out about their earlier life
- Maintaining their comfort.
Develop a care plan
Good communication can facilitate the development of a comprehensive care plan that is both medically sound and has the patient’s wishes and values at the forefront1. If discussions around the preferences for end of life care are prolonged or avoided, patients and their family may have limited opportunity to appropriately prepare for death.
Do not assume
Be curious and do not assume that the patient does not want to discuss their prognosis or end of life care just because they have not raised the issue themselves or because of their cultural or spiritual background. It is also important not to force the patient to have discussions about their prognosis or end of life care.
Check advance care planning
Check if the person has an advance care plan. Advance care plans identifies and documents and individual’s future wishes and preferences based on the values that are important in their life and ensures that end-of-life goals have been established. It also helps establish a plan based on discussions between the person, the family and their care providers and assists them to understand a person’s end-of-life choices.
1. Balaban, R.B., A Physician's guide to talking about end-of-life care. Journal of General Internal Medicine, 2000. 15: p. 195-200