When a patient's disease is progressing and their care needs are changing, having honest and open conversations with them and their family is important. This may include discussing the patient's understanding and expectations of their current treatment and prognosis. Often this role will fall to the doctor or nurse, but sometimes patients themselves will want to talk about it with allied health professionals.
This often occurs within the context of functional decline. When bodies increasingly prevent people from doing everyday activities, ongoing deterioration cannot be avoided. Allied health professionals may also identify when someone may be eligible or appropriate for palliative care. For example, in acute health settings, allied health professionals may have facilitated transition to palliative care where the surgical or medical team have been reluctant to do so.
Patients don’t always expect clinicians to have the 'right answers' and it is alright to say you don’t know. Sometimes people just want to be heard and listened to, not abandoned. [1] If you can’t answer a specific question it is important to direct them to someone who can.
While introducing the concept of palliative care can be difficult for some health professionals, it is understandably very confronting for patients: 'Disease changed my life as husband, father, professor and everything else. I had to learn to be dependent. I was unreliable in practical matters and often emotional ones as well, and incapable of doing tasks that I had considered normal. It was no small thing to rediscover myself as I changed.' [1]
Research has linked effective patient-centred interviewing with improved health outcomes, such as patient satisfaction and quality of life. [2] This approach helps us to understand what the patient understands and how they think about their situation. The use of open-ended (‘how’ or ‘why’) questions enhance disclosure and can improve communication. Providing quick advice and reassurance can have the opposite effect. [3]
The appropriate use of silence is another effective communication tool. Some health professionals are not always comfortable with this as the compulsion to fill the ‘quiet space’ with talk is natural. However, practitioners have often noted that when they consciously ‘hold patients in that space’ and are comfortable with silence, what often unfolds is really quite important and profound. Another tip for professionals is to avoid rushing or ‘shutting down’ patients due to their ‘busy-ness’.
Care should be taken to explain the difference between 'palliative care' and 'terminal (end-stage) care' and the importance of realistic goal-setting. It is vital for allied health professionals to reflect medical and nursing opinion, so that the information given to patients is coordinated.