One of the key components of effective patient-centered end-of-life care is effective communication and shared decision-making. These components demand that activated, informed, and participatory patients and the members of their family interact with a team of patient-centered care providers that possesses effective communication skills (Rhodes et al., 2015; Jordan et al., 2016). The team must also be supported by a well-organized, accessible and responsive healthcare organization. However, this is not always the case, and communication barriers can result in to undue suffering on the part of the patient and their family members, as shown in the case study. Let us look at some of the barriers to communication present in the highlighted case.
One barrier that is evident, and which occurs often, is that family members and the patient may misunderstand prognosis or medical procedures. Such misunderstanding are common when there is bad news being communicated and when the family members are psychologically, physically or emotionally stressed (Osinski et al., 2017). Cindy’s husband is already very stressed after having her wife in the intensive care unit for five days. It is possible that he did not understand the explanations on resuscitation provided by the physician. To prevent such misunderstandings, health care professionals should give information in small chunks, and ascertain understanding. Even for family members and patients who appear to understand the information, it is prudent to offer repeated explanations and to respond to questions. The fact that Cindy’s husband had to solicit clarification from the nurses demonstrates that he did not fully understand the explanations given by the physician.
We can do it today.
An important quality indicator when looking at communication in emergency situation in palliative care is the collaboration between the various members of the multidisciplinary team in making important decisions and communicating on issues relating to the patient. As indicated by Lachman (2010), the multidisciplinary team must present a unified front when communicating with the patient. In the case presented, there is no sense of harmony in the team, with the physician’s definition of important concepts differing from those provided by the nurses. Cindy’s husband cites his decision to rescind his decision on resuscitation as having been influenced by the lack of agreement in the different definitions given by the different members of the care team.
To ensure proper communication, the team should have met to discuss the condition of the patient and to clarify the goals or treatment, and the needs of the patient and the family, before communicating with the patient about the options. The providers should also have addressed any conflicts within the clinical team, including personal differences in understanding before meeting the patient’s family. Regular meetings should also have been carried out between the care team and the family to review the status of the patient and to respond to any questions or concerns. This way the husband would not have had to solicit information on his own. The husband should have also been prepared adequately for the dying process.
In conclusion, communication between professionals and between professionals and patients and their family members ought to be improved in palliative care, especially in emergency situations. In some cases, documentation may not match the discussions leading to the use of technology to prolong life when it may not be warranted because discussions were not sufficient. It is recommended, therefore, that issues surrounding such care, including those on resuscitation directives must be clarified based on discussions with the entire care team.
- Jordan, K., Elliott, J. O., Wall, S., Saul, E., Sheth, R., & Coffman, J. (2016). Associations with resuscitation choice: Do not resuscitate, full code or undecided. Patient education and counseling, 99(5), 823-829.
- Lachman, V. (2010). Do-not-resuscitate orders: nurse’s role requires moral courage. Medsurg Nursing, 19(4), 249.
- Osinski, A., Vreugdenhil, G., de Koning, J., & van der Hoeven, J. G. (2017). Do-not-resuscitate orders in cancer patients: a review of literature. Supportive Care in Cancer, 1-9.
- Rhodes, R. L., Tindall, K., Xuan, L., Paulk, M. E., & Halm, E. A. (2015). Communication about advance directives and end-of-life care options among internal medicine residents. American Journal of Hospice and Palliative Medicine®, 32(3), 262-268.