Skip to main content
SpringerLink
Log in

Communication in Palliative Care

  • Chapter
  • First Online:
Essentials of Palliative Care

  • 3621 Accesses

Abstract

Taking care of palliative care patients and breaking bad news to them will never be an easy task. Excellent communication skills are essential while taking care of patients who face a life-threatening disease and while communicating with their distressed loved ones. Such skills are also important to work well with other members of the healthcare team. Excellent communication not only offers the best care to the patient, but also helps support team members who handle these difficult situations. The patient will also benefit from perfecting the collaboration and communication among the numerous involved physicians. Training to improve these communication skills is essential. Such training ideally starts early in the course of professional education. Several models have proven to be effective. This chapter will review the mandatory elements of a good meeting where bad news is communicated, give tools to discuss with distressed and sometimes “difficult” families, and emphasize the importance of coordinated teamwork and communication among the various physicians and other health workers involved in the patient’s care.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Rosenbaum ME, Ferguson KJ, Lobas JG. Teaching medical students and residents skills for delivering bad news: a review of strategies. Acad Med. 2004;79(2):107–17.

    Article  PubMed  Google Scholar 

  2. Rider S, Hinrichs MM, Lown BA. A model for communication skills assessment across the undergraduate curriculum. Med Teach. 2006;28(5):e127–34.

    Article  PubMed  Google Scholar 

  3. Stiefel F, Barth J, Bensing J, et al. Communication skills training in oncology: a position paper based on a consensus meeting among European experts in 2009. Ann Oncol. 2010;21:204–7.

    Article  PubMed  CAS  Google Scholar 

  4. Kissane DW. Communication skills training for oncology professionals. J Clin Oncol. 2012;30(11):1242–7.

    Article  PubMed  Google Scholar 

  5. Moore PM, Wilkinson SSM, Rivera Mercado S. Communication skills training for health care professionals working with cancer patients, their families and/or carers. Cochrane Database Syst Rev. (2):CD003751. doi:10.1002/14651858. Published online: 21 Jan 2009.

  6. Vandekieft G. Breaking bad news. Am Fam Physician. 2001;64(12):1975–8.

    PubMed  CAS  Google Scholar 

  7. King LS. Medicine in the USA: historical vignettes. IX. The AMA sets a new code of ethics. JAMA. 1983;249(10):1338–42.

    Google Scholar 

  8. Oken D. What to tell cancer patients. A study of medical attitudes. JAMA. 1961;175:1120–8.

    Article  PubMed  CAS  Google Scholar 

  9. Armstrong L. It’s not about the bike: my journey back to life. New York: Putnam; 2000.

    Google Scholar 

  10. Mitnick S, Leffler C, Hood VL. Family caregivers, patients and physicians: ethical guidance to optimize relationships. J Gen Intern Med. 2010;25(3):255–60.

    Article  PubMed  Google Scholar 

  11. Fine P, Peterson D. Caring about what dying patients care about caring. J Pain Symptom Manage. 2002;23(4):267–78.

    Article  PubMed  Google Scholar 

  12. Chung GS, et al. Predictors of hospitalized patients’ preferences for physician-directed medical decision-making. J Med Ethics. 2012;38(2):77–82.

    Article  PubMed  Google Scholar 

  13. Buckman R, Baile W. Truth telling: yes, but how? J Clin Oncol. 2007;25(21):3181.

    Article  PubMed  Google Scholar 

  14. Von Gunten CF, Ferris FD, Emanuel LL. The patient-physician relationship. Ensuring competency in end-of-life care: communication and relational skills. JAMA. 2000;284:3051–7.

    Article  Google Scholar 

  15. Bailey W, et al. SPIKES-A six-step protocol for delivering bad news: application to the patient with cancer. Oncologist. 2000;5:302–11.

    Article  Google Scholar 

  16. Back AL, Arnold RM, Baile WF, et al. Efficacy of communication skills training for giving bad news and discussing transitions to palliative care. Arch Intern Med. 2007;167:453–60.

    Article  PubMed  Google Scholar 

  17. Park I, et al. Breaking bad news education for emergency medicine residents: a novel training module using simulation with the SPIKES protocol. J Emerg Trauma Shock. 2010;3(4):385–8.

    Article  PubMed  Google Scholar 

  18. Rowland-Morin PA, Carroll JG. Verbal communication skills and patient satisfaction. A study of doctor-patient interviews. Eval Health Prof. 1990;13(2):168–85.

    Article  PubMed  CAS  Google Scholar 

  19. Meier DE, Back AL, Morrison RS. The inner life of physicians and care of the seriously ill. JAMA. 2001;286(23):3007–14.

    Article  PubMed  CAS  Google Scholar 

  20. Shanafelt TD, Sloan JA, Habermann TM. The wellbeing of physicians. Am J Med. 2003;114(6):513–9.

    Article  PubMed  Google Scholar 

  21. Pereira SM, Fonseca AM, Carvalho AS. Burnout in palliative care: a systematic review. Nurs Ethics. 2011;18(3):317–26.

