End of Life Communication

It is important as a primary care provider to have effective communication skills for quality health 

 management. Communication skills come from experience in the classroom and in the practice setting 

 spending time talking with patients and gaining confidence in the art of communication. It is just as important 

 that providers have effective skills at discussing end of life care for patients and their loved ones. Learning 

 this vital skill allows the patient and loved ones have a full understanding of the diseases process and the 

 stages to the process of dying. According to Metzger, August, Srinivasan, Liao & Meyskens (2008) primary care providers form the backbone of an integrated team by providing an unbiased medical perspective, providing continuity during a stressful disease course, supporting patients and their families through emotional ups and downs, negotiating or mediating decisions, monitoring for complications, and providing perspective on the illness.

            Providing guidance for patients and their loved ones during end of life care needs to be viewed as a special gift that providers are allowed to be a part of.  Developing the skills needed to be an effective communicator needs to be honed by the practitioner. Han, Keranen, Lescisin & Arnold (2005) stated that no educational intervention has yet been devised to allow residents to learn and demonstrate communication skills with actual seriously ill patients in real clinical settings, although several experts argue that this would be ideal. In addition, skill development requires practice; educational interventions that simply increase knowledge may not necessarily lead to improved action. According to the JAMA (2000) physical care is expectedly crucial, but is only one component of total care. Whereas physicians tend to focus on physical aspects, patients and families tend to view the end of life with broader psychosocial and spiritual meaning, shaped by a lifetime of experiences. In addition, providers should recognize that there is no one definition of a good death and quality care at the end of life is highly individual and should be achieved through a process of shared decision making and clear communication that acknowledges the values and preferences of patients and their families.

            Provider’s patients and loved ones all play a critical role in creating the experience at the end of life. As our experience on death and dying expands, further research is needed to define our role during the period of the dying process and provide quality end of life care. The challenge for providers is to understand the feelings of patients and loved ones and  be effective at communicating the disease processes and permit a variety of expressions for a good death for everyone involved.

Reference

Han, P., Keranen, L., Lescisin, D & Arnold, R. (2005). The Palliative Care Clinical Evaluation      Exercise (CEX): An Experience-Based Intervention for Teaching End-o-Life Communication Skills. Academic Medicine: 80(7), 669-676

Metzger, Q., August, K., Srinivasan, M., Liao, S & Meyskens, F. (2008). End-of-  Life Care:        Guidelines for Patient-Centered Communication. American family Physician, 77(2) Steinhauser, K., Christakis, N., Clipp, E., McNeilly, M., McIntyre, L., Tulsky, J. (2000). Factors Considered Important at the End of Life by Patients, Family, Physicians, and Other Care Providers. The Journal; Of the American Medical Association, 284(19), 2476-2482. doi:10.1001/jama.284.19.2476