The Parliamentary and Health Service Ombudsman’s Dying Without Dignity report is an uncomfortable but essential read for anyone concerned with healthcare: doctors; nurses; patients; carers; even politicians. The key themes are graphically illustrated by real case reports ahead of the conclusions, with poor communication clearly identified as a major issue.
“Almost all the cases we looked at highlighted failings in communication: between clinician and patient, clinician and families, clinicians and their teams, clinicians and other teams and between hospitals and care providers in the community.”
In the conclusions section there is the statement: “the cases in this report show health care professionals need to be supported to be better at having open discussions about care towards the end of life.”
End of life conversations are clearly at the extreme end of breaking bad news and agreeing care plans – a more common requirement for some clinicians than others. “Bad news” is a very broad spectrum, meaning different things to different people and must always be handled carefully. Any of us are likely to be upset by “life changing” news.
So how can health care professionals be most effectively supported in this area?
On one hand there is the essential, direct support of colleagues and peers. Within the workplace this requires the conscious development of Team communication skills and knowing where to escalate issues, e.g. counselling by appropriately trained professionals where the clinician has themselves been traumatised by events.
On the other, there are models to support the development of direct communication with patients and those concerned in their welfare. On our Advanced Patient Communication Skills course we regularly explore utilising the SPIKES model. Originally developed in the field of oncology it has been effectively applied across healthcare disciplines and beyond. If you are unfamiliar with the model, or not reviewed it recently, the steps are as follows:
- Set up – Prepare yourself, the receiver of the bad news and the environment
- Perception – Check what does the patient knows, understands and believes?
- Invitation – How much information does the patient want to know and how do they want to receive this?
- Knowledge – Deliver the facts, ensuring what needs to be heard is heard
- Emotions – Manage the emotions with empathic concern
- Strategy and Summary – Agree on how to proceed and recap
Of course each step mentioned requires in-depth comprehension and significant skill with an appropriate attitude demonstrated by the clinician. This can only be achieved through deliberate review and proactive development activity, an expectation of which is made clear within Good Medical Practice and the various codes of ethics for every healthcare discipline.
What proactive steps are you taking to enhance your communication skills?
Oxford Medical Training is the UK’s leading provider of high quality career development for doctors of all levels. We specialise in advancing interview, leadership, management, teaching and communication skills in the medical environment.
