Communication at End-of-Life

What can I do?

Communicating about end-of-life issues can be difficult. You may like to ask how you can help. Remember that listening and acknowledging concerns may be of great comfort.

Patient and families appreciate being listened to, being invited to ask questions. You may not know the answer to every question, but you can be of help by sharing information. “Here is a brochure, maybe you could talk to …. about ….”

Familiarise yourself with types of questions people may ask Asking questions can help: An aid for people seeing the palliative care team (614kb pdf).

Checking a person’s understanding of the current situation is a good way to start a discussion. You can use ask-tell-ask technique to structure these discussions.

Use Communication Cards to communicate with people in their preferred language. (From The Centre for Cultural Diversity in Ageing) 

What can I learn?

• about breaking news, helping people plan, supporting carers and identifying end of life patients from Dying Matters.
• about active listening (158kb pdf).
• a factsheet: Talking with Families (75kb pdf) from the PA Toolkit.
• ‘Supporting a good end of Life' (544kb pdf) for tips on communication for staff of residential aged care facilities.
• Palliative Care Network of Wisconsin Fast Facts and Concepts Responding to Patient Emotion.
• Clayton J, Hancock K, Butow P, Tattersall M, Currow D. Clinical practice guidelines for communicating prognosis and end-of-life issues with adults in the advanced stages of a life-limiting illness, and their caregivers. Med J Aust. 2007 Jun 18;186(12 Suppl):S77, S79, S83-108.
• Therapeutic Guidelines Communicating with the patient in palliative care (subscription required).
• Responding to Strong Emotions from CareSearch.
• The Vital Talk website has tips and even the VITALTalk Tips app.

• Palliative Care and the Human Connection: Ten steps for what to say and do when talking about palliative care. It is principally for doctors but can be of interest to many people.
• "Someone is dying. What do I say?"- Care, compassion and communication at end of life (48 minutes) from the PA Toolkit.

• Communicating with people with life-limiting illnesses.
• Communication principles.
• Responding to losses.
• End-of-life concerns.

What can my organisation do?

Have readily available to families Asking questions can help: An aid for people seeing the palliative care team.

Develop a list of flags to clearly identify the triggers for palliative care or end-of life care discussions or review discussions.

Providing comfortable non-clinical meeting rooms for end-of-life discussions may offer a more nurturing environment for discussion, putting everyone at ease.

Have a member of staff or key health professional provide a telephone follow up after initial discussions to check how information has been received and understood. Offering the opportunity to clarify information may reduce stress and anxiety experienced by the person and his/her family.

Provide a qualified medical interpreter if practical and not costly. 

• Department of Social Services provides a Free Translating Service to approved community organisations and individual service providers. 
• National Accreditation Authority for Translators and Interpreters (NAATI) provides an Online Directory to assist in finding an accredited interpreter. 

Conducting a family meeting can be useful to provide information, to address the family's questions and concerns, and to establish goals of care. Information on how to conduct a family meeting in palliative care is available from the Therapeutic Guidelines (Palliative Care)  (with subscription) in the section: Supporting families in palliative care.

Family meetings often require a skilled facilitator, consider that skill set in a recruitment process.