Therapeutic Communication in End-of-Life Care

Hi, my name is Tasha

and I'm me

Jennifer.

Today we'll be making a video to explore how therapeutic communication techniques

can improve care for terminally ill cancer patients and reduce false hope.

Many clinicians agree that there is no correct or best

way to deliver the news of a terminal diagnosis.

Furthermore,

there are many issues discussing end of life treatment plans,

an advance directive such as moral distress,

spiritual distress and making hard decisions for everyone involved, the client,

the family and the clinician alike,

death and dying are inevitably uncomfortable and difficult topics to handle.

Many clinicians find that these conversations become even harder to complete

with a lack of knowledge and training surrounding this area.

Studies show that clinicians find conversations

about end of life even worse when patients

even worse.

When patients had low health literacy,

patients or families had unrealistic hopes of recovery or survival

when in the denial stage or if the

family requested information be withheld from the patient.

And when there were other non palliative treatment still available.

Furthermore,

they did not have confidence when they felt

they would crush hopes of survival or trust

when prognosis and deterioration were not learned

if there were concerns of emotional tolls on patients,

when unsure with how to respond to emotional communication

or when clinicians had their own discomfort around it,

using therapeutic communication can increase

our confidence in speaking about end

of life care and benefit both patients and health care providers

by prompting these discussions sooner and creating clearer goals sooner.

Currently, many end of life discussions are only happening

when something major changes in a patient's health

in a patient's health status such as inability to function without a ventilator.

There are a few main problems that needed to

be addressed when having end of life discussions between

c clinicians and patients.

One was a lack of confidence in health care

providers and having end of life conversations to begin with

two was understanding and supporting patients

and families through the grieving process.

And three was presenting information to patients in a way that they can understand

that does not influence them in one way or another and in a way that is respectful,

culturally safe and holistic,

we formulated four areas of therapeutic communication

that can address these integral pro problems.

Terminally ill cancer patients might have.

One was establishing rapport.

During the first few encounters with the patient,

the nurse needs to create an atmosphere in which trust and report can grow.

Report can be nurtured by demonstrating genuineness and empathy,

developing positive regard,

showing consistency and offering assistance in

problem solving and providing support.

Next is respect and autonomy.

Respecting the client's decision making need for privacy and confidentiality

are essential to form a therapeutic relationship

and to provide the patient with autonomy

being respectful involves showing kindness,

active listening and cultural sensitivity.

This creates an environment where the patient and family can grieve,

have privacy and make decisions about their plan of care.

Expressing support,

kindness and a nonjudgmental attitude fosters this therapeutic relationship.

Next is providing education and utilizing interes

communication.

Patients and families often need to discuss

concepts and plans of care multiple times.

In order to fully understand and make decisions about care,

it is best to offer patients and families repeated explanations as needed.

It is also best practice to avoid medical jargon and use simple terms

to make patient care as effective, efficient and comfortable as possible.

Interp profession, communication is vital.

Having all of the health care team on the same page with the same information allows

the patient to feel at ease with their care and contributes to a holistic approach.

So the fourth one is compassion and empathy,

compassion and empathy are larger and compassing terms that

describe many aspects of communication with our patients.

This involves being present,

genuine and actively listening as well as use of therapeutic touch,

nonverbal cues and validating emotions,

providing time, privacy and the right space were also key components of compassion

reading.

The room allows the healthcare provider to determine when the

patient and families are ready for end of life.

Discussions

and finding the right space for privacy is vital

to allow patients to feel safe and maintain confidentiality.

Finally, we know that families and patients can experience

anticipatory grief.

So providing emotional and spiritual spiritual support is

vital for the nurse to facilitate coping mechanisms,

these therapeutic communication techniques can help the

patient and family through the grieving process,

provide clear and simple education and provide a

holistic method of care for the patient.

However,

we wanted to dive deeper in the issue of lack

of confidence in health care providers to provide these conversations.

In the next part of this video, we will be discussing false hope

and how the best case, worst case scenario,

communication tool can help healthcare providers be the more confident,

be more confident having these conversations

and avoid

providing false hope.

In

MADRS

study,

researchers looked at a relationship between pre hospitals

care workers such as paramedics and false hope.

False hope occurred

when patients were unnecessarily transported to hospital

and paramedics felt pressured to provide unnecessary resuscitation

attempts for someone whose death was inevitable,

leaving bodies on the site,

allowing families to witness CPR and not engaging

in unnecessary resuscitation resulted in family members better understanding

that the person has died and to begin a healthier grieving process

avoiding transportation also allows pre hospital

care workers such as paramedics to

transition from carrying of the deceased to

caring for the bereaved family members.

What particularly interested me in this research study was the very

last few questions posed to EMT workers which were as follows.

One was,

do you think it would be helpful to have a professional with training on end of life

care be available or present on these calls such as a social worker or a nurse?

And two,

what roles or tasks could another professional take on

to combat false hope?

I think as nurses being available to assist with calls

surrounding death can be very beneficial for family members,

implementing therapeutic communication skills to

begin a healthy grieving process

is an essential role that the nurse can fulfill.

