Palliative Care Communication Research Articles

Simulation training in non-cancer palliative care for healthcare workers: a systematic review of controlled studies

BackgroundThe need for healthcare workers (HCWs) to have skills and knowledge in non-cancer palliative care has been recognised. Simulation is increasingly being used for palliative care training, offering participants the...

Best Practices for Teaching Clinicians to Use a Serious Illness Conversation Guide.

With the palliative care workforce shortage and changes in advance care planning reimbursement, many institutions are requesting that palliative care specialists provide serious illness communication training across their institution's workforce. Based on our experience training clinicians to use the Partners Serious Illness Conversation Guide, a structured guide to teach basic palliative care communication skills, we propose a set of best practices to help others teach use of a communication guide at their institution, including fostering a safe learning environment, explicit teaching of structured communication, and preparing cofacilitators to adapt to differing skill levels of learners.

Empowering Interpreters to Partner in Palliative Care Conversations: Effect of a Dialogue-Based Curriculum on Interpreter Attitudes and Confidence (GP701)

•Design a 6-session curriculum for their practice site to improves dialogues with face-to-face interpreters who partner with them in conducting palliative care conversations with patients and their families with limited English proficiency.•Plan to overcome barriers in their practice site to conducting the dialogues, identify colleagues to be recruited to join the sessions (e.g. social workers, chaplains), and identify resources needed (e.g. financing lunches or afternoon snacks). Effective communication across cultural and linguistic barriers during breaking bad news, DNR, and EOL conversations requires professional medical interpreters skilled in PC communication and clinicians skilled in working with interpreters. Train interpreters in palliative care (PC) terminology; Train interpreters to be effective cultural brokers during PC conversations; Increase interpreters' sense of empowerment, professionalism, and team membership. A six-session curriculum: “Palliative Care Dialogues with Interpreters”, facilitated by an experienced PC social worker (SW) and physician, was delivered to medical interpreters from Brigham and Women's Hospital and Dana-Farber Cancer Institute. The curriculum included links to relevant materials, and structured 1-hour sessions including role-plays on: Initiating and managing a pre-encounter conference; Family meetings; Terms used in PC meetings; Family meetings to discuss code status and end of life-prolonging therapies; Cultural Mediating; Interpreting for SWs and chaplains (with SW and chaplains doing role plays); and Experiencing being a cultural mediator in End of Life Care. 41 participants completed a 23-question pre- and post-course survey on their attitudes towards and confidence in interpreting for palliative care conversations. There was a highly significant improvement in interpreter post-course attitude (N = 48; p=.0050) and confidence (N = 41. p=1.4080 x 10-11). Facilitated dialogues enabled interpreters to assert concerns, share knowledge, and practice new behaviors in a “safe” space, behaviors they reported they then used in clinical practice. Dialogues provided clinicians an opportunity to learn about the challenging linguistic, cultural and emotional experiences of medical interpreters. Facilitated and well-structured dialogues, including didactics, discussions and roleplaying caused highly significant improvements in interpreter attitudes about and confidence in interpreting PC conversations.

Communication and shared decision-making with patients with limited health literacy; helpful strategies, barriers and suggestions for improvement reported by hospital-based palliative care providers.

Communication and shared decision-making (SDM) are essential to patient-centered care. Hospital-based palliative care with patients with limited health literacy (LHL) poses particular demands on communication. In this context, patients' emotions and vulnerable condition impact their skills to obtain, understand, process and apply information about health and healthcare even more. If healthcare providers (HCPs) meet these demands, it could enhance communication. In this study, HCPs were interviewed and asked for their strategies, barriers and suggestions for improvement regarding communication and SDM with LHL patients in hospital-based palliative care. A qualitative interview study was conducted in 2018 in four Dutch hospitals with 17 HCPs-11 physicians and 6 nurses. Transcripts were analyzed using thematic analysis. In general HCPs recognized limited literacy as a concept, however, they did not recognize limited health literacy. Regarding SDM some HCPs were strong advocates, others did not believe in SDM as a concept and perceived it as unfeasible. Furthermore, five themes, acting as either strategies, barriers or suggestions for improvement emerged from the interviews: 1) time management; 2) HCPs' communication skills; 3) information tailoring; 4) characteristics of patients and significant others; 5) the content of the medical information. According to HCPs, more time to communicate with their patients could resolve the most prominent barriers emerged from this study. Further research should investigate the organizational possibilities for this and the actual effectiveness of additional time on effective communication and SDM. Additionally, more awareness for the concept of LHL is needed as a precondition for recognizing LHL. Furthermore, future research should be directed towards opportunities for tailoring communication, and the extent to which limited knowledge and complex information affect communication and SDM. This study provides first insights into perspectives of HCPs, indicating directions for research on communication, SDM and LHL in hospital-based palliative care.

