Strategies for Improving Communication During End-of-Life Care

TON - October 2019, Vol 12, No 5

Anaheim, CA—Good communication skills are essential for providing high-quality cancer care. However, communicating effectively becomes more complicated when patients have received a poor prognosis. At the 2019 Oncology Nursing Society 44th Annual Congress, Andria Caton, BSN, RN, OCN, CHPN, Assistant Nurse Manager, Northeast Georgia Medical Center, Gainesville, provided oncology nurses with strategies for improving communication with patients and their families during end-of-life care.

Ms Caton shared valuable insights based on her extensive experience providing compassionate, end-of-life care to patients with cancer. She stressed the importance of engaging in open and honest communication, which includes listening attentively to what patients have to say. “That’s why God gave us 2 ears and 1 mouth,” she said.

She reminded nurses to communicate appropriately and clearly with patients and their families, especially in light of the sensitive nature of the situation, admitting that even with her years of experience, this can be challenging.

Selecting the Right Words

Ms Canton explained that the use of complex medical terms and professional jargon may lead to miscommunication and create a situation where patients and family members are not on the same page as the healthcare team. She cited an example in which a patient’s loved ones were confused by the terms she had used during conversations with them. When she finally spoke to the patient’s brother using more direct language, she discovered that the family did not realize that the patient was close to death.

Although it may sound harsh, “dying” is a more direct word than “declining” and offers clarity to patients and family members who do not need the added emotional strain caused by a misunderstanding. Ms Canton urged attendees to be direct, and encouraged them to ask patients or their loved ones questions to confirm an understanding of what is going on, especially if they feel there is potential for ­miscommunication.

“There’s no need to confuse them further with indirect beat-around-the-bush language, seeing that people already have a hard time retaining even a fraction of what they’re told under stressed conditions,” she said.

Using Soft Language

Ms Canton noted that there is also a place for “soft language” when speaking with patients and their families. This helps patients know that they are in compassionate hands and their feelings are being taken into consideration. An example may be the phrase “death is a little closer today.” However, she advised nurses to refrain from using the phrase, “I’m sorry,” because it may convey a sense of aloofness, negativity, or pity. A better approach may be to use “I wish” statements, which demonstrate empathy but acknowledge the limitations of treatment (eg, “I really wish we had better treatments for your cancer”).

Ms Canton explained that it is important to update family members whenever there are changes to the patient’s health. To ascertain what patients comprehend about their current situation, nurses can ask, “What is your understanding of what the doctors told you?”

She also urged nurses and other health professionals to do everything in their power to help patients and their family members feel informed, empowered, and in control.

Being Mindful

Ms Canton said that “being present” has become more challenging in today’s fast-paced world, and nurses need to put extra effort into staying in the moment with patients and their loved ones during difficult times such as end of life. She noted that there are many ways for nurses to make their presence known in a supportive way—sometimes just being in the room can be very helpful. They can also be instrumental in facilitating a sacred space for patients and their family members to spend quality time together.

She reminded nurses not to intrude or get involved in personal matters unless they are invited to do so. “Be mindful that these are trying times for patients and their loved ones and will ignite a lot of emotions and feelings,” she said.

Providing Individualized Care

Ms Canton emphasized the importance of using an individualized approach to care that takes into account a patient’s specific background and cultural identity. Nurses must also rid themselves of any preconceived notions or biases that could influence their interactions with patients. It is essential to ask patients and their loved ones questions rather than rely on assumptions. Each person will deal with end of life differently, and nurses must remain open and respectful.

“There is no ‘correct’ way to deal with end-of-life circumstances, and given the gravity of the situation, a little ‘abnormal’ is to be expected,” she emphasized.

Setting the Stage

Ms Canton said that it is critical to “set the stage” before handling sensitive subjects. This often involves finding an appropriate environment to begin a difficult conversation, as well as determining whether patients and their loved ones are well-rested or fatigued. When preparing to discuss end-of-life care, nurses must also ensure that no one will be called away in the middle of the conversation. Finally, if one or more family members have been designated to speak on behalf of the patient, it is the nurse’s responsibility to ensure that this is properly communicated, she concluded.

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