Is Effective Communication a Core Element of Palliative Care



Is Effective Communication a Core Element of Palliative Care?

The key or core elements of any type of care can only be determined after a full analysis of what the “care” involved is meant to accomplish. The word “palliative” is a form of the word “palliate.” The word “palliate” means to “to reduce the violence of (a disease); ... ease (symptoms) without curing the underlying disease” and to “moderate the intensity of” something, such as pain or discomfort (Webster). By understanding this definition it becomes clear then that palliative care involves the easing of symptoms and lessening of discomfort or difficulties associate with serious, chronic, or life ending illnesses. The core elements involved in palliative care, therefore, would include all things that lessen discomfort, from whatever source it derives.

The treatment of pain and other physical discomforts is what is normally first addressed in palliative care. Living, or dying, with a disease, however, involves much more than physical pain or discomfort (IAHPC). Patients who suffer from serious, chronic, or terminal diseases normally undergo the stages of grief identified by Elizabeth Kubler-Ross: denial, anger, bargaining, depression, and acceptance (Massachusetts General). Addressing the emotions, reactions, behaviors, and effects of these stages of grief is also part of palliative care because their treatment, or the failure to treat them, will affect the success of the treatments applied to the pain and physical discomforts. Because the identification and treatment of these stages of grief, just as the identification and treatment of other fears, confusions, emotions, questions, behaviors, and reactions to illness cannot be done without communication between care givers, patients, and their families communication is a core, necessary element of palliative care. In fact, palliative care programs include communication in the identified “steps” of palliative care (Duke Univ.; IAHPC; Hauser; WHO).

For far too long Western medicine has focused only on the physical care of patients, regardless of the patient’s stage of illness or mental or emotional condition (Muller). As one physician put it, “‘There is a saying that Western doctors have relationships with diseases rather than with patients, ... I think that's a flaw in our system,’” (Muller). Patients have needs beyond those of their body. When a patient lives with constant acute pain or other physical symptoms these do take priority. However, at some point in time, when those physical discomforts are addressed as well as they can be, other patient needs must be satisfied. For some patients, the need may be simply that of getting better reading material, help with insurance companies, help with bills or food needs, and other quality of life issues. For other patients, however, this will include other needs that should be addressed. Chief among these needs is often the fact that many in the medical profession fail to treat them as people and often ignore or fail to respond to them when they ask questions that are “uncomfortable” to the professional (Cole; Lynn).

The goal of palliative care is to improve the quality of life of a patient facing serious, chronic or terminal illness. It differs from hospice care in that while hospice care also focuses on improving quality of life for patients, hospice care also focuses on helping patients die from their illnesses, while palliative care is more focused on helping patients live with their illnesses. Moreover, hospice care takes place in buildings or homes dedicated to dying, while palliative care often takes place on an out-patient basis or in a hospital ward dedicated to improving life, not death. The difference is monumental. Although a patient receiving palliative care may, indeed, be dying, the change in location or goal of the treatment may help improve the results of their care, if only because the focus is on life, not death. A focus on life may have the ability to energize patients where a focus on death, while important in helping patients accept their diagnosis and plan for their families, will not provide that energy.

Many medical professionals, particularly in a hospital or hospice setting, act in ways to distance themselves from patients with terminal illnesses (Cole; Lynn; Massachusetts General). This is an acute problem. Care of a patient includes all aspects that help a patient either recover or feel better. A patient whose full needs are not being met, such as the need to talk, to obtain information, to simply have someone understand them, is less likely to feel cared for or better. The issue of communication is so important to patient care that nurses and doctors now regularly speak of its importance in the care of patients, particularly those with serious, chronic, or terminal illness. The materials available today fully include communication, from teaching medical professionals how to speak to patients, families, and each other, to telling them how to listen to patients, families, and each other so that they can effectively interact. While communication may make common sense, not everyone is good at it. There are many materials that try to assist those who may find communication awkward or difficult. However, there is nothing that can turn a person who only gives one work responses into a loquacious speaker – the best that he or she may be able to do is just to practice and try to be more complete in his or her responses and interactions. Listening is sometimes the most important part of communication, and the materials on communication rarely bring this up (Arnold). This is unfortunate, because while it may be difficult for some professionals to speak easily to patients and families, they can always just listen to them and, by listening, they can help them too.

