Communication Skills

in Palliative Care
Gian Nurmaindah Hendianti, RN.,MNS.
Objectives

• Concepts of Communication in Palliative Care

• Communication Principles related to Palliative Care
• Breaking Bad News
“Effective communication between care providers,
patients and their families is very essential in palliative
care. Identification and management of symptoms,
physical and psychological, hinge on interaction”

(Holland and Chertkov, 2004)

The Concepts…
• Communication is
– Two-way process (in exchanging
information) between two or more
persons in which ideas, feelings, and
information are shared, with ultimate
aim of reducing uncertainties and
clarifying issues
– Communication only becomes
complete when there is feedback
The Communication Process

Message

Source Medium Receiver

Feedback
Communication Principles in PC Effective
Communication

• Identifies and aims to address all the needs of the

patient, family and care provider (i.e.
psychological, spiritual, social, cultural and
physical issues);
• Provides information according to the patient’s
preferences (whether good or bad news);
• Invites the patient to share their agenda in a
conversation;
• Aims to communicate the truth by means of
accurate essential information
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• Facilitates appropriate referrals, inter-disciplinary
assessment, continuity of care, discharge planning,
end-of-life care and bereavement support, as well as
conflict resolution and stress management;
• Advises on the resources available to address holistic
needs and concerns;
• Provides patients with a sense of security,
consistency and comfort;
• Educates family members and care providers on how
to manage pain, distress and other symptoms in the
patient and how to communicate effectively;
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• Aims to improve relationships at all levels,
including those involving family members,
care providers and the community;
• Documents as appropriate the main
discussions with the patient, family and
other care providers;
• Ensures a good flow of information within
and between organizations involved in
service delivery
Continue… PC with Child.
• Uses an honest and open approach as the basis of
all communication with a child and their family;
• Enables parents to be central to a child’s well-
being; and, where possible, they, or a designated
care provider, are present and involved in all
aspects of the child’s care, guided by the age and
wishes of the child;
• Provides information to a child and their family
about the signs and symptoms of approaching
death in a manner · appropriate to their
individual needs and circumstances.
Types of Communication
• Verbal communication is the exchange of ideas
through spoken expression in words. It is a
medium for communication that can entail using
the spoken word, such as talking face-to-face, on a Listening Skill
telephone, or through a formal speech; similar
communication can occur through writing.
• Non-verbal communication involves the
expression of ideas, thoughts or feelings without
the spoken or written word. This is generally Emotional
expressed in the form of body language that Skill
includes gestures and facial expressions and,
where appropriate, touch.
Targeted Aspects in PC Communication
• All aspects which make an individual
complete, i.e. psychological, spiritual, social,
cultural and physical aspects;
• Prognosis and goals of care, as these are
essential for quality care;
• Disclosure, diagnosis, prognosis, transition to
palliative care and the holistic care plan;
• A patient’s fears and concerns;
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• Disease progression and end-of-life care
issues, such as the use of aggressive
treatments in the end-of-life stage, · decisions
on readmission, review of medications, family
rituals and the family’s role;
• Patient and family styles and practices for
coping with grief, loss and bereavement, and
the support required from care providers;
• Discussions about the future, as this is vital if
patients are to be permitted the dignity of
deciding how to spend their remaining time
Continue… Child patient
• The beliefs and values of a child patient and their
family regarding death and dying, and assistance
to prepare and plan for death by discussing
expectations in order to reduce fear and
encourage involvement;
• End-of-life issues and the anticipation of the death
of a child patient, each being honestly discussed
with the child and their family.
• Give the child the opportunity to say goodbye and
express last feelings and wishes. Bereavement
counselling and support for children.
Breaking Bad News
• SPIKES
• Setting up
• Perception
• Invitation / Information
• Knowledge
• Emotion/ Empathy
• Summary
SPIKES
• S  Prepare well. Know all the facts
before meeting the patient/family. Sitting
down. Minimize distraction. Fam/friend
possibly present
• P  Review how much the patient already
knows by asking for a summary of events.
You can ask, ‘Can you bring me up to date
me on your illness and how things are
now?’
• I  Check that the patient/family
wants more information and how much
more. You can say, ‘We have more
results now. Would you like me to give
you an update on what we know? I will
go step by step and you can stop me
whenever you want.’
 When Families
Wish To Filter Or
Block Information
• Don’t simply respond with “It’s their
right to know” and dive in.
• Explore reasons / concerns – the
“micro-culture” of the family
• Perhaps negotiate an “in their time,
in their manner” resolution •
• Ultimately, may need to check with
patient:
• “Some people want to know everything
they can about their illness, such as
results, prognosis, what to expect. Others
don’t want to know very much at all,
perhaps having their family more involved.
How involved would you like to be
regarding information and decisions about
your illness?”
• K  What information is necessary for decision
making. Indicate that the information to be given
is serious. You can say, ‘I am afraid it looks rather
serious,’ and then allow a pause for the patient to
respond.
• E  Encourage expression of feelings – this is the
key aspect in terms of patient satisfaction with a
session. Give more information if requested,
systematically and in simple language. Listen to
concerns and ask questions. You can say, ‘what are
your main concerns at the moment?’ or ‘What
does this mean to you?’
• S  Wind down the session by
summarizing issues that are raised and
plan with the family the next steps.
Make yourself available to discuss the
illness further, as needed.
• When breaking bad news to a child, try
to do it in an age-appropriate manner.
• Never underestimate what a child
knows and can understand.
Consecutives of Ineffective
Communication
• Not communicating accurate essential information to patients may
provoke greater problems.
• Protecting patients from the reality of their situation often creates further
problems and can lead to inconsistent (messages being given by other
members of the inter-disciplinary team)
• Hiding the truth often leads to conspiracies of silence that usually build up
to a heightened state of fear, anxiety · and confusion, rather than provide
one of calmness.
• Poor communication is a threat to patient care and can lead both to
mistrust and to a source of staff stress.
• Communicating effectively is essential for engaging the patient and their
family in their care.
• Not communicating about the nature and seriousness of an illness can
lead to a lack of planning for the future – · e.g. not writing a will, not
planning who will take care of the children.