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Education in Palliative and End-of-life Care - Oncology

The. EPEC-O. TM. Education in Palliative and End-of-life Care - Oncology. Project. The EPEC-O Curriculum is produced by the EPEC TM Project with major funding provided by NCI, with supplemental funding provided by the Lance Armstrong Foundation.

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Education in Palliative and End-of-life Care - Oncology

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  1. The EPEC-O TM Education in Palliative and End-of-life Care - Oncology Project The EPEC-O Curriculum is produced by the EPECTM Project with major funding provided by NCI, with supplemental funding provided by the Lance Armstrong Foundation.

  2. EPEC - Oncology Education in Palliative and End-of-life Care - Oncology Module 7 Communicating Effectively

  3. Overall message A structured approach to communicating helps the oncologist perform this important role

  4. Objectives • Demonstrate ability to apply a 6-step protocol for delivering information • Know what to do at each step

  5. Video

  6. Importance • Most people want to know • Strengthens physician-patient relationship • Fosters collaboration • Permits patients, families to plan, cope

  7. 6-step protocol . . . 1. Getting started 2. Find out what the patient knows 3. Find out how much the patient wants to know Adapted from Robert Buckman

  8. . . 6-step protocol 4. Share the information 5. Respond to patient, family feelings 6. Plan, follow-up Adapted from Robert Buckman

  9. Step 1: Getting started . . . • Plan what you will say • Confirm medical facts • Don’t delegate • Create a conducive environment

  10. . . . Getting started • Allot adequate time • Prevent interruptions • Determine who else the patient would like present • If child, patient’s parents

  11. Step 2: What does the patient know? • Establish what the patient knows • Child’s parents • Assess ability to comprehend new bad news • Reschedule if unprepared

  12. Step 3: How much does the patient want to know . . . • Recognize, support various patient preferences • Decline voluntarily to receive information • Designate someone to communicate on his or her behalf

  13. . . . Step 3: How much does the patient want to know • People handle information differently • Race, ethnicity, culture, religion, socioeconomic status • Age and developmental level

  14. Advance preparation • Initial assessment • Preparation for critical tests • What does the patient know? (step 2) • How does the patient handle information? (step 3)

  15. When family says‘don’t tell’ . . . • Legal obligation to obtain informed consent from the patient • Promote congenial family alliance • Honesty with a child promotes trust

  16. . . . When family says‘don’t tell’ • Ask the family: • Why not tell? • What are you afraid I will say? • What are your previous experiences? • Is there a personal, cultural, or religious context? • Talk to the patient together

  17. Step 4: Share the information . . . • Say it, then stop • Avoid monologue, promote dialogue • Avoid jargon, euphemisms • Pause frequently • Check for understanding • Use silence, body language

  18. . . . Step 4: Share the information • Don’t minimize severity • Avoid vagueness, confusion • Implications of “I’m sorry”

  19. Step 5: Respond to feelings . . . Normal reactions • Affective response • Tears, anger, sadness, love, anxiety, relief, other • Cognitive response • Denial, blame, guilt, disbelief, fear, loss, shame, intellectualization • Basic psychophysiologic response • Fight-flight

  20. . . . Step 5: Respond to feelings . . . • Be prepared for • Outburst of strong emotion • Broad range of reactions • Give time to react

  21. . . . Step 5: Respond to feelings • Listen quietly, attentively • Encourage descriptions of feelings • Use non-verbal communication

  22. Step 6: Planning, follow-up . . . • Plan for the next steps • Additional information, tests • Treat symptoms, referrals as needed • Discuss potential sources of support

  23. . . . Step 6: Planning, follow-up • Give contact information, set next appointment • Before leaving, assess: • Safety of the patient • Supports at home • Repeat news at future visits

  24. When language is a barrier . . . • Use a skilled translator • Familiar with medical terminology • Comfortable translating bad news • consider telephone translation services

  25. . . . When language is a barrier • Avoid family as primary translators • Confuses family members • How to translate medical concepts • Modify news to protect patient • Supplement the translation • Speak directly to the patient

  26. Summary A structured approach to communicating helps the oncologist perform this important role

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