Transcript End of life care education

End of Life Care Education
MODULE 1
Module 4
Communication in End of Life Care
Importance - Guidelines
 Honest, accurate and early disclosure of prognosis
 Consensus among family and between family and
physicians
 Discussion and communication of modalities of endif-life care with family
 Shared decision-making
 Ensure consistency among family members
 Effective and compassionate support throughout,
including bereavement care
Ethical principles
Autonomy
Beneficence
Non-malfeasance
Social justice
Goals of communication during end-of-life
discussions
Establishing consensus about the disease process
among care-givers
Providing accurate and appropriate information
about the disease process to the family
Eliciting and resolving the concerns prompted by
end-of-life decisions (EOLD)
Communication skills at EOLD
Ability to distinguish between cognitive and
emotional components in the concerns expressed
by patient and family
 Use of empathy
Ability to understand and clarify doubts
”Active listening”
S-P-I-K-E-S approach in patient and family centered
communication
 Setting – time, space, privacy
 Perceptions – of the family/patient about the illness and
progress
 Invitation – family/patient expresses a wish to discuss about
the illness and management options
 Knowledge – about the illness and prognosis informed to the
family in a clear understandable language
 Emotional support and Empathy – Identifying the emotions in
the family and responding appropriately to it
 Strategy and summary – summarizing the current situation,
further plans for comfort care and accurate documentation
Patient and family centered
communication - components
Empathy
Collaboration
Clarification
Avoid being judgmental
Perception of patient’s wishes
Recapitulation
The VALUE mnemonic
Value statements by family members
Acknowledge family members’ emotions
Listen to family members
Understand who the patient is as a person
and how decisions are made in the family
Elicit questions from family members
Non-verbal communication-‘SOLER’
Face the patient Squarely at eye level and
indicate your involvement and interest
Adopt an Open body posture
Lean towards the patient and family
Use Eye contact to show that you are
listening attentively to the patient
Maintain a Relaxed body posture
Different communication styles of
physician
 Inexperienced messenger
 Emotionally burdened
 Rough and ready expert
 Well-intentioned but tactless expert
 Distanced expert
 Empathic professional
Conflicts during EOLD
Gap between ‘what is’ and ‘what
should be’
Failure to achieve consensus in goals
of care and related treatments at EOL
despite allowing time and repeated
discussions between involved parties
Various factors
Some barriers to good communication
and contributors of conflicts in EOLC
• Psychosocial
distress/strong emotion
• Language, cultural
barriers
• Lack of understanding
of context
• Communication skills
• Depth of understanding
of patient’s condition
• Lack of consensus
among medical team
• Grounding of medical
ethics
• Type of hospital
• Developed/developing
country
• Society’s expectations
from medicine
CONFLICT RESOLUTION
LATER
After death care
Bereavement support
CONCLUSION
 Importance of communication skills in EOLD
 Approaches
 Styles
 Barriers
 Conflict resolution
THANK YOU
This education program is a joint initiative of Indian Society of Critical Care
Medicine and Indian Association of Palliative Care. 2014
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