Communication issues
It is not always comfortable having conversations about end-of-life decisions with patients. It is recognised that these conversations can be more difficult for the doctor if:
- The GP-patient relationship has been long
- The diagnostic process has not gone smoothly
- The care has been fragmented by time spent in hospital or being mainly managed by specialists
- The GP is troubled by either clinical or philosophical concerns about the care of the patient - in this case, a discussion with the local palliative care service may be helpful.
When curative options are diminishing, many patients want the continuity of the relationship with their GP. Some of the valued qualities are honesty, empathy, and being willing to talk about end-of-life concerns.
It is possible to learn how to communicate better, or to refine one’s existing skills. It can also be valuable to reflect on conversations that have gone well or badly, in order to become more confident and skillful in future challenging situations.
The University of Toronto's online education module on Communication with Patients and Families covers such issues as:
- Things to avoid saying
- Dealing with difficult emotional responses
- Estranged family members, or family coming from far away
- Communication over the phone
- Language and cultural barriers to communication
- When the patient is a medical professional or a family member.
"Asking questions can help: an aid for people seeing the palliative care team” from Palliative Care Australia is an Australian booklet designed to help patients talk about concerns which may be difficult for them to raise otherwise. It has been shown that this material is most useful if given to the patient by their doctor.
Online resources related to advance care planning can also help by giving patients more information about what to expect. Useful websites include:
- CareSearch / Knowledge Network webpages for patients, caregivers, families and friends contain up to date Australian information about palliative care;
- Handbook for Mortals - a well written book from the United States with helpful plain language descriptions of various medical interventions. It is available online to help people think about advance care planning decisions.
NH&MRC Clinical Practice guidelines for the Psychosocial Care of Adults with Cancer provides advice on evidence-based psychosocial care for patients with cancer. The guidelines cover:
- How people react to the challenges of cancer
- General interactional skills for health professionals
- Discussing prognosis and treatment choices
- Emotional and social support, and support towards the end of life
- Continuity of care
- Exploring and responding to specific concerns
- Types and benefits of specialised care
- Treatment of anxiety and depression.
While this evidence relates to patients with cancer, much of it is also relevant for patients with end-stage non-malignant diseases.
This page was created on 26 March 2007 and is due for review in March 2009