Breaking News Honestly but Softly:
8 Tips for Having Difficult Conversations with Patients and Families
One of the heaviest responsibilities weighing upon medical professionals is that of informing patients and their families of life-limiting diagnoses. Though effective and accurate communication skills are essential to nurses’ and physicians’ daily routines, practitioners receive very little formal training on how to break the most difficult news.[1] Clinicians often delay, avoid, or delegate such conversations because they worry they may diminish hope, compound a family’s suffering, or unleash emotional responses they feel incapable of handling.[2] However, patients and families deserve kindness and honesty more than ever when they are informed of a life-limiting diagnosis, and miscommunication stemming from a physician’s discomfort can have serious, even legal, consequences. Below are some helpful tips to guide medical professionals through difficult conversations:
- Make sure everyone is comfortable: When initiating a difficult conversation, choose a private, relaxed time. There should be no distractions, and the patient and/or family member should feel comfortable before you begin.[3]
- Make time: One of the most common complaints of patients and their families is that busy clinic schedules seldom leave time for in-depth conversation.[4] Even if time is limited, medical professionals should never appear in a rush, and need to be aware of the grave consequences this conversation will have on those who it concerns.
- Don’t be afraid: Many medical professionals’ fear of a patient’s response keeps them from communicating effectively, or causes them to talk too much. Keep in mind that the most important thing to do is to listen; the conversation should be about encouraging the patient to explore what is going on and what they want.[5]
- Be gently honest: Physicians and nurses should give a simple explanation of what’s going on without using euphemisms or jargon.[6] Empathy is important, but honesty is equally important for building a relationship of trust with the patient and family members.
- Practice good communication: Medical professionals should use simple language, follow cues given, be engaged, and communicate a treatment plan appropriately.[7] As mentioned already, active listening and encouraging questions is crucial as well.
- Be “present”: Showing that you’re “in the moment” with the patient establishes that you care about them and their health. It is critical to maintain eye contact, employ touch if appropriate, and give your full attention.[8]
- Recognize how a patient processes a diagnosis: A life-limiting illness is not a single event, and though the critical phases of an illness can be thought of as a linear process, coming to grips with such a diagnosis is rarely a linear process for patients.[9] Be patient and allow patients and family members the opportunity and time to express their fears and grief.
- Remember that you’re not alone: Though it can be intimidating going into a room and telling a family the worst, know that there are other members of the medical team to support you.[10] If needed, have another expert with you to help or step in.
Each phase of an illness presents the possibility of distress for a patient and their family, but each phase also offers opportunities to change a patient’s perception of the illness, especially with the help of open communication.[11] If medical professionals are sensitive but not afraid of such conversations, the process will not be easier, but it will go much smoother for all involved.
[1] Marcus, Joel D. and Frank E. Mott, “Difficult Conversations: From Diagnosis to Death,” The Ochsner Journal, Winter 2014, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4295750/
[2] Meyer, Elaine C. Deborah E. Sellers, David M. Browning, and Kimberly McGuffie, “Difficult conversations: Imroving communication skills and relational abilities in health care,” Pediatric Critical Care Medicine, April 2009, https://www.researchgate.net/publication/24238127_Difficult_conversations_Improving_communication_skills_and_relational_abilities_in_health_care
[3] Hanson, Janine, “Difficult Conversations: Tips for health Care Providers on Starting the Hospice Conversation with Patients and Families,” Hospice Red River Valley, n.d. http://www.hrrv.org/blog/health-care-professionals/difficult-conversations-tips-for-health-care-providers-on-starting-the-hospice-conversation-with-patients-and-families/
[4] Marcus and Mott, “From Diagnosis to Death”
[5] Brown, Troy, “How to Have Difficult Conversations With Patients, Families,” Medscape, May 9, 2012, http://www.medscape.com/viewarticle/763543
[6] Ibid
[7] Marcus and Mott, “From Diagnosis to Death”
[8] Troy, “How to Have Difficult Conversations”
[9] Marcus and Mott, “From Diagnosis to Death”
[10] Troy, “How to Have Difficult Conversations”
[11] “Marcus and Mott, “From Diagnosis to Death”