Published by the Gerontological Society of America in 2012, this guide to communication provides practical tips based on evidence-based literature including general tips, face to face communication, optimizing interaction, and communicating with older adults with dementia.
Diane Meier, MD, and the Director of CAPC (Center for Advancement of Palliative Care), challenges healthcare professions to view giving bad news as a medical procedure. By that, she means it’s something that takes extensive training, observation, and practice. It’s not something you send a junior resident in to do when the attending is occupied with other things.
There is limited communication training in PHO fellowships despite ACGME requirements and fellows’ interest in this training. Didactic learning remains the most frequently described training method, yet educational theory identifies the limitation of didactic lectures alone. Communication training employing novel teaching methods and emphasizing communication challenges identified by fellows should be developed and evaluated.
Reassurance, agreeing to avoid opioids, and information gathering were the three most common communication strategies used by physicians and their patients with chronic pain. Those are the findings from a small pilot study conducted to determine how doctors and patients approach the inherent uncertainty of opioid use, given the absence of long-term data about opioids’ efficacy in noncancer or end-of-life pain treatment.
Learning how to speak with patients about end-of-life topics is often anxiety provoking for medical trainees. However, it also provides a unique opportunity for personal growth. The surprising reward of having such a conversation is presented in this reflection.
Taken together, these results suggest that policies supporting more frequent and longer duration of PDC may improve patient outcomes in hemodialysis.
A number of caregivers who have left comments or emailed me have asked for my advice on dealing with their loved ones’ dementia. Since I have absolutely no personal experience in that area, I can only offer second-hand advice that I can’t personally vouch for. In two previous posts (here and here), however, I did review the book Contented Dementia, which offers a good general framework for thinking about the issue. I’ve also recently come across a set of “Tips for the Caregiver” from the Bureau of Geriatric Psychiatry in Tuscaloosa, AL. The tips are taken from a larger “Caregiver Packet”* which is also well worth reading.
The Communication and Mealtimes Toolkit is a guide for caregivers and long-term care professionals on creating a person-centered care approach to communication and mealtime for persons with dementia. The toolkit looks at issues that arise on a daily basis and gives straightforward and practical advice to caregivers wanting solutions to these common problems.
Conclusions The findings can serve as starting point for reflection on professional decision-making in pancreatic cancer and larger representative surveys on ethical issues in treatment decision-making in pancreatic cancer.