Open, clear, and professional team-based communication can help facilitate the challenging conversations that must take place when preparing a patient and their family for end-of-life care.
In an AMA Journal of Ethics paper, Mark Pfeifer, MD, and Barbara A. Head, PhD, CHPN, ACSW, of the University of Louisville School of Medicine in Kentucky, examined the best approaches to discussing diagnosis and prognosis, treatment goals, and future plans with patients and their families.
According to the paper, discussions delivered by clinicians from multiple disciplines are highly recommended when speaking to patients about end-of-life care in an effort to ensure comprehensive communication across the board.
There are several factors associated with dying that extend beyond the critical medical concerns, including social, spiritual, psychological, and financial components of care. Many argue that these factors should not be separated from clinician conversations with patients; rather, they should be implemented into an overall communication approach involving a multidisciplinary team. Nurses, chaplains, physicians, and social workers can work together to provide this communication during end-of-life decision-making discussions.
During conversations about care goals, prognosis, treatment options, and advanced care planning, the authors suggested that at least 2 team members be present. In addition, a family meeting consisting of the patient, other family members, and members of the multidisciplinary team may be warranted for the development of a holistic care approach for patients at the end of life. Multiple follow-up conversations are also encouraged, with the interdisciplinary team dividing conversation responsibilities among team members to reduce overall pressure on the physician.
For end-of-life discussions, a clinical team should focus on the who, what, when, where, and how when presenting information. Patients should have input on who delivers certain aspects of communication, and clinicians should know what information is to be delivered prior to a conversation. Discussions should also be scheduled to avoid conflict with routine hospital care, and discussions should be conducted in a quiet room and without interruptions. Semi-structured conversations are recommended, with an initial goal in mind and allowances for free-flowing conversation from the initial starting point.
When caring for patients at the end of life, clinicians should continually focus on “honing the essential skills for these common yet critical conversations,” according to the authors, as this has a “tremendous ability to influence the lives and well-being of our patients and their families.”
Pfeifer M, Head BA. Which critical communication skills are essential for interdisciplinary end-of-life discussions? AMA J Ethics. 2018;20(8):E724-E731.