When a trigger or a verbal or non-verbal cue suggesting emotional distress is recognized, patients and families should be asked directly about their feelings. It’s OK to ask, “Are you struggling?” or to say, “I’m wondering if you’re feeling [overwhelmed/sad/angry/scared] by what’s going on.” Even the process of asking questions and listening carefully to the answers can be therapeutic. Open-ended questions and attentive listening are useful to explore problem areas, values, concerns and readiness to hear bad news. The person must be given time to respond to each question. For the health professional, this means being comfortable with periods of silence. As the professional listens carefully to each answer, focused follow-up questions should be asked, using the person’s own language, if possible, and asking for clarification when necessary.
• Professional: “How have things been going since last month?”
• Person with MS: “It seems like my world is falling apart . . .”
• Professional: “Falling apart? Tell me more about that.”
It is important to acknowledge the person’s fears, concerns, worries and hopes before discussing the goals of care. Asking permission to discuss care goals is important; if patients and families are reluctant to proceed, they may need for you to refocus the conversation on unresolved worries and concerns before discussing goals of care. After patients and families feel their concerns have been heard, they are more likely to be able to move on to develop a care plan. A structured approach to communication prepares patients and families to discuss palliative care, conveys information in a sensitive but straightforward way and allows for the expression of emotions before a care plan is developed.
To know more about palliative care call PallEx Healthcare c/o Deccan Hardikar Hospital, 1st Floor, University Road, Shivajinagar, Pune-5 on 020-41095000 / 020-41095002.