Core Modules

module 2 | Activity 4: Communication principles

Effective and efficient communication is crucial for providing care and support to people affected by life-limiting illness.[1, 2] However, some people can find these conversations challenging. There are some general communication strategies that help facilitate conversations about concerns, and demonstrate respect for the person’s individuality.

The PREPARED communication framework outlines key strategies that can be used when communicating with a person with a life-limiting illness, their family and carers.[3]

The PREPARED communication framework

P Prepare for the discussion, where possible
R Relate to the person
E Elicit preferences from the person and their caregiver/s
P Provide information tailored to the needs of both the person with a life-limiting illness and their families and carers
A Acknowledge emotions and concerns
R (foster) Realistic hope (eg, peaceful death, support)
E Encourage questions and further discussions
D Document

The PREPARED communication framework in clinical practice

The SPIKES communication framework

The SPIKES framework is another tool that can assist healthcare professionals with breaking bad news.[2] SPIKES can complement the PREPARED framework by assisting with the four most important objectives of breaking bad news:

  1. Gathering information
  2. Transmitting medical information
  3. Providing support
  4. Eliciting the person’s collaboration in developing a strategy or treatment plan for the future.

Although some of the steps of SPIKES are similar to the steps in PREPARED, SPIKES concentrates on delivering bad news (such as the initial diagnosis), while PREPARED focuses on the holistic support of the person and their family throughout their illness and can be used to frame discussions in a range of palliative contexts.[4-7]

S Setting up the conversation
P Assessing the person’s perception
I Obtaining the person’s invitation
K Providing knowledge and information to the person
E Addressing the person’s emotions with empathic responses
S Strategy and Summary

The SPIKES communication framework in clinical practice

Adapted SPIKES communication framework for paramedics

It is important to note that these frameworks are guides only and not prescriptive checklists for having a conversation with a person affected by a life-limiting illness. Use the steps in the frameworks to guide your interactions and to assist you in planning and preparing for difficult conversations.

NURSE Statements

Developing skills in communication with people affected by life-limiting illness can also require learning how to respond when people voice concerns or express strong emotions. Demonstrating empathy using NURSE statements

N Name: name the emotion from the communication cues you have observed (eg, I can see that you are feeling…).
U Understand: acknowledge that their experience is challenging (eg, I can only imagine how difficult this must be).
R Respect: show your respect for the person (eg, I can see that you have been trying hard).
S Support: show your support for the person (eg, I will do everything I can to make sure you have the support you need).
E Explore: explore the person’s emotions and experiences (eg, Can you tell me more about what you mean when you say…).

Communication resources for underserved groups

A key aspect of effective communication involves gaining an understanding of the barriers that are experienced by many people in accessing palliative care. Recent reports have highlighted that there are various groups of people in our communities who experience barriers to the provision of palliative care, referred to as under-served population groups.[8]

These resources from the PEPA/IPEPA project aim to support communication in these groups:

  1. Consider your experience of discussing existential and psychological concerns with people.
    • What aspects of communication are you most comfortable with in this area?
    • What aspects of communication do you find challenging?
    • What are some key learnings you have made in leading or hearing such conversations?
    • What might you change or improve within future conversations?

If you have not experienced this kind of difficult conversation, reflect on a discussion you observed within your student context or review the case study video ‘Michelle’s story – Receiving distressing news’. Select one of the tools described in this section (ie, PREPARED or SPIKES) to guide your reflections on your observations of these interactions.

  1. Using the principles described in this section, outline:
    • What communication strategies you most commonly use
    • What additional strategies you could implement.
  1. CareSearch. 2022. Communication is key to quality palliative care.
  2. Therapeutic Guidelines. 2023. Communicating with the patient in palliative care. Melbourne.
  3. Clayton, J.M., et al., 2007. Clinical practice guidelines for communicating prognosis and end-of-life issues with adults in the advanced stages of a life-limiting illness, and their caregivers. Medical Journal of Australia. 186.
  4. Kaplan, M., 2010. SPIKES: a framework for breaking bad news to patients with cancer. Clin J Oncol Nurs. 14(4): p. 514-6.
  5. Rosenzweig, M.Q., 2012. Breaking bad news: a guide for effective and empathetic communication. The Nurse practitioner. 37(2): p. 1-4.
  6. Monden, K.R., L. Gentry, and T.R. Cox, 2016, Delivering bad news to patients. Proceedings (Baylor University. Medical Center). 29(1): p. 101-102.
  7. Ferreira da Silveira, F.J., C.C. Botelho, and C.C. Valadão, 2017, Breaking bad news: doctors  skills in communicating with patients. Sao Paulo Medical Journal. 135: p. 323-331.
  8. Commonwealth of Australia – Department of Health, 2020, Exploratory Analysis of Barriers to Palliative Care – Summary Policy Paper.
  9. Vital Talk. 2019. Responding to emotion – Respecting: Articulating empathy using NURSE statements.