Communication with Patients, Carers, and Family

Communication that is open, respectful, culturally safe, and comfortable enables effective conversations. This forms a key part of providing comprehensive care.

To support assessment, use your communication skills to:

• actively listen and allow the person to express themself; this may involve periods of silence
• ask open-ended questions, for example:

• ‘What troubles you the most?’
• ‘With what you know about your illness, what’s most important to you?’

• paraphrase and summarise to check that you have understood correctly:

‘What I hear you saying is that you have been experiencing … which has been making you feel … Have I understood that correctly?’

• ask what information the person and their support network want to receive:

• ask about the impact of any symptoms and what other factors influence this impact them:

• ask whether there are any other practical issues that might influence the choice of treatment, including cultural, spiritual, and geographical factors
• ask the person about their current and intended place of care
• document what is discussed and said so that all providers of care are informed.

For more detailed information go to End-of-Life Essentials resources to adopt and adapt.

Triggers indicating the need for discussion include:

• when a life-limiting advanced progressive illness is diagnosed
• when a treatment decision needs to be made
• when there is a change in the person’s condition, or when the person, carers, or a health professional perceive a change
• when a person seeks information about treatment options or to plan for the future
• when a person moves to a residential aged care facility
• if treatment is not working or there are complications from this treatment that limit its effectiveness
• after a hospitalisation
• when there is a change in the person’s social context (change within the family or affecting a carer)
• when family or carers are distressed or overwhelmed
• if there are requests or expectations that are inconsistent with clinical judgement
• when the person is referred to a specialist palliative care service.

Preparation for a discussion can include:

• finding a private space or making a space more private (e.g. closing a door, moving to a room or more private space, waiting for a space to be more calm/private, booking a meeting space)
• limiting noise and external interruptions (people, telephone)
• choosing a time when the person is comfortable, alert and their condition is stable
• making the sure the person is mentally capable of taking part in the discussion (e.g. not confused, not distressed)
• having a relative, friend or advocate present who makes the person feel more at ease
• providing the person the opportunity to discuss things with and without others present
• ensuring there is enough time to answer questions or repeat information so that it is understood – if not, make sure that another time is set
• optimising any communication aids as required (e.g. hearing aids or an interpreter)
• assistance for a person with cognitive impairment (e.g. a support person, a facilitator, information in a format that is accessible for the person, extra time to present information at an acceptable pace with time for the person to consider what they have heard and to express themself).

During care you should be aware of both verbal and non-verbal signals that you are communicating.

Verbal communication

• • introduce yourself and others in the room there to help
  • describe what you and other team members are going to do
  • ask permission before you begin
  • describe what you and other team members are doing
  • invite the person to ask questions
  • ask about their needs and goals, and any concerns they might have and acknowledge these
  • acknowledge the role of carer(s)
  • speak with a caring voice tone, paying attention to not speak too loudly or quickly

Non-verbal communication

• respect the person’s privacy and dignity e.g. draw a curtain, close the door as appropriate
• give the person your full attention
• use eye contact where appropriate
• nod your head to show you are listening but do not interrupt the person talking
• when talking with the person, where possible, position yourself to be the at their level
  • use touch where appropriate – care and reassurance
• A person’s health literacy levels (how people access, understand and use health information) should guide the way and the level of information that is provided to them. Assume low health literacy and use plain language and avoid clinical jargon and acronyms. Give information in small chunks, at the person’s pace and ask them to tell you what they have understood.

Culturally appropriate communication pays attention to the person’s beliefs and practices about death and dying including family participation in decision-making, gender roles, communication norms guiding decision-making and the breaking of bad news, and rituals.

It may be necessary to involve interpreters, cultural liaison workers or advocates from the person’s community to assist and ensure that the information is understood.

Using an interpreter

It can be helpful to prepare by checking that the interpreter

• is acceptable to the person
• is fluent in the person’s language and dialect
• speaks fluent English.

Speaking to the interpreter about what is likely to be discussed to check that they are comfortable with this can help ensure that little or no shame or embarrassment occurs during the discussion.

When using an interpreter in palliative care, remember that:

• face-to-face interpreter services are preferable to telephone services for conversations about palliative care or dying
• you will need to allow time for the interpreter and the person to fully introduce themselves
• the interpreter may need time to fully relay information in each direction
• the healthcare professional should look at the person when speaking and listening (if culturally appropriate), and act as if it is the person talking
• talking in small ‘chunks’ helps the interpreter and the person
• sometimes there is no direct translation for words used in palliative care so these may need explanation for the person and the interpreter
• it is important to check the person’s understanding or interpretation of what is said
• the interpreter and the person should understand that the discussion is confidential.

Using a family member as an interpreter may be difficult as it may not be appropriate for a particular family member to hear the information being discussed, or they may filter information. For more information on cultural groups and vulnerable populations, visit the CareSearch section: Providing Inclusive Care.

Visit CareSearch – Providing Inclusive Care

Providing Inclusive Care