People affected by life-limiting illness often need help and support in order to overcome the challenges they face from their illness and to manage their expectations. Most people want specific, honest information about their prognosis, symptom management and treatment options. This will aid them with making decisions, establishing realistic goals of care and planning for their remaining time.[1, 2]
Providing support to people affected by life-limiting illness requires health professionals to use communication skills that assist with understanding the meaning of the illness and its effects on the person.[3, 4] Talking about dying and death, communicating distressing news and prognostic information, are a necessary part of this care.[1, 5-7] Early and ongoing conversations that include careful questioning and active listening can help health professionals explore and understand the wishes and expectations of the person and their family/carers:
- Expectations can be better managed, even if they are unrealistic, if health professionals know what they are early on in the process
- The person’s concerns and any sources of distress can be identified and appropriate management plans can be developed in partnership with the person and healthcare providers.[3, 4]
This support commences from initial diagnosis and continues throughout the person’s illness.[3, 4]
Consider the concept of supportive communication in relation to Michelle, who was introduced earlier in this module.
Michelle’s CT scan shows that her cough is caused by the spread of the cancer to her lungs.
She also has evidence of metastases in her liver. She attends an appointment with Dr Meredith North, her medical oncologist. Meredith explains the significance of these results and what they mean for Michelle’s prognosis and further treatment.
- What are the main sources of distress for Michelle and Pete at this time?
- How aware of her symptoms and possible diagnosis does Michelle appear to be?
- What specific communication strategies did Meredith use to provide the news to Michelle and Pete about the progression of her illness?
- What additional communication strategies could the oncologist use to improve this interaction?
- Therapeutic Guidelines Ltd, Communicating with the patient in palliative care. 2019: Melbourne.
- Virdun, C., et al., Dying in the hospital setting: A meta-synthesis identifying the elements of end-of-life care that patients and their families describe as being important. Palliat Med, 2017. 31(7): p. 587-601.
- Palliative Care Australia. National Palliative Care Standards. 2018; 5th Edition:[Available from: http://palliativecare.org.au/standards].
- Collier, A., Communicating about end-of-life care. Communicating Quality and Safety in Health Care, 2015: p. 93.
- Ciałkowska-Rysz, A. and T. Dzierżanowski, Personal fear of death affects the proper process of breaking bad news. Archives of Medical Science : AMS, 2013. 9(1): p. 127-131.
- Monden, K.R., L. Gentry, and T.R. Cox, Delivering bad news to patients. Proceedings (Baylor University. Medical Center), 2016. 29(1): p. 101-102.
- CareSearch. Communication. 2018 [cited 2018 12/07/2018]; Available from: https://www.caresearch.com.au/caresearch/tabid/3392/Default.aspx.