Dr Oleg Kiriaev 23 October 2018 Engaging in difficult conversations Dr Oleg Kiriaev 23 October 2018

Dr Oleg Kiriaev 23 October 2018 Engaging in Meaningful conversations Dr Oleg Kiriaev 23 October 2018

What makes conversations difficult? They arise from difficulties in people’s lives: Their fears Their losses Their uncertainties

What makes conversations difficult? They arise from difficulties in people’s lives: Their fears Their losses Their uncertainties And compounded by our responses: Our fears Our losses Our uncertainties

Social Communication model Thoughts & Feelings Thoughts & Feelings Dialogue Dialogue Experience Encoding Decoding Management

Social Communication model Thoughts & Feelings What’s said 10% How it’s said 30% Nonverbal 60% Thoughts & Feelings Dialogue Dialogue Experience Encoding Decoding Management

Added difficulties in dementia Progressive loss of language skills Increasingly repetitive… More difficult to follow and tangential… Shorter conversational turns… Truncated or delayed responses… Disjointed and non sequiturs … Substitutions, semantic paraphasias, neologisms… Grammar and structural fragmentation… etc…

Our risk of Negative responses Disregard Intimidation, withholding, outpacing Depersonalise Infantilisation, labelling, disparagement Devalue Invalidation, treachery, invalidation Disenfranchise Disempowerment, imposition, disruption, objectification Exclude Stigmatisation, ignoring, banishment, mockery

Communication goes both ways Importance of time and place Reduce distractions Correct sensory deficits Position yourself directly Introduce yourself Ensure adequate set up = Cultivate and maintain rapport = Ensure you match their pace = Modify your style = + Paying full attention Maintain positive conversational tone Acknowledge Focus on remaining strengths + Speaking slowly and clearly in plain language Allow plenty of pauses + Allow them to led the conversation Know when and how to interrupt by reframing and redirecting Ask simple questions and only one at a time Keep to the present tense

Additional pearls Be opportunistic: all conversations can be meaningful Facilitative nonverbal communication needs to be made overt Often the important information is contained not in the words but rather the emotional message behind it Always try to achieve a positive emotional outcome at conclusion

Patient centred care

Relationship centred care

Relationship centred care

Network of care

Serious Illness Conversation Guide