Communication Challenges in Palliative Care

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       Palliative care is an approach to care that focuses on improving the quality of life of patients and their families facing the issues that are associated with life-threatening chronic incurable illnesses (Jarrell, 2016). It is important to note that palliative care does not mean end of life care and patients can be on palliative for years before they die (Wallerstedt et al., 2019). Palliative care has four stages namely, Stable, deteriorating, unstable and terminal. Palliative care management plan must be made in collaboration with patients and their families in order to achieve optimal care (Hui & Bruera, 2016).  

      This paper aims to explore the communication challenges that clinicians in palliative/end of life care face. It will also explore the importance of good communication in providing dignity and respect to people on palliative care. And will end by looking at the reason communication is very important to improving nursing practice.  

      In Australia, from 2012- 17 the number of palliative care-related hospitalisation increased by 25%, from about 61,600 to almost 77,400. Between 2016-17, 51.6% of the patients who died as an admitted patient had been palliative during their   hospitalisation. The steady growth in the levels of hospitalisation in Australia, can likely be put down to the increase and the aging of the Australia population. Also, the increase in the levels of chronic, and incurable illnesses (Australian Institute of health, 2019).   

Importance to Nursing Practice   

      Firstly, Communication is arguably the most important skills in palliative nursing. Patients centred communication is important to a nurse as it enables the patient and their families make informed decision that are consistent with their own values, goals and preferences (Warmling & de Souza, 2018). (Macpherson, 2018) Found that many physicians find palliative care discussions difficult, this is due to the lack of training in communication interaction, difficulties dealing with emotions and fear of taking away the patient’s hope. Even with a clear knowledge of the whole palliative process, and a willingness to facilitate the discussion, clinicians face tensions between, respecting the needs of the patient, avoid undermining cultural values and meeting the needs of the children. 

        Secondly, having an open-ended dialogue when residents are first admitted to care homes is important, as it provides a clear framework of what sort of medical interventions clinicians can make when the patient becomes critical (Hack et al., 2017). This is normally done through an Advanced Care Directive, an ACD details the needs and wants of the resident should they become critical, and the medical interventions that can be pursued. However even if an ACD is available, accessibility to it is very difficult, because either the doctors, nurses or families are not aware it exists. Moreover, ACD’s are dependent on the current condition of the resident/patient (Page, 2019).  

      (Brighton & Bristowe, 2016) Found that poor communication among clinicians can often lead to poor assessment, evaluation and management of patient symptoms. This is especially true when caring for people with major cognitive decline, like dementia and Alzheimer’s. Advanced care directives are supposed to give clinicians a decision-making framework for when patients deteriorate. But an ACD, only gives guidance for the gradual deterioration of patients and specific guidelines on whether to resuscitate. They are, however, very vague when it comes to medical emergencies where the patient does not die but the outcome significantly takes away the right of the patient to die with dignity and respect. For individuals without a valid ACD, clinicians normally wait until there is a drastic change in the functional status of the patient. That can either be brought on by a fall, stroke or flue, in order to have a conversation about palliative care/end of life care (Carr & Luth, 2017).   

      Furthermore, the more multicultural the Australian society becomes, the harder it will be to provide person centred care. This is because different cultures have different ways they deal with palliative care.  Differences may relate to whether the most usual cultural approach to end of life care is family based or focused on the autonomy of the patient.  Since nurses spend the most time with the patients they are better placed to advocate and know the dislikes and the needs of the patients and their families (Modares & Matei, 2018). 

     To conclude, good communication is important to improving practice in palliative care as it allows clinicians to provide person centred care. It also allows nurses to provide that meets the needs of the patient and their families.  Additional education after graduation is required among nurses in order to effectively communicate with people on palliative care.

References

Jarrell, J. A. (2016). Palliative Care. In Care of Adults with Chronic Childhood Conditions (pp. 355-362). Springer, Cham. 

Wallerstedt, B., Benzein, E., Schildmeijer, K., & Sandgren, A. (2019). What is palliative care? Perceptions of healthcare professionals. Scandinavian journal of caring sciences, 33(1), 77-84. 

Hui, D., & Bruera, E. (2016). Integrating palliative care into the trajectory of cancer care. Nature reviews Clinical oncology, 13(3), 159. 

Australian Institute of Health and Welfare. (2019). Palliative care services in Australia. Retrieved from https://www.aihw.gov.au/reports/palliative-care-services/palliative-care-services-in-australia 

Warmling, L., & de Souza, P. A. (2018). The Importance of Communication among the Members of the Nursing Team. Creative Education, 9(06), 993. 

Macpherson, C. (2018). Difficulties for a practitioner preparing a family for the death of a parent: A narrative inquiry. Mortality, 23(3), 247-260. 

Page, D. (2019). THE BARRIERS TO COMPLETING AN ADVANCE DIRECTIVE: THE PERSPECTIVES OF HEALTHCARE PROFESSIONALS. https://doi.org/10.17615/nevz-rm58

Hack, J., Buecking, B., Lopez, C. L., Ruchholtz, S., & Kühne, C. A. (2017). Advance directives in clinical practice: Living will, healthcare power of attorney and care directive. Zeitschrift fur Rheumatologie, 76(5), 425-433.

Brighton LJ, Bristowe K, Communication in palliative care: talking about the end of life, before the end of life, Postgraduate Medical Journal 2016;92:466-470.

Deborah Carr, PhD, Elizabeth A Luth, PhD, Advance Care Planning: Contemporary Issues and Future Directions, Innovation in Aging, Volume 1, Issue 1, 1 March 2017, igx012, https://doi.org/10.1093/geroni/igx012

Modares, M., & Matei, A. C. (2018). End of life care in a multicultural framework: to treat or not to treat. University of Toronto Medical Journal, 95(3), 43-33.

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