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Modules:

  • Introduction
  • 1. Advance Care Planning
  • 2. Communicating Bad News
  • 3. Whole Patient Assessment
  • 4. Pain Management
  • 5. Assisted Suicide Debate
  • 6. Anxiety, Delirium
  • 7. Goals of Care
  • 8. Sudden Illness
  • 9. Medical Futility
  • 10. Common Symptoms
  • 11. Withholding Treatment
  • 12. Last Hours of Living
  • 13. Cultural Issues
  • 14. Religion, Spirituality
  • 15. Legal Issues
  • 16. Social and Psychological
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    Back to Module 3: Whole-Patient Assessment
    Nine Dimensions

    Step 5. Communication & Information Sharing Step 6. Social

    Step 5. Communication & Information Sharing
     
    Does the Patient Have Someone to Talk To?

    • Whether a person is a ‘talker’ or a ‘silent type’, communication happens and it matters
    • Most people do better if there is someone to share difficulties with
    • Assess whether the patient have someone to share fears with? talk to? plan with?
    • Identify who this person is for the patient. Keep in mind that it may be family, but it may not
    • One of the most challenging aspects of end-of-life care is when the patient is alone. Then, the physician, and members of the health care team become critical components of support

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    Does the Patient Understand You?

    • Accurate information generally leads to the best outcomes
    • Misunderstandings over information are usually problematic
    • As part of routine interaction with the patient, ask if the patient understands what is being said and if they have answers to all their medical questions
    • Is the information clear? understandable?

    What Does the Patient Want to Know?

    • Keep in mind that there are different personal styles of information sharing
    • Ask the patient whether he or she wants a lot of information or not so much

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    Who Else Should You Talk to?

    • Be aware that there are different family styles of information sharing
    • Ask the patient how he or she wants to involve family and friends in information about the illness
    • Be particularly attuned for difficulties if the patient is keeping his or her diagnosis a secret, or if the family is doing the same in reverse
      • In such cases, it can be helpful to ask [the informed party] if you can check with [the uninformed party] to see how much information they would like to have

      • Sometimes it helps to organize a family meeting where the physician can help "tell" the information and ensure that all hear the same information at the same time

      • Social workers can be particularly helpful in this regard

      • This is the only aspect of confidentiality that is quite often different from other aspects of patient care. (see Module 15: Legal Issues)

    What if Language is a Barrier?

    • If language is a barrier, try to find a professional translator

    See Module 2: Communicating Bad News and Module 13: Cultural Issues for more information

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