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Seven ways to talk to terminal patients

Before COVID-19 arrived in our lives, chronic illness was considered the next worldwide pandemic. But COVID-19 did arrive and life as we knew it has radically changed. Healthcare workers, particularly nurses and physicians, are now having frequent palliative care (the area of end-of-life care that focuses on patient comfort) conversations although most are not trained as palliative care specialists.

The prolific use of telehealth has also placed a demand on all healthcare providers to rely on communication exchanges which can be facilitated with tools and resources from the COMFORT model.  Originally introduced in 2012 for nurses, the model is not a linear guide, an algorithm, a protocol, or a rubric for sequential implementation by only nurses; rather, it is a set of holistic principles that can be practiced by all healthcare providers during patient/family care across the entire illness journey, not just at the point of terminal care. COMFORT consists of seven basic communication principles: C—Connect, O—Options, M—Making Meaning, F—Family Caregivers, O—Openings, R—Relating, and T—Team. During the last five years, the COMFORT model has been taught to healthcare providers nationwide who integrated the curriculum and concepts into their own institutions and, through a train-the-trainer approach, delivered components of the model to more than 10,000 healthcare providers across the United States.

We share selected highlights from the COMFORT model to support palliative care communication for nurses and for all providers that are navigating acute and terminal care with patients, families, and team members during this challenging pandemic.

  1. Connect to the patient/family story. 
    Nurses have an essential role in the delivery of difficult news. Listening to patient and family concerns and capturing important information about what they value builds trust. Encouraging storytelling is one way to connect and share messages.
  2. Share options.
    Patients and their caregivers are unique and doctors and nurses shouldn’t assume preferences based on patients’ appearance, ethnicity, or origin. Nurses should recognize that simply providing information does not always equal understanding. Patient and caregiver health literacy is created from interaction between providers, systems, and communities.
  3. Make meaning of suffering.
    Patients, families, and colleagues can endure great suffering if they can find meaning in that suffering. Patients and families relate serious illness and end-of-life to ways in which this will affect their relationships and day-to-day living. Healing and compassionate presence involves deep listening to share emotions and respond with compassion.
  4. Recognize that family caregivers are partners.
    A key role of nurses is to be adaptable and flexible to the diverse decision-making structures that exist within families. Nurses become like family when family cannot be there.
  5. Open conversations about feelings and fears and goals.
    Intimate conversations that facilitate openings can profoundly and positively impact patient suffering and fear. Patients may fear discrimination and feel threatened because of their marginalized status in the U.S. (e.g., African Americans distrust the medical system because of their history of being underserved.) or due to their cultural, religious or linguistic practices and values.
  6. Relate to the uncertainty of this shared experience.
    The nurse cannot know the reaction or perspective of the patient/family without first receiving and listening to it. Accept that not all patient’s or family members will be able to process news or make decisions. Truly relating to a patient and their family creates the opportunity to learn about fears associated with uncertainty.
  7. Team up with colleagues. 
    Compromising and adapting are the only ways to plan in the midst of COVID-19. Being flexible with roles and responsibilities in the team environment demonstrates trust and respect for professional colleagues. It’s important for healthcare providers to let team members know what is working for them and share their feelings about the experiences with other team members. It’s also very important to share thoughts about other team member’s strengths.

Nurses must be agile to meet the unprecedented challenges of COVID-19 and the effect it has upon the lives of patients and their families. Nurses find themselves having unplanned, sudden and difficult communication disclosures with patients and families and may not always feel prepared.

Adapting several of the suggested strategies from the COMFORT model can assist nurses and healthcare providers when providing comprehensive care for patients and their families.

Practicing person-centered holistic principles will support physical, spiritual, and psychological comfort that is beneficial to all during unprecedented and challenging times.

Featured Image Credit: by sabinevanerp via Pixabay 

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