As a healthcare professional, good communication is part of the job description. It’s vital for medical professionals to have the skills necessary to provide patients and their families with diagnoses and information around a patient’s current health, healthcare plans and options for treatment. These conversations don’t only require precise, clear and honest communication, but they very often require sensitivity and empathy. It’s such an important part of the job. So why is there still difficulty around talking about death?
I came across a recent study in the UK which looked at communication in palliative care and how extra training could come in handy for some healthcare professionals when talking about death. Another 2018 study conducted by the Royal College of Physicians looked at how doctors, in particular, could do with “greater compassion and confidence” when having opening up to dying patients. There seems to be a bit of a struggle for healthcare professionals to confidently approach one of the most important issues a person can face during healthcare––dying.
The study of palliative medicine reviewed in particular, the “qualitative evidence concerning characteristics of communication about prognosis and end-of-life care between healthcare professionals and relatives of patients approaching the end-of-life”
I guess the question I have is, what are the right characteristics for these conversations?
I also came across an interesting blog by Dr. Grahame Tosh, Medical Director at UK Cancer Centre, Marie Curie recently discussing the big divide between healthcare professionals and patients and their loved ones around the subject of death.
The thing is, it’s not only the way in which the prognosis of death is relayed to patients and their families but that the conversations are even being had at all is still up for question. Ok, so the importance might seem obvious, they are in palliative care, of course, they are probably going to die, families can put two and two together. The thing is, families may be putting two and two together and expecting the inevitable with their loved one, but it is still really important for the process that it is discussed on a medical level to help come to terms with it.
It’s such a tricky one though because no one wants to be the one delivering that news. Not only that but often in medicine, there’s room for something to change and so I guess many doctors want to hold onto that hope for as long as they can, particularly if the patient is still receiving treatment. So, it can become the sort of elephant in the palliative care unit. For families going through it with their loved ones however, it is a conversation that would be helpful if initiated by healthcare professionals.
Tosh says, however, doctors mustn’t anticipate what people are capable of handling and suggests that families would be much better equipped to deal with death if they had the time to accept the death of a loved one from a medical point of view.
There are some interesting arguments against this in the Journal of Medical Ethics. The first, that it is the doctor’s prime responsibility to maintain the welfare of the patient, and on top of everything else a terminally ill patient is dealing with, the discussion of death and dying might just add to their stress and pain. Secondly, as I touched on before, no diagnosis is truly final with medicine, and patients can never have time to understand the intricacies of the medical situation to get their head around the variables so maybe it’s best not to expose them to the full story? The third is they just might not want to know.
While these three arguments above are valid, this particular edition was published in 1982, that’s almost 40 years ago and I believe we have come a long way ethically around the conversations about death. Remembering we have recently seen the first legal voluntary assisted death in Victoria’s history. And this was a welcomed law. Proof we now see death and dying in a very different light.
So, what is the best way to deal with the death talk as healthcare professionals?
I think the best answer I have heard so far is from Dr. Nick Christakis, a professor of medical sociology at Harvard Medical School. Christakis says it’s important doctors look case by case and judge their patients accordingly. Assessing each individual’s needs and be as honest as possible.
He told ABC News in the US,
“Some patients say they don’t want to know anything, and others say, ‘Give it to me straight, doc,'” Christakis said. “Once you’ve established what kind of patient you’re dealing with, you should be as willing to be as specific as science allows.”
And that is where your job skills kick in.