MEDRADSC 3DH3 Lecture Notes - Lecture 3: Dementia, Comorbidity, Materialism
18 Jun 2018
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Challenges with Communication in Palliative Care
Can be more difficult encounters
Even experienced HCPs can find it daunting
Various factors can challenge interaction
Don’t avoid opportunities to engage; can be enriching for both you and the patient/family
Barriers to Effective Communication
Social
oHave not witnessed death
Approx 65% of people die in hospital; century ago 90% died at home
Family support is more difficult to provide
oChanging role of religious beliefs
oHigh expectations of health and life
oMaterialism of our society
HCP’s characteristics
oPersonality, gender
oIndividual’s life experience and/or education
Underestimate impact
Feelings of personal inadequacy, failure, guilt (e.g. “I’m sorry”- sympathy or
apology?)
oSocial background
oCulture
oEmotions
Afraid to show emotions
Own fear of dying
Patient’s characteristics
oSpecific diagnosis, co-morbid illness(es), symptoms
oPhysical challenges (e.g. hearing loss)
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oEmotions (e.g. fear)
Fears about the dx:
What symptoms am I going to experience from the disease? Am I going
to be nauseous or even worse, have pain?
Will I lose my mobility?
Psychosocial fears:
I hope I don’t break down
I hope I don’t lose my mind! (e.g. dementia)
Fears around Death:
Existential issues
Religious concerns
Fears about treatment
Side effects (baldness, pain)
Surgery (pain, mutilation)
Altered body image (surgery, colostomy, mastectomy)
Fears about family and friends
Loss of sexual relations
Being a burden
Loss of family role
Fears about finances, status, job
Loss of job
Possible loss of medical insurance
Expenses of treatment
Being out of the mainstream
oFamily dynamics
oSocioeconomic factors
oGeographic location
oCulture
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Don"t avoid opportunities to engage; can be enriching for both you and the patient/family. Approx 65% of people die in hospital; century ago 90% died at home. Family support is more difficult to provide: changing role of religious beliefs, high expectations of health and life, materialism of our society. Hcp"s characteristics: personality, gender, individual"s life experience and/or education. Feelings of personal inadequacy, failure, guilt (e. g. i"m sorry - sympathy or apology?: social background, culture, emotions. Patient"s characteristics: specific diagnosis, co-morbid illness(es), symptoms, physical challenges (e. g. hearing loss, emotions (e. g. fear) I hope i don"t lose my mind! (e. g. dementia) Being out of the mainstream: family dynamics, socioeconomic factors, geographic location, culture. When conversation begins, be in listening mode; active listening can have therapeutic value in and of itself. Need to ask direct questions related to symptoms and functioning. Assess additional domains of care, either directly or indirectly. How is treatment going for you (your family)? .
