People with a life-limiting illness should have the opportunity to discuss their condition, their prognosis, recent changes and what lies ahead. Nurses can help them understand and retain information, adapt to the changes and progression of the life-limiting illness, prepare them for death, and support people who may be struggling with bereavement.
These discussions can be difficult. Nurses can help the person and their family start and continue these discussions and make decisions about care. The person and their family may wish to have separate conversations. Carers may want or need different or more information than the person themselves. The following examples consider the needs of both.
Discussion might include:
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These discussions are not one-off but held over the course of the person’s illness. Discussion topics and decisions may change as needs change.
It can help to have an experienced nurse as a mentor who can model and teach skills of good communication.
Carers may need or want more information including practical information to help them as a member of the team providing care. It is important to discuss care with them and to acknowledge their role as a partner in providing care. However, they are not there as a health professional providing formal palliative care and this is also important to remember.
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The focus of discussions will also reflect the evolving nurse-patient relationship:
Where care is provided by a number of nurses these relationships may differ. However, it is important to be prepared to step in at any time to have discussions about the person's care or concerns. Provide what information you can and offer to find out more and come back, or ask if they would like you to find someone to speak with them.
These conversations are not easy. They may start spontaneously as you are providing care. Many people look to health professionals to start these discussions. Others may hesitantly try to start these discussions with a question or a comment providing a “hint” at their readiness or need to talk. Others may not be open to or be ready for these discussions. End-of-Life Essentials gives examples of these conversations in the module: Patient - centred communication and shared decision-making.
If you are unable to respond immediately to the person’s concerns, fears, or need for information, it is important to acknowledge these needs and if possible find someone else to speak with the person now.
Planned discussions give people time to prepare themselves and can help limit misunderstandings.
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Communication that is open, respectful, culturally safe, and comfortable enables effective conversations. This forms a key part of providing comprehensive care.
To support assessment, use your communication skills to:
'What I hear you saying is that you have been experiencing … which has been making you feel … Have I understood that correctly?'
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to adopt and adapt.
Triggers indicating the need for discussion include:
Preparation for a
discussion can include:
During care you should be aware of both verbal and non-verbal signals that you are communicating.
Culturally appropriate communication pays attention to the person’s beliefs and practices about death and dying including family participation in decision-making, gender roles, communication norms guiding decision-making and the breaking of bad news, and rituals.
It may be necessary to involve interpreters, cultural liaison workers or advocates from the person's community to assist and ensure that the information is understood.
It can be helpful to prepare by checking that the interpreter
Speaking to the interpreter about what is likely to be discussed to check that they are comfortable with this can help ensure that little or no shame or embarrassment occurs during the discussion.
When using an interpreter in palliative care, remember that:
Using a family member as an interpreter may be difficult as it may not be appropriate for a particular family member to hear the information being discussed, or they may filter information.
For more information on cultural groups and vulnerable populations, visit the CareSearch section: Diversity.
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Atul Gawande on How to Talk About End-of-Life Care with Dying Patient
This information was drawn from the following resources:
Go to End-of-Life Essentials for more on communicating with patients
Visit VitalTalk Communication Tips and Resources
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Page updated 13 October 2022