In backus's

study around hoping cancer patients,

the overwhelming finding was that cancer patients who

express hope positively and adequately to their health condition

have a greater sense of self agency more often correctly

use adaptive strategies of coping with stress resulting from the

the disease

and are characterized by a lower level of various types of of negative feelings.

True hope was characterized as having hope that was meaningful,

real and wise in the patient patient's perspective.

This type of hope is what allows patients to cope with their diagnosis.

Whereas false hope can be damaging and produce negative feelings.

As clinicians, we usually want to be the person who can fix diseases.

However,

in a situation where a patient is going to die and there's nothing we can fix anymore.

It is vital that we do not provide a sense of,

of false hope and instead support the

patient and family with healthier coping mechanisms

and work towards creating true hope.

Now let's talk about communication with families.

Some families can take the news of their loved ones dead well,

but others can threaten the health care provider

demand that more be done or have other emotional reactions.

As noses are plans of care for cancer patients

with terminal diagnosis must include care of the family as well.

Preventing false hope is a big factor.

But there are other strategies that we can implement

including empathy educating,

offering the self silent, spiritual care, active listening

and personal sharing,

using therapeutic communication to eliminate false hope,

offer support counsel, explore treatment options,

provide information and provide holistic and culturally safe care

are all vital areas that nurses should be trained on and confident in.

However, an overwhelming theme in end of life,

communication between clinicians and patients are a

major lack of confidence from the clinicians.

These conversations can be emotional, frightening

or create uncertainty for many reasons.

While researching, we came across the best case or worst case scenario too

that aids clinicians in communication

with trauma in the IC U.

Now, let's look at the best case, worst case communication tool.

This tool was piloted in trauma intensive care units for patients who were

for example, in a move

for vehicle accident.

We theorized that this tool could also be used for terminally ill cancer patients.

One major issue that many healthcare providers experience is

that patients do not understand the extent of the disease

and want the most rigorous survivor

based approach

which could come from a viewpoint of f

food.

This tool simplifies the treatment options provided

utilizes a graphic aid to make scenarios clear,

makes it apparent that many treatments or scenarios do end in debt for the patient.

And it even includes a most likely portion of each scenario that a physician

would mark off as what they think will result from that specific option.

So for example,

if we have a Jane Doe who is recently diagnosed with stage four cancer,

there's still many treatment options. She and her family can choose from.

We have to somehow get the message across that Jane will die

and that treatments may only lengthen her life by

little while implementing therapeutic communication

techniques can be very useful

uh to help frame a logical state of mind.

The best case,

worst case tool can support communication and ultimately provide the family

with what scenario is best for them in a simple way.

Let's explore a care plan for genes cancer.

Scenario.

Number one is no treatment for her cancer where the

best case is that Jane has a three month life expectancy

and most likely Jane will live for three months but experiences a lot of pain.

The worst case is Jane's condition can rapidly deteriorate

and she dies in less than three months.

The family's next option is comfort measures which will keep

the same three month life expectancy in the best case,

but most likely Jane will live for those three months with little to no pain.

The worst case is that Jane's condition rapidly deteriorates

again and she dies in less than three months.

The last option is chemotherapy which um can

increase Jane's life expectancy by up to one year.

The physician theorizes that most likely Jane will

experience the symptoms of chemotherapy for two months,

but she will uh live for the year.

The worst case is that chemotherapy doesn't work for Jane and she

experiences the symptoms of it anyway and still dies within three months.

So here is what works about this communication tool

by using the term die instead of pass,

it is a concrete time that really solidifies the family's mind that Jane will in all

in a rose die.

It gives the family an idea of what the healthcare providers think is the

most likely case and reality of what will happen when choosing between the options.

It uses graphic a and simplifies the medical jargon for a patient friendly approach

and support and guide therapeutic communication between

the patient and health care providers.

This pilot study did have significant benefits

in communication with patients and families,

particularly

in preventing false hope.

This was the most interesting part of the study to us.

I think by reducing false hope,

we can allow patients with terminal cancer diagnosis

to begin their grieving process in a healthier way

this opens the floor to focus our approaches with the patient, to utilize true hope

and help with the other aspects of grieving process.

Ok. In conclusion across all studies completed

around communication with grieving families,

a lack of training and confidence was prominent.

One assumption that we made before viewing the literature was that

although conversations surrounding grief and control

are always difficult,

we thought that the care providers would most of

the time be confident in their communication skills.

However,

one of the biggest factors in a lot of these scenarios is

lack of confidence that leads to

avoiding such conversations and poor communication.

With what we've discussed in our literature review.

There are many applicable skills and tools to use in our future as nurses

having a more comprehensive idea of what therapeutic

communication techniques can be used for terminally ill patients

will allow our counseling, our counseling treatment and patient care to thrive

by utilizing the tool to help guide conversations and avoid providing false hope.

We can have more confidence in ourselves to explore the

patient and their family's grieving process and offer support.

There's no way to make these conversations easy.

But using these tools and techniques can give us more confidence

and ultimately improve service and quality of life for patients.

Therapeutic Communication in End-of-Life Care

Chapters

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