Core Curriculum Module 6 Communication

Section I: Overview of Communication

Communication Terminal illness is a family experience Imparting information, so individuals may make informed decisions Requires interdisciplinary collaboration

Three Journeys Affected by Communication (or Lack Thereof) Isolated Journey Absence of hospice/palliative care Rescued Journey Rescue from isolated journey through referral to hospice/palliative care Comforted Journey Palliative care, later to hospice Wittenberg-Lyles et al., 2011

Patient/Family Expectations Build rapport Be honest Elicit values and goals Keep family and patient informed Communicate with the team Take time to listen Provide safe space Coyne et al., 2009; Dahlin & Wittenberg, 2015; Seccareccia et al., 2015; Wittenberg-Lyles et al., 2010a

Communication with Patient/Family Recognize individuality Deconstruction Your role Understanding life prior to illness Externalization

Communication with Patients/Family (cont.) Ask how much patient/family want to know Initiate family meetings Be aware that illness can strengthen or weaken relationships Base communication with children on developmental age

Barriers to Communication Fear of mortality Lack of experience Avoidance of emotion Insensitivity Sense of guilt Desire to maintain hope

Barriers to Communication (cont.) Fear of not knowing Disagreement with decisions Lack of understanding culture or goals Role relationships Personal grief issues Ethical concerns

Barriers to Communication Regarding Prognosis Perceived risk Disconnect Uncertainty Discomfort McLennon et al., 2013; Wittenberg-Lyles et al., 2010a

Myths of Communication Communication is deliberate Words mean the same to sender/receiver Verbal communication is primary Communication is one way Can’t give too much information

Caregiver Assessment Questions What else is going on? What is it like at home? Is the care you are providing interfering with your work? Financial needs? Who holds the insurance? What is most important/meaningful to you? Fears/worries? What do you hope for your family? What kinds of needs do you have? Support systems? Dahlin & Wittenberg, 2015; Wittenberg-Lyles et al., 2010a

Verbal and Non-Verbal Communication Includes body language, eye contact, gestures, tone of voice 80% of communication is nonverbal Boreale & Richardson, 2011; Dahlin & Wittenberg, 2015; Wittenberg-Lyles et al., 2013

Cultural Considerations Culture pervades/invades human behavior Hierarchical structure Cultural humility

Guidelines for Encouraging Conversation Setting the right atmosphere Does the patient/family want to talk? Attentive listening Dahlin & Wittenberg, 2015

Attentive Listening Encourage them to talk Be silent Share your feelings Avoid misunderstandings Don’t change the subject Take your time in giving advice Encourage reminiscing Create legacies Dahlin & Wittenberg, 2015

Mindful Presence Requires: Acknowledging vulnerability Intuition Empathy Being in the moment Serenity and silence Wittenberg-Lyles et al., 2013

Listening Exercise