From Days of "Nonverbal Communication" to Days of “Masks” and "EVisit": Effective Palliative and Cancer Care Communication in the Times of Covid-19

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Death and End of Life: Perceptions Throughout The Career About Death, Palliative Care, and Educational Process.

To evaluate the perception of attending physicians, medical residents, and undergraduate medical students about death and dying, the end of life (EoL), and palliative care (PC) during training and clinical practice, highlighting knowledge gaps, and the changes needed in medical school curricula. Cross-sectional study of 12 attending physicians, residents, and undergraduate medical students randomly selected from a single teaching hospital in São Paulo, Brazil, 2018. Semi-structured interviews were conducted, transcripts were coded in depth, and categorizing analysis was carried out. Three topical categories were recognized: Negative feelings about death and the EoL, importance of PC, and gaps in curricular structure hindering preparedness for PC and EoL communication. Besides differing perspectives depending on their years of experience, all participants strongly endorsed that the current medical school curriculum does not train and support physicians to handle EoL and PC. Medical education plays a fundamental role in the development of knowledge and skills on death, dying, and PC. Such practices should extend throughout the course and be continuously improved after graduates move to clinical practice.

Emotionally reflexive labour in end-of-life communication

Within palliative care, clear and open communication about death is encouraged. Euphemisms are discouraged as threats to promoting clear understanding of the prognosis; to opening communication about what a good death means to individual patients and families; and to fostering collaborative planning aimed at achieving this ‘good death’. Principles of patient-centred and culturally competent care, however, which reflect trends of individualisation, plurality and multiculturalism that are characteristic of late modernity, encourage respect for and support of patients' and families' preferences. These may include wishes to avoid open communication, preferences for euphemisms, and definitions of a ‘good death’ that vary from the practitioner's, and within families. The aim of this study was to examine how physicians navigate these competing priorities. Analysis is based on interviews with 23 doctors, ranging in experience from medical students through to senior palliative care specialists, and eight recorded observations of palliative care multidisciplinary team meetings with 52 clinicians collected in 2017 at two hospitals in one Australian metropolitan area. Findings show that synonyms familiar to clinicians are often used to communicate prognoses in multidisciplinary meetings. In communication with patients and families, doctors rely on emotional and cultural cues to decipher the preferred terminology and response. Drawing on a late modern re-imagination of emotion management, we conceptualise the work performed in this context as emotionally reflexive labour. These findings suggest that blanket protocols for direct communication overlook the complexity of end-of-life communication in an era where a ‘good death’ is understood to be culturally relative.

Palliative Care Communication: Outcomes From COMFORT, a Train-the-Trainer Course for Providers.

With increasing support for the integration of palliative care and standard oncology, communication training programs are needed to teach oncology nurses and other providers about palliative care communication. This study reports on the outcomes of COMFORTTM SM Communication for Oncology Nurses, a train-the-trainer communication course to educate oncology nurses about palliative care communication and improve patient-centered communication and cancer care. 355 oncology nurses attended the two-day course. This study used 6- and 12-month follow-up data from nurses who provided feedback on the progress of these goals. Nurses taught an additional 9,720 oncology providers, conducted needs assessments of communication processes, and initiated institutionwide palliative care communication training. Barriers to completing outcome goals included a lack of institutional support, specifically an absence of leadership, financial backing, and dedicated time.

