A spoken word is something you can never take back.
That makes it all the more important to delicately select words when you’re discussing end-of-life care and palliative care options with a patient and their family. During this incredibly vulnerable encounter, each phrase can determine how they’re going to understand and cope with the diagnosis.
“If the communication is done in a manner that makes sense—with clear, appropriate messages—that leaves the patient and their family feeling comfortable during a highly emotive time,” said Nneka O. Sederstrom, PhD, MPH, MA, FCCP, FCCM, director of the clinical ethics department at Children’s Hospitals and Clinics of Minnesota. “When we start fighting death and start making it seem like death is some how a failure on the physicians’ part, that’s when you have conflict and anger. You don’t want to leave the conversation open so patients get confused and communication gets jumbled.”
Dr. Sederstrom believes there hasn’t been enough training around mastering the art of communication between physicians and patients. She is looking to change that in the session Mastering Communication in the ICU: Using Targeted Language to Influence Clinical Outcomes, which will train physicians to use appropriate and culturally responsible language to discuss dying and death. The session starts at 7:30 am on Tuesday in room 217C of the convention center.
Dr. Sederstrom offered an example of discussing heart failure with a patient. An inappropriate communication strategy would be to ask the patient what the physician should do if his/her heart stops. An appropriate answer would be to explain that their disease process will eventually not be able to support the function of the heart.
“And when that happens, we will make sure to keep you comfortable and make sure that you have no more pain,” she said. “We’ll make sure you’re not suffering and make sure your loved ones are around you. Most patients don’t fight that. That’s why it’s really important to say the right words at the right time that convey the right message, and I don’t believe that we’ve done a good job in training clinicians on how to use the right words.”
Dr. Sederstrom will help physicians develop better communication skills through several interactive scenario trainings. These will help physicians learn to pause before their normal word choice and decide whether that’s the appropriate word choice for the message they’re trying to convey.
“So we’re going to have a series of options of ‘If you say it this way, how do you think it would make somebody feel now?’”
There are other nonverbal cues physicians can use to improve communication, Dr. Sederstrom added. This could be sitting down, taking off their white coat, looking at them in the eye, and touching hands if need be. These are all techniques that aren’t new and are incorporated in social work, for example, but have been removed from medicine.
“So the people who have the skill sets are not actually the ones in the forefront of the conversation,” she said. “There’s a ton of literature, and there’s a ton of training modules and workshops out there for appropriate communication skills; we just have to reincorporate it into medicine.”
Dr. Sederstrom emphasized that this session also will raise consciousness to consider both conscious and unconscious biases expressed by words and highlight unintended consequences of written words.
“You need to check your own biases at the door before you bring them to the table,” she said. “Because you could destroy communication instantaneously.”