A key reason why listening is so important to communication in palliative care is that by listening medical professionals will learn what the patient wants to know or discuss (Arnold; Cole; Faulkner; Lynn; Muller). Medical professionals have often been taught that they know what is best (Muller). In palliative care, however, medical professionals need to remember that a patient living with a serious, chronic, or terminal illness is more knowledgeable about what they feel, need, or want, and about what can best help them (Hauser). This involves more than just listening to how they feel physically and includes looking at their non-verbal communication, not just relying on their spoken communications (Arnold). Non-verbal communication is a very powerful communicator. Non-verbal communication often reveals much more than a person can say verbally. Particularly in a situation where a patient is afraid, as is often the case in palliative care, non-verbal communication often speaks volumes. The medical professional that can tap into what a patient’s non-verbal communication is saying will be able to satisfy needs a patient is afraid or embarrassed to bring up, but which are, nonetheless, necessary to address in order to meet their full needs. Because meeting a patient’s full needs is what palliative care is about, therefore, non-verbal communication must be listened to and responded to by care givers.

Palliative care also includes the education of patients regarding their illnesses and their care options. In order to effectively educate patients about their diseases and care options, medical professionals, in addition to listening and speaking to their patients and observing their non-verbal communication clues, should also learn about their patient’s abilities, desires, and motivations. These things will reveal a great deal about patients’ abilities to cope with their current situation and handle changes in treatment and life. Learning about these things involves listening to what patients say both verbally and non-verbally, but, more importantly, involves listening to what patients fail to say. As has often been said, “reading between the lines” is great way to learn. As palliative care includes making suggestions and recommendations for future treatment and life changes, understanding patients’ potential responses to such things is one way in which communication will be central to providing effective palliative care. A failure to know who a patient is will ruin palliative care because the patient will be provided with information, options, and “care” that is unsuitable for him or her and which he or she will be likely to resist.

Palliative care fulfills many needs and serves many purposes. It is a rather new area of care, but it is a very necessary area of care. As the American population ages, as people live longer, as once deadly diseases more and more become chronic instead of terminal, the need and demand for palliative care will increase. Just as there is no perfect patient there is no perfect palliative care. However, improvements in palliative care, no matter how small or large, will help get palliative care that much closer to perfection. As with any other area of life, palliative care must rely on communication, in all forms, to improve and properly address those it serves and those whom it will serve in the future.

References

Arnold, R.M. (2003). Do we Really Care About Doctor-Patient Communication or is it Just Talk? Editorial. Journal of Palliative Medicine, September 2003; 6/2: 189-192. Retrieved June 12, 2008, from

Cole, M.R. (2004). To Know, To Listen, To Care: The Nurse's Gift to the Dying. Nursing Spectrum. Retrieved June 12, 2008, from

Duke University School of Medicine, Center for Palliative Care.

Faulkner, A. (1998). ABC of Palliative Ccare: Communication with Patients, Families, and Other Professionals. British Medical Journal, January 10, 1998, 316:130-132. Retrieved June 12, 2008, from

Hauser, J.M. (2007). Palliative Care: Expanding the Boundaries of Communication. Medscape Nurses. Retrieved June 12, 2008, from

International Association for Hospice & Palliative Care. (NA). The IAHPC Manual of Palliative Care, Second Edition. Retrieved June 12, 2008, from

Lynn, J. (NA). How to Talk About End of Life Concerns. . Retrieved June 12, 2008, from

Massachusetts General Hospital for Children. (NA). Terminal Illness. Retrieved June 12, 2008, from

Muller, J. (2005). Can Acupunture and Massage Ease Chronic Pain? Experts in Western Medicine Are Looking to the East to Help Treat Pain. Retrieved June 12, 2008, from

World Health Organization. (2007). Cancer Control: Knowledge into Action, WHO Guide for Effective Programs. Palliative Care. Retrieved June 12, 2008, from

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