CanPROS Scientific Conference 2019 Poster Abstracts: Presented by CanPROS Congress, A Catalyst for Whole-Person Care; Hilton Garden Inn, Calgary, Alberta; 13-15 November 2019.

Background: Palliative care is an approach that improves quality of life for patients and families facing challenges associated with life-threatening illness. In Alberta, most people who received palliative care received it late. Late palliative care negatively affects patient and caregiver experiences and decreases quality of life. This study aims to understand patient and caregiver experiences of advanced colorectal cancer care to inform an early palliative care pathway for advanced cancer care. Methods: A qualitative study that is embedded within a larger program of research on the implementation of the Palliative Care Early and Systematic (paces) pathway. Semi-structured telephone interviews with patients and their caregivers living with advanced colorectal cancer were conducted to explore their experiences with cancer care services received before pathway implementation. Interviews were transcribed, and the data were thematically analyzed, supported by the qualitative analysis software NVivo. Results: Interviews with 15 patients and 7 caregivers from Edmonton and Calgary were conducted over the telephone. Most participants found the Putting Patients First tool to be useful at their appointments; however, some mentioned a preference for viewing their scores over time. A total of 6 main themes were identified: (1) Meaning of palliative care (2) Communication (3 main subthemes: communication of diagnosis, communication between patient and oncologist, communication between providers) (3) Relationship with health care providers (including oncologist, family doctor, and nurses) (4) Access to care (cost of care, proximity to care, after hours care) (5) Patient readiness for advance care planning (6) Patient and family engagement in care, with mixed experiences in how patients were involved in their care. Conclusions: Most participants misperceived palliative care to mean “end-of-life care,” suggesting a need for improvement in the delivery of palliative care information. Understanding the care experiences of patients and caregivers will inform the development of a care pathway for early palliative care.

GiTalk: A Novel Palliative Care Communication Curriculum for Gastroenterology Fellows (QI619)

GiTalk: A Novel Palliative Care Communication Curriculum for Gastroenterology Fellows (QI619)

Oxford Textbook of Communication in Oncology and Palliative Care.

Oxford Textbook of Communication in Oncology and Palliative Care.

Virtual Family Meetings: A Novel Pediatric Palliative Care Teaching and Communication Tool

Virtual Family Meetings: A Novel Pediatric Palliative Care Teaching and Communication Tool

Neurology clinicians' views on palliative care communication: "How do you frame this?"

The communication process of preparing patients and families facing progressive neurodegenerative diseases for future illness has not been empirically elucidated; the goal of this qualitative study was to explore neurology interdisciplinary health professionals' communication experiences, including current approaches, facilitators, and challenges. Three focus groups were conducted with 22 clinicians representing a range of health professions from several multidisciplinary neurology outpatient clinics at a large academic medical center. A thematic analysis approach was used to develop a coding structure and identify overarching themes. Neurology clinicians highlighted that in their practice, (1) conversations are triggered by acute events and practical needs; (2) conversations occur routinely but are rarely documented; (3) loss of patient capacity and resultant surrogate decision-making can be ethically fraught, especially in times of family conflict; (4) prognostic uncertainty, unfamiliarity with disease trajectories, and patient or surrogate avoidance pose communication challenges; and (5) generalist- and specialty-level palliative care roles should be better defined. There is a need for a systematic, structured approach to communication that can be applied early in the disease trajectory and considered when developing integrated neuro-palliative care programs.

