Guidelines for Communicating with Patients and Families at the End of Life
Some general guidelines and helpful hints for the professional caregiver in applying interventions are as follows:
- Use an empathetic approach
- Encourage self-expression
- Listening may be more important than speaking
- Maintain the patient’s dignity
- Help the patient to feel secure
- The tone and manner of interacting is important
- Maintain hope
- Focus on remaining capabilities
- Reminiscing may bring a sense of closure
There are no easy cookbook answers to working with dying patients and their families. A set of guidelines is just that — guidelines, not hard and fast rules. We adapt our caregiving to the nature and needs of the individuals involved.
Listen and Watch
- Listen carefully in order to decipher essential information
- Pay attention to everything the patient says
- Watch for key signs: glassy-eyed look; the appearance of staring through you; secretiveness or distractedness; seemingly inappropriate signs or gestures
- If you don’t know what to say don’t say anything
- Keep an open mind
- Accept and validate what is told to you by the patient (Example: “I’m so pleased you are telling me this. I really want to understand what is happening to you.”
- Respond in ways that tell the patient you accept whatever they see or hear
- Follow up what is said in a gentle way by asking questions
- Encourage patients to repeat the question(s) if necessary. (Example: “I’m not sure I follow you. Can you explain a little more?”)
- When you do not understand what is happening, respond with gentle questioning (Example: “Can you tell me what is happening? You seem different today. Can you tell me why?)
- Be honest about having difficulty understanding. (Example: I think you are trying to tell me something important and I am trying, but I am not understanding what you are telling me. Please do not give up on me. I will keep trying.”)
- Pose open-ended questions. (Example: If the patient whose parent is long since dead says, “My mother is waiting for me,” turn the comment into a question. “ Mother is waiting for you? or “I’m so glad she is close to you. Can you tell me about it?”)
- Support the patient
- Do not challenge or argue. Do not push.
- Reinforce the interest you have in what they have to say and offer to be available when needed.
If you found this article informative and useful share it with your friends and colleagues.