    Article  PubMed  Google Scholar 

  22. Christakis NA, Lamont EB. Extent and determinants of error in doctors’ prognoses in ­terminally ill patients: prospective cohort study. BMJ. 2000;320:469–72.

    Article  PubMed  CAS  Google Scholar 

  23. Olson DP, Windish DM. Communication discrepancies between physicians and hospitalized patients. Arch Intern Med. 2010;170(15):1302–70.

    Article  PubMed  Google Scholar 

  24. Curtis JR, Patrick DL, Caldwell ES, Collier AC. Why don’t patients and physicians talk about end-of-life care? Barriers to communication for patients with acquired immunodeficiency syndrome and their primary care clinicians. Arch Intern Med. 2000;60:1690–6.

    Article  Google Scholar 

  25. Ventafridda V. According to the 2002 WHO definition of palliative care…. Palliat Med. 2006;20(3):159.

    Article  PubMed  Google Scholar 

  26. Lautrette A, Ciroldi M, Ksibi H, Azoulay E. End-of-life family conferences: rooted in the evidence. Crit Care Med. 2006;34(11):S364–72.

    Article  PubMed  Google Scholar 

  27. King DA, Quill T. Working with families in palliative care: one size does not fit all. J Palliat Med. 2006;9:704–15.

    Article  PubMed  Google Scholar 

  28. Crawley LM, Marshal PA, Koenig BA. Respecting cultural differences at the end of life. In: Snyder L, Quill T, editors. Physician’s guide to end of life care. Philadelphia: American College of Physicians; 2001. p. 35–8.

    Google Scholar 

  29. Spruyt O. Team networking in palliative care. Indian J Palliat Care. 2011;17:S17–9.

    Article  PubMed  Google Scholar 

  30. Junger S, Pestinger M, Elsner F, et al. Criteria for successful multiprofessional cooperation in palliative care teams. Palliat Med. 2007;21(4):347–54.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Section of General Internal Medicine and Geriatrics, Tulane University School of Medicine, New Orleans, LA, USA

    Dominique Anwar M.D.

  2. Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, LA, USA

    Sean Ransom Ph.D.

  3. Tulane Cancer Center, Tulane University School of Medicine, New Orleans, LA, USA

    Roy S. Weiner M.D.

Authors
  1. Dominique Anwar M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sean Ransom Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Roy S. Weiner M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dominique Anwar M.D. .

Editor information

Editors and Affiliations

  1. Department of Anesthesiology, Yale University, New Haven, 06520, Connecticut, USA

    Nalini Vadivelu

  2. Citrus Road 278, River Ridge, 70123, Louisiana, USA

    Alan David Kaye

  3. Keck School of Medicine, Department of Anesthesiology, Pain Medic, of the University of Southern California, Los Angeles, 90035, California, USA

    Jack M. Berger

Appendices

Review Questions

  1. 1.

    In a global population discharged from the hospital, how many patients can tell you their current diagnosis?

    1. (a)

      90%

    2. (b)

      75%

    3. (c)

      57%

    4. (d)

      35%

  2. 2.

    For how long does a “standard” physician let a patient talk before interrupting him?

    1. (a)

      18–23 s

    2. (b)

      30–60 s

    3. (c)

      2–3 min

    4. (d)

      Usually does not interrupt him

  3. 3.

    When you have to break bad news to a patient, what is one of the most important initial step?

    1. (a)

      To be sure that you will have time to address all the important issues, such as diagnosis, prognosis, treatment, advanced directives

    2. (b)

      To find somebody willing to do this for you

    3. (c)

      To discuss in the corridor, standing, to avoid to spend too much time with the patient

    4. (d)

      To try to have all the relevant information available

  4. 4.

    Is Palliative Care a medical specialty with higher risk of burn-out than others?

    1. (a)

      Yes

    2. (b)

      No, it is ICU

    3. (c)

      No, it is surgery

    4. (d)

      No, the risk is the same in all medical specialties

  5. 5.

    The best way to improve your communication skills is:

    1. (a)

      There is no way to improve, either you are an innate good communicator, or you are not

    2. (b)

      To observe skilled colleagues or mentors

    3. (c)

      To learn from our mistakes

    4. (d)

      To follow a formal communication training

Answers

  1. 1.

    (c) 57%

  2. 2.

    (a) 18–23 s

  3. 3.

    (d) To try to have all the relevant information available

  4. 4.

    (d) No, the risk is the same in all medical specialties

  5. 5.

    (d) To follow a formal communication training

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this chapter

Cite this chapter

Anwar, D., Ransom, S., Weiner, R.S. (2013). Communication in Palliative Care. In: Vadivelu, N., Kaye, A., Berger, J. (eds) Essentials of Palliative Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-5164-8_5

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-5164-8_5

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-5163-1

  • Online ISBN: 978-1-4614-5164-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation