1. Dr Oleg Kiriaev 23 October 2018
Engaging in difficult conversations
Dr Oleg Kiriaev
23 October 2018

2. Dr Oleg Kiriaev 23 October 2018
Engaging in Meaningful
conversations
Dr Oleg Kiriaev
23 October 2018

3. What makes conversations difficult?
They arise from difficulties in people’s lives:
Their fears
Their losses
Their uncertainties

4. What makes conversations difficult?
They arise from difficulties in people’s lives:
Their fears
Their losses
Their uncertainties
And compounded by our responses:
Our fears
Our losses
Our uncertainties

5. Social Communication model
Thoughts
&
Feelings
Thoughts
&
Feelings
Dialogue
Dialogue
Experience
Encoding
Decoding
Management

6. Social Communication model
Thoughts
&
Feelings
What’s said
10%
How it’s said
30%
Nonverbal
60%
Thoughts
&
Feelings
Dialogue
Dialogue
Experience
Encoding
Decoding
Management

7. Added difficulties in dementia
Progressive loss of language skills
Increasingly repetitive…
More difficult to follow and tangential…
Shorter conversational turns…
Truncated or delayed responses…
Disjointed and non sequiturs …
Substitutions, semantic paraphasias, neologisms…
Grammar and structural fragmentation…
etc…

8. Our risk of Negative responses
Disregard
Intimidation, withholding, outpacing
Depersonalise
Infantilisation, labelling, disparagement
Devalue
Invalidation, treachery, invalidation
Disenfranchise
Disempowerment, imposition, disruption, objectification
Exclude
Stigmatisation, ignoring, banishment, mockery

9. Communication goes both ways
Importance of time and place
Reduce distractions
Correct sensory deficits
Position yourself directly
Introduce yourself
Ensure adequate set up = Cultivate and maintain rapport = Ensure you match their pace = Modify your style = +
Paying full attention
Maintain positive conversational tone
Acknowledge
Focus on remaining strengths +
Speaking slowly and clearly in plain language
Allow plenty of pauses +
Allow them to led the conversation
Know when and how to interrupt by reframing and redirecting
Ask simple questions and only one at a time
Keep to the present tense

10. Additional pearls
Be opportunistic: all conversations can be meaningful
Facilitative nonverbal communication needs to be made overt
Often the important information is contained not in the words but rather the emotional message behind it
Always try to achieve a positive emotional outcome at conclusion

11. Patient centred care

12. Relationship centred care

13. Relationship centred care

14. Network of care

15. Serious Illness Conversation Guide