The communication deficit among healthcare professionals, families, and patients is a barrier in the delivery of end-of-life care and can result in conflict, according to Elizabeth Thiel, MD, MS, of the Medical College of Wisconsin in Milwaukee, and Andria Caton, BSN, RN, OCN®, CHPN, of Northeast Georgia Medical Center in Gainesville. Thiel and Caton discussed end-of-life communication and the role that nurses play in those conversations during a session on Wednesday, April 10, 2019, at the ONS 44th Annual Congress in Anaheim, CA.
The Importance of Communication
Communication during cancer treatment is complex and becomes vital after a patient receives bad news. Open, honest communication and attentive listening are paramount, and nurses are a crucial component of end-of-life conversations. They have the most contact with patients and families; act as patients’ advocates, supporters, and information brokers; bear witness to patients’ and families’ stories; provide anticipatory guidance about expected trajectories of care; and have relationships with other medical providers who are a part of the delivery of end-of-life care.
At key end-of-life treatment decision points and during conflict about medical care, communication becomes crucial. Often, family members are patients’ primary caregivers and decision makers, so they should be included in conversations about end-of-life care. Communicating with family members can relieve their anxiety, ensure that patients’ final wishes regarding treatment are honored, help family members begin the grieving process, and enable them to move on after a patient’s death.
From a nursing standpoint, challenges in communicating with patients and their families revolve around lacking information, having access to information that has not been shared with patients and families, and fearing not knowing the answers to questions. During a critical decision point, nurses should assess patients’ and family members’ understanding, obtain patients’ background, describe treatments options in general terms, provide support, acknowledge emotions, and provide empathy.
How to Handle Conflict
Conflict is common in end-of-life communication. Thiel and Caton reported data from a study of 102 patients in intensive care units who had decided to limit life-sustaining treatment, and they identified the following conflict types:
- Family-family conflict
- Staff-family conflict
- Staff-staff conflict (e.g., nurse-physician, physician-physician)
- No conflict
Most nurse-physician conflicts revolve around life-sustaining treatment decisions, communication to families, communication among staff, pain control, and the decision-making process. Of note, conflict between nurses was rarely reported.
Thiel’s and Caton’s presentation also provided information on how to deal with conflicts between patients and families and the medical team, conflicts between patients and their families, and conflicts between family members.
“No matter what your experience level is, end-of-life conversations can be challenging,” the speakers said. “End-of-life care communication skills are best learned through being mindful of others, gaining knowledge from peers, and accumulating patient and family experiences. Good communication at the end of life can help patients and families gain a sense of control and can help to provide closure and meaning to end-of-life care for nurses.”