Claire Henry, Director of Transformation and Improvement for Hospice UK introduces our new joint film exploring how good communication makes a difference to people at the end of their life.
Communication is a skill
A friend of mine once told me that when he was about seven his family’s beloved guinea pig died. His mother had found it dead, and came to tell him. She then asked him to tell his sister, because she thought it would be good for him to learn how to break bad news.
You might think that seven is possibly too young an age to be tasked with telling even younger children about the death of a family pet, and I wouldn’t argue if you did. But I do think that the general point stands. Communicating anything is a skill. We learn most of what we need as part of growing up, studying and our early years at work. Some are naturally better than others, but all can learn how to do it, and for the most part, learn how to do it well.
But communicating bad news well requires an extra level of ability. And sharing the news that someone is dying, or news when they are dying, is the hardest of all. Because we tend to shy away from bad news, we don’t pick up the skill as much as we do other communication skills as we grow and learn.
Good communication is about more than just breaking bad news
Doctors and nurses have to quickly acquire skills in breaking bad news. But just because we’ve done it a lot, doesn’t mean we are doing it well, or that there aren’t areas we can improve. It isn’t just about giving someone the news that their condition is no longer curable. It’s all the other aspects of the treatment that follows, the information that needs to be shared, the options that need to be considered, and the decisions that need to be taken.
When death is near, time is precious. So on the one hand brevity and clarity are important. But at the same time we can’t ignore the human element: a life is nearing its end, and we need to acknowledge the pain that comes with that.
My colleagues in the communications team always stress that the best communication is two-way: listening as much as speaking. This is clearly so, so important in end of life situations, when we have only one chance to get it right. We have to listen to people nearing death, and to their families. We have to hear what they say, and ask. And sometimes we have to be alert to what isn’t being said, because people are afraid, or nervous, or just confused.
Talking about end of life care
Last year the National Council for Palliative Care teamed up with the GMC to produce (with the Media Trust) a pair of short videos, one looking at communication at the end of life, and another at the specific issue of hydration and nutrition. Both have been very popular, and so we’ve teamed up again to produce a third. All three take the same format, featuring doctors in conversations with people with life-limiting conditions or their families.
This looks at how good communication – even of rubbish news, as one person puts it – makes such a difference to dying people and their families. I’d urge all doctors to watch it and then reflect on conversations they’ve had with patients nearing the end of life and consider ‘what more could I do?’.
More about Claire
My name is Claire Henry and I am Director of Transformation and Improvement for Hospice UK, which recently merged with the National Council for Palliative Care.
The work NCPC championed is not finished. The baton has passed to the new organisation, retaining the name Hospice UK but dedicated to improve end of life care wherever it is delivered, and to support all those working in palliative and end of life care.
A lot of NCPC’s best work was done in partnership with others, and we are really proud of the work done with the GMC over the years. We’re looking forward to a lot more in the future.