Palliative Care Communication Section I Communication Principles Overview of communication Chapter One Approaches to Communication Relationshipdriven Patient and family do not receive information they cocreate messages and construct meaning with providers ID: 532271
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Slide1
Textbook of Palliative Care Communication
Section I: Communication PrinciplesSlide2
Overview of communication
Chapter OneSlide3
Approaches to Communication
Relationship-driven
Patient and family do not receive information; they co-create messages and construct meaning with providers
Information is not the main outcome of clinical communication
Outcome is the relationship built between provider and patient/family.
Information-driven or sender-based
Outcome is based on delivery and receipt of medical knowledgeReceipt of information is considered effective communicationOutcome derives from the sender’s performance Slide4
Our Concept of Communication
Transactional
The parties contribute to and negotiate the meaning of messages, both verbally and nonverbally
Relational
A
ll messages have at least two levels of meaning: the task or informational level and the relationship level, which cues
interactants how to interpret and process the message itselfMutual – Communicators influence one anotherSlide5
COMFORT Communication Model
The seven basic principles of palliative care communication, from a relational communication perspective:
C
ommunication
(clinical narrative practice)
O
rientation and opportunityMindful communicationFamilyOpeningsRelatingT
eamSlide6
A historical perspective in Palliative Care communication
Chapter TwoSlide7
Communication:
The
Cornerstone of Quality Care
Early Focus of
Communication in Healthcare
Avoided the subject of death and dying
Discussing death and dying was perceived as stressful to patientSlide8
Hospice and the Role of Communication
Hospice Movement: Strides forward in
Communication
Hospice
providers encouraged open and honest communication
Introduction of team-based care and team communicationSlide9
Communication Comes to the Forefront
National Consensus Project
In 2004,
clinical
practice guidelines
were developed
by a consortium of the leading palliative care organizations, representing a major advance in palliative careQuality communication is at the core of all the palliative care guidelines:Domain 1-Structure and Process of CareDomain 2 – PhysicalDomain 3 – Psychological and PsychiatricDomain 4 – SocialDomain 5 – SpiritualDomain 6 – CulturalDomain 7 – End of LifeDomain 8 – Ethical and LegalSlide10
Current Communication Trends in Palliative Care
Literature
Patients’ and families’ desire for honest and open communication
The importance of communicating hope in palliative settings
Barriers to communication
Communication needs among pediatric populations
Use of technology to improve communicationSlide11
Current Limitations of Palliative C
are
C
ommunication
Research has focused on physician-patient interactions
Communication education restricted to “breaking bad news” discussions
Protocols or “step” approaches have excluded relational approachTraining has been limited to lecture formatSlide12
Transactional Communication
Chapter ThreeSlide13
Transmission Model of Communication
Also called the
sender-oriented
approach
Sender transmits message to receiver
Shortfalls:Uneven balance of power between sender and receiver (ex: healthcare provider and patient
)Depicts communication as product of independent parties without a guarantee that important information will be heard and understood by receiverLittle concern for medium and medium’s effectiveness (face-to-face, telephone, email)Slide14
Transactional Model of Communication
People are simultaneously senders and receivers in an ongoing process
Each person is influenced by the
other
Emphasizes shared meaning and what happens “between people”, between the sender and receiver
Benefits:
Encourages people to share powerReminds people to be attentive to cues about how others interpret information Recognizes social, environmental, personal factorsSlide15
BATHE
A five-part guide for responding to emotions
B
ackground information (Briefly, what has been going on?)
A
ffect (How has this affected you?)Trouble (What troubles you most?)
Handling things (How have you been handling this situation?)Empathy (It sounds like this is very stressful)Slide16
Relationship-Centered Care Model
Focus on how relationships are enacted across all healthcare providers who are serving the patient
Mindful Communication (awareness of self, others, relationships, and being open to new ideas)
Diversity of Mental Models (how to manage diversity within the context of care)
Mutual Respect (team members are honest, respectful of each other)
Mix of Social and Task-Related Interactions (have fun, but be productive)Slide17
Consumer Communication and Public Messaging
Chapter FourSlide18
Knowledge of Palliative Care
In 2011, a national poll revealed that 7 in 10 Americans are not knowledgeable about palliative care
Providers are also unfamiliar with the scope of palliative care, equating palliative care to hospiceSlide19
Definition of Palliative Care
Palliative care is specialized medical care for people with serious illnesses. Its goal is to provide relief from the symptoms, pain, and stress of a serious illness – whatever the diagnosis – to improve the quality of life for both the patient and the patient’s family.
