Guidelines for Communicating with Patients and Families at the End of Life

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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.

 

Helpful Hints

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

 

Accept

  • 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

 

Question

  • 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

  • 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.

 

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