Communication skills

Question 1

What are the aims of communication

Answer 1

• reduce uncertainty
• enhance relationships
• give the patient and family a direction in which to move
• enabling patients and carers to make informed decisions about care

Question 2

How does the palliative care team convey acceptance and affirmation in a time of increasing uncertainty?

Answer 2

‘No matter what happens to you, we will not desert you’ (acceptance).
‘You may be dying, but you are still important to us’ (affirmation).

Only part of this can be said in words:
‘We can relieve your pain and can ease most other symptoms.’
‘I will see you regularly.’
‘One of us will always be available.’
‘Let’s work out how best we can help you and your family.’

Question 3

Discussing palliative care issues with a patient

Answer 3

May be helpful for a new patient to tell their story from the start of illness, even if this was several years ago. Eg: ‘We’ve not met before; it would help me if you could start right from the beginning’

Allow them to set the agenda:

‘How can I help you?’
‘What would you like to tell me about first?’
‘What do you hope will come out of this consultation?’

If there is a long list of problems, ask the patient to prioritise them.

Question 4

Open q’s to find how the pt is feeling and what their main concerns are

Answer 4

‘How are you feeling today?’
‘How have you been coping since we last met?’
‘What worries you most about your situation?’
‘What causes you the most suffering?’

Question 5

Determining how much a pt would like to know about their illness

Answer 5

‘Are you the sort of person who likes to know what’s happening?’
‘What things have been running through your mind as to the underlying cause of your symptoms?’

Question 6

What are the important points for breaking bad news?

Answer 6

• Warning shot: e.g. ‘Tests indicate that we could be dealing with something serious’
• move gently towards it, eg: ‘some abnormal cells’ rather than immediately cancer

If a patient with incurable cancer asks directly, ‘Have I got cancer?’, first discover what they understand by ‘cancer

Question 7

Gentle truth to soften the initial impact of emotionally negative words?

Answer 7

Not ‘You’ve got cancer’ –> ‘Tests indicate that it is a form of cancer
Not ‘You’ve got 3 months to live’ –> ‘Time is probably limited.’
Not ‘Things are getting worse’ –> ‘Things don’t seem to be so good this week’
Anger –> ‘Given what you’re having to cope with, you’ve every right to be angry’

Question 8

What are the good points to emphasise?

Answer 8

• there will still be good times ahead despite progressive illness
• there is much that can be done to relieve pain and other distressing symptoms

Question 9

Flow chart

Answer 9

• prep + location
• find out what the patient knows
  “it would help me to know what you understand about your illness”
• is more info wanted?
  “I have your results, would you like me to discuss them with you?”
• warning shot: “I’m afraid its more serious than we’d hoped”
• allow pt to refuse more info “I know this is a lot to take in at the moment. Would you like to know more?”
• open q’s to find out how they’re feeling/ concerns: how are you feeling hearing that? Is there anything thats particularly worrying you?
• don’t give false hope or more info than what’s wanted
• Its okay to say, ‘I don’t know’
• summarise and plan “your main concerns at the moment seem to be..”
• offer follow up and support
• document in notes, letters, inform team and gp