Story Arcs in Serious Illness: Natural Language Processing features of Palliative Care Conversations

ObjectiveSerious illness conversations are complex clinical narratives that remain poorly understood. Natural Language Processing (NLP) offers new approaches for identifying hidden patterns within the lexicon of stories that may reveal insights about the taxonomy of serious illness conversations. MethodsWe analyzed verbatim transcripts from 354 consultations involving 231 patients and 45 palliative care clinicians from the Palliative Care Communication Research Initiative. We stratified each conversation into deciles of "narrative time" based on word counts. We used standard NLP analyses to examine the frequency and distribution of words and phrases indicating temporal reference, illness terminology, sentiment and modal verbs (indicating possibility/desirability). ResultsTemporal references shifted steadily from talking about the past to talking about the future over deciles of narrative time. Conversations progressed incrementally from "sadder" to "happier" lexicon; reduction in illness terminology accounted substantially for this pattern. We observed the following sequence in peak frequency over narrative time: symptom terms, treatment terms, prognosis terms and modal verbs indicating possibility. ConclusionsNLP methods can identify narrative arcs in serious illness conversations. Practice implicationsFully automating NLP methods will allow for efficient, large scale and real time measurement of serious illness conversations for research, education and system re-design.

Comunicação em cuidados paliativos: equipe, paciente e família

Resumo Cuidados paliativos visam acolher o paciente e sua família de forma integral em casos de impossibilidade de cura da doença, valendo-se de boa comunicação para melhorar a qualidade de vida. Este estudo objetivou avaliar a comunicação na assistência paliativa e sua influência na relação entre equipe, paciente e família. Trata-se de pesquisa qualitativa, descritiva e exploratória envolvendo seis participantes abordados em instituição hospitalar de saúde pública da cidade de Suzano, no estado de São Paulo. Dados foram coletados em entrevistas semiestruturadas e avaliados com a técnica de análise de conteúdo. Conclui-se que o diálogo adequado é estratégia relevante para estabelecer boa relação entre as três partes, sendo, no entanto, necessário identificar outros fenômenos que estão além das habilidades comunicativas dos profissionais. Na perspectiva da bioética, a comunicação se destaca na assistência e cria vínculo que possibilita decisões compartilhadas.

435P - Telephonic communication in palliative care for better management of terminal cancer patients in rural India: An NGO based approach

BackgroundDue to financial incapability and absence of manpower poor families often fail to carry their advanced cancer patients to the nodal centres. This pilot study will explore whether communication by mobile phone can lessen this burden. MethodsInitially a plan was generated regarding management of an advanced cancer patient in a nodal centre at District Head Quarter. Subsequently every two week a trained social worker attached to nodal centre will follow up and give necessary advice and emotional support to the patients and their families through their registered mobile phone number. Patient’s family were also encouraged to communicate with the team by phone in case of fresh complain and urgency in between. ResultsSince last one year, 193 cancer patients were contacted by mobile phone every two weeks to enquire about their difficulties. In 76% of the situation trained social workers could give necessary advice by phone regarding management of their physical symptoms. Moreover, patient’s family were really overwhelmed by the emotional support offered by the team over phone. Only 24% of cancer patients has to attend the nodal centre for expert advice from Palliative Care specialists. ConclusionsThis novel approach helped:• In providing regular physical and emotional support to the patients and their families.• In significantly reducing the financial and manpower problems of carrying patients to the nodal units.• In improve the quality of life of patients by continuous guidance.More and more team members can take help of this new strategy for better communication and uninterrupted care. Legal entity responsible for the studyThe author. FundingHas not received any funding. DisclosureThe author has declared no conflicts of interest.

Empowering interpreters to partner in palliative care (PC) conversations: Effect of a dialogue-based curriculum.

