By G. Jay Westbrook, RN, MS, CHPN
There are many emotional obstacles and communication barriers one must face when a person is nearing the end of life. Individuals, families and professionals alike often stumble over the correct words, or say nothing about the mass of conflicting emotions they experience as the journey goes forward.
As a hospice nurse, certified Grief Recovery specialist, and credentialed spiritual counselor, I help people find a kind and curious voice with which to explore these puzzling and conflicting feelings, within themselves and with others.
Here are a few suggestions both professionals and patients can use to explore these feelings.
1. Ask the right questions
Learning to ask questions, especially the right questions—questions requiring thought… that are often uneasy to answer—can be both helpful and freeing. Of course, anyone being asked questions must remember to both listen and clarify before formulating an answer.
The words “silent” and “listen” both contain the same six letters. Perhaps there’s a connection between the two?
2. Attribute meaning
“Will I lose my dignity?” a patient may ask.
Dignity is the quality of being worthy of esteem or respect. Is the patient asking if they will lose esteem or respect, or are they asking if they will lose control of bowel and bladder? Both are legitimate questions, not easy to ask, and demand thoughtful and differing answers.
3. Define concepts
In an advance directive a person may write that they do not want to be kept alive, or do not want to be put on a ventilator, unless they are “likely to be able to lead a life of quality.”
A statement like this, which fails to define or specify the criteria of what a life of quality means, does not provide clear communication to a healthcare professional (or their own family or healthcare proxy) of the choice the person would want made in a given situation.
4. Recognize communication barriers
Other than just not listening or not being specific, there are many barriers or blocks that could confuse communication at the end of life, including:
- Using words that have no meaning to the listener
- Using words that have different meanings to different listeners (such as using “grave” as a hole in the ground where a coffin and body are placed, or “grave” meaning serious, i.e., “I have grave news”)
- Not acknowledging feelings before delivering facts
- Not employing defense-lowering statements
- Failing to present and/or normalize all the given choices in a given situation
- Ignoring directional focus
- Approaching the communication with an agenda and/or intent to manipulate others
Example: Misperception as a barrier
I once spoke with an enraged young man who was just over one year clean and sober. “I can’t believe my father doesn’t trust me with the news of his terminal diagnosis,” he said.
On the same day, the young man’s father said to me, “I just don’t think I can speak to my son about my terminal diagnosis without completely breaking down, and I’m not willing to burden him with that.”
Misperceptions, due to miscommunication or absent communication, are important because they drive both feelings and behaviors, and do so over long periods of time.
Learn the tools to improve your communication skills
To improve your end-of-life communication skills join me at the Coalition for Compassionate Care of California 8th Annual Summit in Newport Beach, CA, where you will learn about these important communication tools:
- 3rd partying
- Reframing
- Embracing the gift of uncertainty
- Always knowing on which side of the door the hinges are located
I am the closing general session speaker on Friday, May 13, and I am excited to share much more with you about practicing ethical communication.
I hope to see you there!
G. Jay Westbrook, RN, MS, CHPN, is a multiple award-winning clinician, author and speaker, and is clinical director of Compassionate Journey—an end-of-life clinical and education service. Click here to learn more about Mr. Westbrook.