What are five communication needs of the patient?
1. information= what will it be like? will I suffer?
2. feelings = okay to express
4. meaning = life had purpose
5. hope = sense of hope, left legacy
What are three communication needs of the family?
1. Information = will they be alone if I have to leave?
2. permission to speak
3. listened to
Ten barriers to communication
Fear of own mortality
Lack of experience
Avoidance of emotion = tears unprofessional
Sense of guilt = failure to help patient
Fear of not knowing answers to questions
Disagreement with decisions
Lack of understanding culture or goals
Personal grief issues
Five myths of communication
1. Communication is deliberate = always happening
2. Words mean the same to sender/receiver
3. Verbal communication is primary = 80% non-verbal
4. Communication is one way
5. Can't give too much information = sometimes overwhelming
What are four patient/family expectations?
1. Be honest
2. Elicit values and goals = reassure you won't abandon
3. Team communication
4. Take time to listen
11 examples of attentive listening
1. Encourage them to talk
2. Be silent
3. Share your feelings
4. Avoid misunderstandings
5. use reflection
6. don't anticipate what is going to be said, just listen
7. Don't change the subject
8. Take your time in giving advice
9. Encourage reminiscing
10. Create legacies = journals for family
11. don't give advice
What five things does presence require?
1. Acknowledging vulnerability - comfort w/other person
4. Being in the moment
5. Serenity and silence
What is bereavement?
Reaction of the survivor = inner feelings & outward actions
What are the four strategies of bereavement?
Talk of death
Feelings are normal
Takes time = years to adjust
Delay long term decisions
What are seven cultural considerations of communication?
1. Conversation style = family present, how to address
2. Personal space
3. Eye contact
4. Touch = acceptability varies
5. Time orientation
6. View of healthcare professionals
7. Learning styles = auditory vs. visual
What is the role of family (3)?
Who makes decisions?
Who is included in discussions?
Is full disclosure acceptable?
What are cultural influences on decision making? (4)
Beliefs about autonomy and other values differ
Disclosure of diagnosis and prognosis
Ascertain desire for disclosure
may value patient, family or community decision making
Language used at EOL (5)
- impacts decision making
- can have negative connotations
When cultures clash (5)
Clashes occur = when places your values over another
Assess your reactions
Offer information & let patient decline
Use cultural guides