1. Textbook of Palliative Care Communication Section VIII: Opportunities for the Future

2. THE STATE OF THE SCIENCE ON PALLIATIVE CARE COMMUNICATION Chapter Fifty

3. Palliative Care is Vital to Providing Quality Healthcare Sixty percent of Americans aged 67 and older have three or more chronic diseases. Palliative care is not end of life or hospice care. It is a vital part of quality healthcare for all patients, not just for the dying. Palliative care communication enables providers to articulate, describe, define, and explain the difference between palliative care and hospice to patients, families, colleagues, and consumers.

4. The Effectiveness of Communication Interventions A primary goal of PC communication research is to demonstrate the effectiveness of communication interventions: family meetings, goals of care consultations, transitions in care conversations, and shared decision-making Currently measured as satisfaction with the care experience; however, standardized measures, grounded in communication, need to be developed. Research must validate and document the benefits, with communication variables as part of data collection and analysis Effectiveness assessments should include: – hospital- or community-based outpatient palliative care – communication needs/preferences during decision-making, prognosis, treatment, and disease

5. Communication Education Currently, communication education involves: – Clinical observation of mentors and real-time practice – Patient simulation New models are needed to advance the field: – Develop core curricula – Promote institutional communication training to increase knowledge about palliative care; teach fellows how to conduct communication research, collaborate with communication researchers, mentor outside the discipline, and identify research needs. – Expand training to all providers, including nurses, social workers, and chaplains – Prepare and provide resources to healthcare educators to teach communication

6. Designing Communication Interventions The focus needs to be on quality communication strategies and processes within advance care planning and family meetings. – Advance care planning material should be easy to read, understand, and access. – Family meetings should include the presence, participation of all team members. – Visual and audio communication should support patient and family decision-making. – Plain language and simple terms should be used to explain diagnosis, treatment, and the dying process to patients/families.

7. Communicating with Tomorrow’s Patient As healthcare becomes more individualized and personalized, more data, more tools, and new technology will be needed. In-home care settings will become commonplace, oral administration of new medicines will be prioritized, and new challenges in educating/communicating with family caregivers will arise. The 2014 Institute of Medicine report includes communication in its recommendations on quality end of life care: – Patients and families need understandable information about cancer prognosis, treatment benefits/harms, psychosocial support, and costs. – Patients need care that meets their needs, values, and preferences. – Communication ensures coordinated and comprehensive patient- centered care and that all cancer caregivers have appropriate core competencies.