21 Background: Effective communication across cultural and linguistic barriers during breaking bad news, DNR, and EOL conversations requires professional medical interpreters skilled in PC communication and clinicians skilled in working with interpreters. But interpreters are rarely included in meetings preceding these conversations, or made aware of the patient’s prognosis or the emotionally-charged subjects likely to arise. They may know the patient and family, cultural norms, and identify the decision makers, but often do not feel empowered to offer this crucial information to clinicians. To be effective cultural brokers, interpreters must be trained in PC terminology and feel empowered to contribute. Methods: A six-session curriculum: Palliative Care Dialogues with Interpreters, facilitated by an experienced PC social worker (SW) and physician, was delivered to medical interpreters from Brigham and Women’s Hospital and Dana-Farber Cancer Institute. The curriculum included links to relevant materials, and structured 1-hour sessions including role-plays on: Initiating and managing a pre-encounter conference; Family meetings; Terms used in PC meetings; Family meetings to discuss code status and end of life-prolonging therapies; Cultural Mediating; Interpreting for SWs and chaplains (with SW and chaplains doing role plays); and Experiencing being a cultural mediator in End of Life Care. 41 participants completed a 23-question pre- and post-course survey on their confidence in interpreting these conversations. Results: There was a highly significant improvement in interpreter post-course confidence ( N = 41. p=1.4080 x 10−11). Facilitated dialogues enabled interpreters to assert concerns, share knowledge, and practice new behaviors in a “safe” space, behaviors they reported they then used in clinical practice. Dialogues provided clinicians an opportunity to learn about the challenging linguistic, cultural and emotional experiences of medical interpreters. Conclusions: Facilitated and well-structured dialogues, including didactics, discussions and roleplaying caused highly significant improvements in interpreter confidence in interpreting PC conversations.

CUIDADOS PALIATIVOS A COMUNICAÇÃO COMO FERRAMENTA NO ATENDIMENTO HUMANIZADO

O presente artigo tem por objetivo analisar a importância da comunicação em cuidados paliativos como ferramenta para um atendimento humanizado. Para tanto, utilizou-se como método de pesquisa a revisão bibliográfica. Foi pesquisado publicações no período de 2014 a 2019, onde foram selecionados 12 artigos que atenderam os critérios de inclusão. Dada a importância dos cuidados paliativos, percebeu-se que no Brasil temos problemas desde a formação do profissional de saúde até a sua atuação. Nota-se que a comunicação é essencial para um atendimento humanizado e que o seu uso correto deve e pode trazer resultados positivos para o paciente, equipe que o assiste e seus familiares.

Promoting Effective Nurse-Patient Communication in Palliative Care Using the SAGE and THYME Model: Can it be Implemented Cross-Culturally?

Effective communication in palliative care is essential in making optimal health care decisions that align with the interests of the patients and empowering them to be involved in their care planning. However, many Asian nurses lacked the prerequisite communication skills required to assess and address the informational needs of advanced cancer patients. These nurses often adopt a routinized approach of giving information to patients to overcome their inadequacies in eliciting patients’ concerns. Thus, this opinion paper seeks to understand whether the SAGE and THYME model can be utilised widely by nurses across different cultural contexts to facilitate more effective communication and to develop therapeutic relationships with advanced cancer patients who are receiving palliative care.

The Role of a Symptom Assessment Tool in Shaping Patient-Physician Communication in Palliative Care

ContextPatients with cancer experience many symptoms that disrupt quality of life, and symptom communication and management can be challenging. The Edmonton Symptom Assessment System (ESAS) was developed to standardize assessment and documentation of symptoms, yet research is needed to understand patients' and caregivers' experiences using the tool and its ability to impact patient-provider aligned care. ObjectivesThe objective of this study was to understand how the ESAS shapes communication between patients and providers by exploring patients' and caregivers' experiences using the ESAS and assessing the level of agreement in symptom assessment between patients and palliative care physicians. MethodsThis study used a mixed-methods design. Thirty-one semistructured interviews were conducted and audio-recorded with patients (n = 18) and caregivers (n = 13). Data were analyzed following a social constructionist grounded theory approach. Patient and provider ESAS scores were obtained by medical chart review. Intraclass correlation coefficients were used to assess the level of agreement between patient-completed ESAS scores and provider-completed ESAS scores. ResultsParticipants reported that the ESAS was a beneficial tool in establishing priorities for symptom control and guiding the appointment with the palliative care physician, despite challenges in completing the ESAS. Filling out the ESAS can also help patients more clearly identify their priorities before meeting with their physician. There was a good to excellent level of agreement between patients and physicians in all symptoms analyzed. ConclusionThe ESAS is beneficial in enhancing symptom communication when used as a guide to identify and understand patients' main concerns.