Authors
- Dorine van Woerden
Institution
- Academic Medical Centre - Division Medical Psychology - Amsterdam - Netherlands
• Too often patients are ‘over-treated’ because the nearby death is not discussed.
• A reason is that doctors are trained to provide curative treatments rather than handle
the heavy emotions of patients facing the end of their life.
• This can cause misunderstanding about the care that is wanted by the patient.
• A timely discussion about the inevitable death of terminally ill patients is imperative
to ensure that appropriate measures are taken.
Effective communication about inevitable death can contribute to optimal palliative care during the final phase of life.
Therefore, we have developed a communication module for physicians.
•This 4 hour training consists of three modules:
a) Group discussion: to make physicians aware of their own
emotions that may hinder effective communication with palliative
patients.
b) Theory: physicians are provided with the relevant theory and
communication skills. Most importantly the phasing of this type of
consultation is provided, namely:
1. agenda setting (explaining the purpose of the consultation)
2. specifying goal (reaching a well-informed decision about palliative care)
3. evaluation of the consultation
4. documenting the decision about palliative care
5. follow-up appointment
c) Role play: physicians practice these communication skills with the help of a professional actor
.
During the last 5-6 years we have offered this module to four hospitals in the Netherlands. Participants were internal oncologists, gynecologists and intensive-care physicians. Satisfaction was measured by means of a semi-structured questionnaire. Participants generally appreciated this module: “…it provides practical communication tools to initiate a consultation about inevitable death”. Results also show that this module enables physicians to initiate this consultation, cope better with emotions and tolerate the fact that they cannot offer options for cure.
Communication skills regarding inevitable death are helpful in initiating a discussion with patients.
A timely discussion about inevitable death requires communication skills that can be taught.