Discussing End-of-Life Issues

doctor_at_deskHow do you tell Ms. Miller her cancer has returned? How do you discuss the poor prognosis of Class IV CHF with Mr. Smith?  These items are difficult to address with patients, and healthcare providers may find themselves uncomfortable and unsure during these conversations.

 In the book, Mastering Communication with Seriously Ill Patients: Balancing Honesty with Empathy and Hope(2009), Anthony Back, Robert Arnold and James Tulsky outline seven principles for effective communication when speaking with patients with life-limiting illnesses and their families.

1. Start with the patient’s agenda. (This does not require that you ditch your own agenda; you just need to find out where the patient is.)

2. Track both the emotion and the cognitive data you get from the patient. (Don’t look past the emotion.)

3. Stay with the patient and move the conversation forward one step at a time. (Never speak more than one step ahead of the patient.)

4. Articulate empathy explicitly. (You are creating a safe conversational space.)

5. Talk about what you can do before you talk about what you can’t do. (You need to show you are working for the patient.)

6. Start with the big-picture goals before talking about specific medical interventions. (Ensure that you have aligned your goals with the patient’s goals before offering details about the interventions.)

7. Spend at least a moment giving the patient your complete, undivided attention. (When the patient tells you something big, put down your pen, stop tying on your computer and show him or her that you are listening.)

By using these communication skills, you can enhance a patient’s ability to adjust to an illness; increase compliance to recommended medications and treatments; and increase the patient’s satisfaction with care.

Back A, Arnold R & Tulsky J. Mastering Communication with Seriously Ill Patients: Balancing Honesty with Empathy and Hope.  New Cambridge, NY: Cambridge University Press; 2009.