1. Communication Models in Palliative Care/End of Life Care
Ping fen Tang
Professor of Nursing
Kunming Medical University, China

2. Role of Communication Skills
Effective symptom control is impossible without effective communication.
Communication as a major component of the delivery of all medical, and particularly palliative care.
Kaplan SH, Greenfield S, Ware JE: Impact of the doctor-patient relationship on the outcomes of chronic disease. In Stewart M, Roter D (eds): Communicating with Medical patients. Newbury Park, Sage Publication, 2001

3. Communication Ethics PATIENT CARE With Family QUALITY LIFE
Empower
Moral
Communication
Reduce
suffering
All health care
term
Intervention
Outcome
Communication as a mediating variable in achieving the goal of palliative care

4. Overview of the COMFORT Model
Wittenberg-Lyles and colleagues developed an evidence-based communication model that elaborates seven principles of communication.
Elaborates 精心制作
Wittenberg-Lyles E, Goldsmith J, Ferrell B, Ragan S.Communication in Palliative Nursing. New York, NY: Oxford
Un iversity Press; 2013.

5. COMFORT Model Communication (Narrative clinical) C
Orientation & Options
Mindful Communication
Family Caregivers
Opening
Relating
Term Communication C O M F O R T

6. Communication (3Rs) Remember the patient as an individual
Reflection on the patient before illness
Remember the patient as an individual
Re-author the story

7. Orientation and Options
Question to determine family orientation
Use plain language planner for palliative care
Question to understand patient/family culture

8. Mindful Communication
Awareness of emotions
Avoiding judgment
Adaptability
Notice signs of stress
Identify positives for patient/family
Silence as a strategy

9. Family Caregivers Caregiver communication tool Concern/response: Pain
Patient & Family communication need
Concern/response: Pain
Prompt/response: Assessment

10. Openings Address the topic Comment on topic
Incorporating quality of life
Spiritual review

11. Relating
Checklist
AMEN
Question

12. Team Communication Term meeting Group think Professional Specific
Risk and Solution
Multi-
Disciplinary
Collaboration

13. Giving bad news to patients/families need different communication skills because the cultural differently.

14. In many countries, including most Asian countries and some southern Europe, decisions about what is told to a patient and the care received is made by the family.
Johnson M.R.D. (2009). End of life care in ethnic minorities. Providers need to overcome their fear of dealing with people from different backgrounds. British Medical Journal 338, a2989

16. Breaking Bad News
Bad news can best be defined as any news that adversely affects the patient's view of his or her future.
Buckman R: Breaking bad news: Why is it still so difficult? BMJ 288: , 1984

17. Breaking Bad News Mode SPIKES WALTER F. BAILE, 2000 ABCDE
Rabow MW, Mcphee,1999

18. S: Setting Strategy & summary P: Perception of condition/ seriousness
• Arrange for some privacy
• Involve significant others& Sit down
• Make connection and establish rapport with the patient
• Manage time constraints and interruptions
S: Setting
Determine what the patient knows about the medical or what is suspected. “Before you tell, ask.”, Listen to the patient’s level of comprehension
• Accept denial but do not confront at this stage
P: Perception of condition/ seriousness
Ask patient if wishes to know the medical and/or treatment
Accept patient’s right not to know
Offer to answer questions later if s/he wishes
I: Invitation from patient to give information
Consider educational level, socio-cultural background, current emotional
• Give information in small chunks, warn the patient bout to give bad news
• Check whether the patient understood what you said & Respond reactions
• Give any positive aspects first
K: Knowledge give medical factor
Prepare to give an empathetic response:
• 1. Identify emotion expressed by the patient (sadness, silence, shock etc.)
• 2. Identify cause/source of emotion
• 3. Give the patient time express his or her feelings
E: Explore emotions & sympathize
• Patients who have a clear plan for the future are less likely to feel anxious and uncertain-so clarify their understanding
• Close the interview
Strategy & summary

19. SPIKES Mode
Perception
Setting
Invitation
Knowledge
Summary
Emotion

20. The SPIKES protocol has been designed specifically for these purposes and will allow the physician to assess the patient's expectations before going on to share the information.
Curtin S, MCCONNELL M. Teaching dental student how to deliver bad news: SPIKES model [J] .J Dent Educ, 2012,76(3):

21. Case

22. ABCDE Mode Advance Preparation Build Environment/ Relationship
Communicate Well
Deal with Patient & Family Reactions
Encourage and Validate Emotions
Rabow MW, Mcphee SJ, Beyond Breaking the bad news: How to help patients that suffer West J Med 1999;171:261

23. Advance Preparation
Who
says To
whom
Timing
Topic

24. Build a Therapeutic Environment/ Relationship
where
Privacy
Comfortable
How
Mood
Feeling

25. Individuals different
Communicate Well
Perspective others
Individuals different
Step by step

26. Deal with Patient and Family Reactions
Process
Observation
Perspective
Empathy
Guide
Supporting

27. Encourage and Validate Emotions
Expects
Cognitive
Validate Emotions
Manage
Assist
Encourage

29. The so-called "death café" movement started 2011 in London by Jon Underwood, who was inspired by the writings of Swiss sociologist Bernard Crettaz.

30. Death Coffee of Kunming
British Death Coffee Guide
Traditional Chinese Cultural
Multidisciplinary Teams
Monthly Coffee Activities

31. Kunming Death Coffee Framework
Implementation
Design
Consultant
International development
Maneuverability, long-term,
attract participants
Chinese traditional culture
Maneuverability 可操作性
National
cultural beliefs
China's current situation
Local application

32. Thank you!