Palliative care is provided by a team of doctors, nurses, and other specialists who work with a
patient’s other doctors
to provide an extra layer of support. Palliative care is appropriate for all patients suffering from serious illness - at any age and at any stage - and can accompany curative treatment.Slide20
Key Messages to Convey about Palliative Care
Palliative Care
:
H
elps provide the best possible quality of life
H
elps manage pain, symptoms, and stress of illnessIs a partnership between patient, family, and healthcare providersProvides the patient and family an extra layer of supportIs appropriate at any age and at any stage of a serious illness, alongside curative treatmentSlide21
Resources for Palliative Care Communication
Vitaltalk
(vitaltalk.org)
Advanced communication skills resources and courses for professionals focused on balancing honesty with empathy, when discussing serious
illness.
Palliative Care Communication Institute (pccinstitute.com)
Free teaching materials to advance a patient-centered training program called COMFORT– designed to teach communication strategies for patient-centered palliative care.Slide22
Communication ethics
Chapter FiveSlide23
Communication Ethics
Ethical communication is a form of care, subject to ethical norms:
Respect for personhood
Minimize harm
Maximize benefit
Cecily Saunders summarizes an approach to sensitive communication: “The real question is not ‘what do you tell your patients?’ but rather ‘what do you let your patients tell you?’”Slide24
Palliative care as a moral practice
Goals of practice need to be well-defined and resonant with larger social values
Palliative care must have
shared internal
values that promote the goals of practice
Palliative care provides “agency” to patients, allowing care to be patient-centered, enabling the patient
to develop and exercise a sense of self by engaging with the world in a manner that sets and achieves goals by doing things for oneself.Slide25
Communication as an Ethical Obligation
Communication should seek to:
discern and incorporate the values and preferences of patients and family members, thereby respecting their autonomy
minimize the risk of avoidable harm, thereby respecting
nonmaleficence
maximize benefit to patients and families by engaging processes and producing outcomes that are consistent with how they would define “good,” thereby honoring beneficence.Slide26
Communication within the Team
Moral
agency of
team members is a significant part of the ethical equation
Be attentive, self-aware, and reflective to the emotional responses of oneself and other healthcare providers
Consider professional hierarchy in healthcareSlide27
Communication in palliative social work
Chapter SixSlide28
Social Work Communication
Diagnosis
Tailor information to individual and family needs
Address Psychosocial concerns
Plan of Care
Organize and interpret patient and family dataAdvance Care Planning
Support patient autonomy, self-determinationInclude caregiversSlide29
Social Work Communication
Pain and Symptom Management
Educate patient and family about medication, side effects
Teach complimentary and alternative techniques
Practical support
Discuss home care needs, insurance, financial needsAssess patient distress
Provide supportive counselingReinforce strengths and coping mechanismsSlide30
Social Work Communication
Religious, spiritual, existential issues
Discuss degree of religiosity, use of spirituality as coping mechanism
Discuss guilt, regret, need for forgiveness
Evaluate role of culture in understanding of illness, role of language, decision-making style
Integrate cultural values into decision-makingSlide31
Social Work Communication
End of life communication
Discuss practical aspects of patient’s death
Discuss hopes and fears for patient and family
Educate about expected course
Talking about hospiceParticipate in intake assessment
Identify psychosocial concernsTarget caregivers with high bereavement distressSlide32
Communication in palliative medicine
Chapter SevenSlide33
Why Communication in Palliative Medicine Matters
Findings across research studies illustrate a need for communication:
Only half of all patients discussed hospice with any doctor two months before death
More than half of lung and colorectal cancer patients thought their chemotherapy was curative
Only a third of lung cancer patients understood that radiation would not cure them
Less than 20% of patients had accurate awareness of their prognosisSlide34
Key Barriers to Communication
Patient factors
Emotional overwhelm, language barriers, cultural barriers may create mistrust of physicians; patients may have limited health literacy, over-estimate cure
