1. End of Life Care Education
MODULE 1
Module 4
Communication in End of Life Care

2. Importance - Guidelines
Honest, accurate and early disclosure of prognosis
Consensus among family and between family and physicians
Discussion and communication of modalities of end- if-life care with family
Shared decision-making
Ensure consistency among family members
Effective and compassionate support throughout, including bereavement care

3. Ethical principles
Autonomy
Beneficence
Non-malfeasance
Social justice

4. Goals of communication during end-of-life discussions
Establishing consensus about the disease process among care-givers
Providing accurate and appropriate information about the disease process to the family
Eliciting and resolving the concerns prompted by end-of-life decisions (EOLD)

5. Communication skills at EOLD
Ability to distinguish between cognitive and emotional components in the concerns expressed by patient and family
Use of empathy
Ability to understand and clarify doubts
”Active listening”

6. S-P-I-K-E-S approach in patient and family centered communication
Setting – time, space, privacy
Perceptions – of the family/patient about the illness and progress
Invitation – family/patient expresses a wish to discuss about the illness and management options
Knowledge – about the illness and prognosis informed to the family in a clear understandable language
Emotional support and Empathy – Identifying the emotions in the family and responding appropriately to it
Strategy and summary – summarizing the current situation, further plans for comfort care and accurate documentation

7. Patient and family centered communication - components
Empathy
Collaboration
Clarification
Avoid being judgmental
Perception of patient’s wishes
Recapitulation

8. The VALUE mnemonic Value statements by family members
Acknowledge family members’ emotions
Listen to family members
Understand who the patient is as a person and how decisions are made in the family
Elicit questions from family members

9. Non-verbal communication-‘SOLER’
Face the patient Squarely at eye level and indicate your involvement and interest
Adopt an Open body posture
Lean towards the patient and family
Use Eye contact to show that you are listening attentively to the patient
Maintain a Relaxed body posture

10. Different communication styles of physician
Inexperienced messenger
Emotionally burdened
Rough and ready expert
Well-intentioned but tactless expert
Distanced expert
Empathic professional

11. Conflicts during EOLD Gap between ‘what is’ and ‘what should be’
Failure to achieve consensus in goals of care and related treatments at EOL despite allowing time and repeated discussions between involved parties
Various factors

12. Some barriers to good communication and contributors of conflicts in EOLC
Patient or family
Psychosocial distress/strong emotion
Language, cultural barriers
Lack of understanding of context
Physician
Communication skills
Depth of understanding of patient’s condition
Lack of consensus among medical team
Grounding of medical ethics
Environmental
Type of hospital
Developed/developing country
Society’s expectations from medicine

13. CONFLICT RESOLUTION
TRUST
HOPE
EMPATHY

14. LATER
After death care
Bereavement support

15. CONCLUSION Importance of communication skills in EOLD Approaches
Styles
Barriers
Conflict resolution

16. THANK YOU
This education program is a joint initiative of Indian Society of Critical Care Medicine and Indian Association of Palliative Care. 2014
© All rights reserved