Terminally Ill Communication

Meruyert Madikenova

Communication in caring for terminally ill patients

Communication plays an important role in establishment of good relationships between the healthcare provider and patients. Good communication affects patient satisfaction, patient compliance and patient health outcomes. It is the one of the essential attributes of healthcare providers, and mastering in effective communication is necessary skill to provide quality patient care. (McCorry and Mason, 2011) The most asked question for terminally ill patients is “How long I will live?”, and answer gives them time to make decisions about end-of-life care. Therefore, healthcare providers should be able to respond properly to help patients address their concerns and promote shared

(Clayton et al., 2005(1)) Health professionals struggle to initiate the discussion because of fear to upset and hurt patient’s feeling. (Clayton et al., 2005(2)) Despite the burden for the patients, they still prefer having doctor who wants to discuss dying. (Clayton et al., 2005(1)) Health professionals, carers and patients have different opinions on who and when to initiate discussion about prognosis and end-of-life issues. According to Clayton (2005), there are four approaches: wait for the patient/carer to raise the topic (1); HPs to offer all PC patients and their carers the opportunity to discuss the future (2); HPs to initiate the discussion when the patient/family needs to know (3); or HPs to initiate the discussion when the patient/family seems ready (4). (Clayton et al., 2005(2)) In the first approach, health professionals wait an offer from patient/carers to discuss the topic. They are afraid of hurting the patients by initiating discussion when their patients are not ready to hear. Also, some doctors pointed that they are uncertain about prognosis and do not want to scare patients. In the second approach, health professionals believe that patients/carers needs permission from them to initiate discussion and, therefore, it is doctor’s responsibility to raise end-of-life conversations. By

(Friedrichsen et al., 2011) In the case of absolute truth, patients are ready to hear the truth because they feel like they control the situation. It gives an opportunity to plan their lives for the remaining time. They don’t want physicians to hide the truth: it will not help, it will hurt them. In the case of partial truth, patients want to hear only some parts of truth which help them to maintain hope. They avoid asking questions regarding information that they don’t want to know. They expect from physicians to discuss topics that will benefit patients, not frighten. In the case of desired truth, patients try to avoid the truth and are looking for other truths. Because of their fear of the truth, they are afraid of asking questions and handling the difficulties of the truth. (Friedrichsen et al., 2011) Telling the truth and destroying patient’s hope is sensitive task for health professionals. However, clinicians prefer full disclosure eve if this process is painful to the patients. They consider it ethical and necessary because patients will be able to face the truth and decide how to cope with it, however, patient have rights to know or not to know. (Friedrichsen et al.,