With the steep and continued demand for palliative care coupled with the transition of death at home to death within institutional settings, palliative care providers are being integrated into or even leading end of life conversations. In this sense, clinicians are being asked to simultaneously enact their medical role while also serving as an expert communicator in prompting discussion, navigating family dynamics and tensions, and enabling sensemaking among themselves, the patient, and the patient’s important others. This presents an incredibly complex communicative network, where communication must function much more deeply than the traditional tool metaphor.
Put simply, participation in such intimate and substantive conversations requires more than the transmission or consumption of a simple message. For example, if a patient expresses that he or she is tired and is reticent to try additional curative treatment, yet wavers in this decision when the family objects a constitutive communicative approach would prompt much deeper questions for discussion and require active listening among all participants. A communicative approach would prompt deeper discussion about the patient’s desires and fears and would allow loved ones to disclose their fears while each party was instructed to listen attentively, without interruption, while they considered the speaker’s wishes from the speaker’s point of view. Emphasizing an other-oriented communicative approach, including listening and trying to make sense from the speaker’s point of view, helps to facilitate understanding. And while there is no communicative silver bullet that promises clarity and agreement among all, focusing on communication as a vehicle to facilitate understanding, responsibility, and individual acceptance continues to be recommended as the most productive and healthiest approach.
Written by: Leah M. Omilion-Hodges, PhD
Considine, J., & Miller, K. (2010). The dialectics of care: Communicative choices at the end of life. Health Communication, 25, 165–174. doi:10.1080/10410230903544951
Omilion-Hodges, L. M., & Swords, N. M. (2016). Communication that heals: Mindful communication practices from palliative care leaders. Health Communication, 31, 328–35. doi:10.1080/10410236.2014.953739
Omilion-Hodges, L.M. & Swords, N.M. (2016). The grim reaper, hounds of hell, and Dr. Death: The role of storytelling for palliative care leaders in competing medical meaning systems. Health Communication. Advance online publication. doi: 10.1080/10410236.2016.1219928
Wittenberg, E., Goldsmith, J., & Neiman, T. (2015). Nurse-perceived communication challenges and roles on interprofessional care teams. Journal of Hospice & Palliative Nursing, 17, 257-262. doi: 10.1097/NJH.0000000000000160
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