Gero Module 2: Communication in Palliative Care

You are taking care of a 68-year-old woman who has advanced metastatic breast cancer. She tells you that she is afraid she is dying and won't be alive to see her first grandchild born in four weeks. You pull up a chair to talk with her and say:

"Can you tell me more about what you are most afraid of?"

You have been the pediatric nurse caring for a young boy with a malignant brain tumor who just died on your unit. The parents are in the room with their son and ask you if you would stay with them. Your best response is:

"I am here and I will not leave you until you are ready for me to."

Roland was just told that his therapy for advanced prostate cancer is not working. He asks you, "Why is this happening to me?" What is the most appropriate response?

"I don't know. I wish I had an answer for you, but I don't."

You are working on developing your communication techniques to use when talking to patients and families. Which of the following indicates you have a good understanding of important communication skills in palliative care?

"I should acknowledge the emotions that the patient and family is expressing."

Mr. G had a meeting with the physician this morning about his wife's condition. He was told she has weeks to live and that they should consider hospice. You have known Mr. and Mrs. G for about 6 months, as she has been in and out of the hospital frequently. Mr. G asks to talk with you because he is upset about this news. Your best initial response is:

"I wish this news was different for you and Mrs. G."

You are teaching your colleagues about myths and realities of communication in palliative care. Which is a correct statement about communication?

"The majority of messages we send are non-verbal."

Simplest way to do a cultural assessment

Ask the pt and their family to tell you something about their life, before the illness and questions like what has been important to you and your family/What gives your life meaning?

Active listening

Be silent, listen patiently, do not interrupt, show empathy, repeating, reflecting, do not change subject, don't give advice, encourage reminiscing

Barriers to Communication

Fears about death, Lack of personal experience, healthcare provider insensitivity, sense of guilt for failure, support perception of hope, disagreements, lack of knowledge and understanding of cultures, personal grief issues, ethical concerns

You are planning to assess the emotional and spiritual needs of a patient in the advanced stages of HIV/AIDS. Your first action to open the communication process should be to:

Find out if the patient feels like talking.

Ms. H's family is in the waiting room of the intensive care unit. Ms. H is very ill and the family has been told she will probably die during this hospital admission. You are walking by the waiting room and you see that they are all seated together, crying. What is your best response?

Go into the waiting room, sit next to them, and give them time to talk with you.

Ask-Tell-Ask

Opening up with a question, after listening then respond as to what you know is the the truth, end with an open ended question to allow pt to continue the conversation

You are entering a room to administer a medication to your patient and as you come in you find that the three family members and the patient are all crying. What should you do next?

Remain silent to give permission to talk with you, holding off on the medication initially.

You are speaking with the family of a patient recently diagnosed with end-stage heart failure. How can you best demonstrate attentive listening?

Use non-verbal signals such as nodding one's head and eye contact.

How to encourage conversation

set the right atmosphere, get comfortable, spend time with them, good non-verbal communication, silence electronics.