Physician factors
Lack of proper communication skills or training in managing emotions; fear of causing pain or taking away hope
Healthcare factors
No incentives for patient-centered communication, multiple transitions of care, multiple subspecialistsSlide35
SPIKES: A strategy for sharing poor prognosis/serious diagnosisSlide36
SPIKES continuedSlide37
Communication in palliative nursing
Chapter EightSlide38
Nurse Communication
Participates in patient assessment and in collaborative care planning with team
Nurses rated by public as most trusted healthcare team member
Uses symptom assessment instruments to evaluate pain, take pain history
Uses verbal or symbolic means appropriate to patient to assess copingSlide39
Nurse Communication
Facilitates communication within circle of care
Patient, family, healthcare team, other providers
Assessment and attention to spiritual issues and concerns for patient and family
Elicits cultural identification, strengths, concerns, needs
Determines cultural background as source of resilience and strength for patient and familySlide40
Nurse Communication
Communicates signs and symptoms of dying process to patient, family, others
Explains what to expect in the dying process and provides support post-death
Contributes to ongoing discussion about goals of care, promoting understanding of patient’s preferencesSlide41
Barriers to Nurse Communication
Personal
Cultural norms, shyness, fears, fear of mortality, unresolved personal losses
Educational
Few nursing schools offer instruction in palliative care
Lack of experience with death, dying, and communication
Younger generation of nurses have had little exposure or practice with face-to-face verbal communicationProfessionalInadequate nursing education and role ambiguity Slide42
Communication in Palliative care chaplaincy
Chapter NineSlide43
Basics of Chaplain Communication
Assist in Meaning-Making
Global meanings
are a person’s most basic values and beliefs about the way the world works
Situation meaning
is the meaning given to a particular event such as illness or deathEmphasis on active listening rather than information-giving
Do not proselytize or impose one’s beliefs on othersSlide44
Barriers
Defining chaplaincy
“Being present” is too vague
Any two chaplains do not describe their work in the same way
Need to translate spiritual work into medical language and processes
Healthcare team members do not know how to conduct spiritual assessment; refer to chaplainSlide45
Chaplain as Team Member
Expert on spiritual subject matter
Offer guidance on spiritual communication
Provide understanding about family culture and spiritual traditions/rituals
A chaplain is often viewed as a neutral, trusted person as compared to other healthcare providers
Assist with families who are awaiting miracle cureSlide46
Future Work
More research is needed to document outcomes and accountability of chaplain services
Document the benefit of chaplain services
Document patients’ spiritual needs
ents
Document interventions to reduce spiritual distressSlide47
Communication in clinical psychology
Chapter TenSlide48
Clinical Psychologist in Palliative Care
Four key roles:
Assess and target treatment services for patients
Provide education and supportive services to families and caregivers
Participate in educational and support activities that assist the palliative care team Slide49
Provision of patient assessment services
Assessment Aims
Symptoms, duration, and situational factors associated with psychosocial health
Assessment Approaches
Interview and self-report questionnaires
Neurocognitive
functioningAssessment DomainsPre-morbid functioning, health literacy, perception of illnessSlide50
Provision of treatment services
Goal-setting and Problem-solving
Establishing goals grounded in patient values
Psychotherapy
Cognitive Behavioral Therapy
Tools to modify dysfunctional thinking and behaviorExistential Psychotherapy
Helping patient confront the struggle of being humanPsychotherapy at the End of LifeAssist patient to achieve a respectful death, dignitySlide51
Psychologists’ involvement with patients’ family systems
Supporting family communication
Cultural health beliefs
‘law of double death’ in families
Awareness of likelihood of death, but do not discuss their fears or concerns with one another
‘third person’ in families
Families cannot discuss anxieties related to death with patient, but can with other partiesSlide52
The Psychologist as a member of the interdisciplinary palliative care team
Contribute patient information to team
Educate staff
Provide staff support and facilitation of self-care as a team member
Assistance with compassion fatigue, trauma