Words That Work: Patient-Centered Strategies for Difficult Conversations (P19)

Abstract

1.List common patient and family frameworks that create challenging communication scenarios for palliative care clinicians.2.Describe communication strategies that effectively reframe difficult conversations into collaborative patient-centered, goal-directed care planning discussions.3.Cite model dialogue that can enhance communication in specific challenging clinical scenarios. Effective communication is a core skill requirement for quality palliative care. Skillful palliative care clinicians achieve successful communication by serving as interpreters bridging the world of medicine that focuses on communicating facts about diagnosis prognosis treatment plans to the world of patients and families who worry about their illness in terms of values purpose and meaning and how to make trade-offs given current and future quality of life. Effective strategies include creating safe environments that invite patients, families, and clinicians to express their opinions frankly and using meta-communication techniques of simultaneously listening to each person's narrative and monitoring one's own words to match others as a way to find common ground and demonstrate that all the participants have been heard. This workshop is responding to the request to expand our 1-hour presentation from the 2010 AAHPM meeting to include more time to review and analyze successful communication strategies and conduct as well as to debrief and discuss role play demonstrations in small groups. For the role playing, we will break into small groups and invite participants to pose their own communication challenges from topics such as eliciting goals of care, discussing miracles, managing uncertainty, dealing with denial, and responding to clinician and family requests to “stop the torture” or “get the DNR.” We will enact the same conversation 2–3 times using different communication strategies to show how the process changes when any one of the four components (ie, words, attitude, body language, and timing) shifts. Our work is based on ethnographic research observing expert clinicians, conducting consults, and our experience translating this research into practical education strategies for medical students and residents. This session is designed for less-experienced practitioners who want to improve their skills as well as educators seeking effective teaching strategies. Psychological and Psychiatric Aspects of Care; Social Aspects of Care; Spiritual, Religious and Existential Aspects of Care; Cultural Aspects of Care