1. Core Curriculum
Module 6 Communication

2. Section I: Overview of Communication

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

4. 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

5. 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

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

7. 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

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

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

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

11. 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

12. 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

13. 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

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

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

16. 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

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

18. Listening Exercise