My learnings from Palliative Care – a series: Communication – the cement that binds

Pouruchisti Wadia is Associate Program Director, Romila Palliative Care at SNEHA

The best part of writing a blog series means that I need not follow a sequence like a book, but share my reflections in any order. Communication deserves special attention in palliative care, after all, as we always say. The Palliative Care team is bound together by the “cement” of skilled communication. This is a large component of palliative care and I will be covering just a glimpse of it here.

To begin with, we cannot ignore its importance in the context of these current, challenging times we all are facing! According to the latest consensus-based 2019 definition of palliative care by IAHPC [1]

“Palliative care is the active holistic care of individuals across all ages with serious “health related suffering” due to severe illness, and especially those near the end of life. It aims to improve quality of life of patients, their families and caregivers….”.

None of us can deny that suffering related to the COVID-19 pandemic has been perhaps the toughest on us so far. There has been a sense of helplessness which almost all of us have experienced at some point in our recent past. The reason to talk about this helplessness in my blog about communication is to link the challenges of a palliative care team in pre-pandemic times whilst talking to patients and their families and our current challenge of talking to them, trying to support them and cope in COVID-19 times. Point being that currently, even we, who emphasize the value of communication are finding ourselves at a loss.

Our patients at Romila Palliative Care have expressed deep gratitude simply for keeping in touch with them. We hope that this means we have been able to communicate our genuine empathy because there have been times when all we have been able to do, is communicate that “We are there with you” just through active listening. [2]

When we talk about communication and medical professionals in the same breath, the general practitioner comes to mind. Back in the day, all of us had “GPs” as they are called, who knew everything about our entire family and were almost a part of the family. They were trusted upon and knew each one’s medical history and unique allergies etc. As medicine grew more and more specialized, we found them slowly missing. The modern technology-based specialist, studied a part of the body in detail and did not go beyond that body part, let alone see the human behind the body. My mom, who is 94 years old, recently (pre-pandemic), was taken to a new doctor, rather than her regular GP. She disliked him intensely because he hardly asked any questions and prescribed medicine without so much as touching and doing a physical examination. Do reflect, when you look back at all the doctors you have interacted with in your life span, who stood out for you and why?

In the palliative care approach, we see the patient as a whole and want to know not just about the illness, but about everything that will impact their quality of life. There is a concept of total pain. So, the doctors make sure they communicate to find out the exact nature of the pain - physical, social, psychological or spiritual. Again, there are protocols of good communication skills that palliative care doctors and team members are taught to follow. One does not ask questions randomly and in a probing fashion. It’s always ask, tell, ask, tell me more. One needs to first assess what the patient/ caregiver already knows and what he or she wants to know. Especially, when they need to break bad news to the patient about their prognosis, they use the SPIKES protocol [3]. But this blog is not to explain technical jargon. Never mind that, I do drop some gems just to show I know what I am talking about!

One of my friends, who did not have a life limiting disease, was fortunate enough to go to a pain management expert for her frozen shoulder. Her doctor was well trained in palliative care. She said she loved him because he really knew how to talk to her and made her feel so relaxed. He not only acknowledged her physical pain, but was also able to find out from her, what was causing her most distress at that time during the pandemic.

This much-need communication skill requirement is common and applies to every member of the multi-disciplinary team that aims to provide palliative care. So much so, that one of our caregivers, who regularly came to our OPD at Romila Palliative Care (back in the pre pandemic days), commented that even our housekeeping staff had imbibed it without any formal training, just by observing us, thus adding to their overall feeling of wellbeing when they came to our Center. When care givers who inquire about palliative care tell me *and really mean it when they say – it was nice talking to you, I feel I have communicated well.

Communication is a skill that is important in almost all walks of life and in every profession, but it’s most important that medical professionals too, focus on soft skills like communication, in order to provide holistic care to their patients. 

[1] International Association for Hospice and Palliative Care; a global platform dedicated to support individuals and organizations, enabling access and optimization of palliative care across the world

[2] https://www.skillsyouneed.com/ips/active-listening.html

[3] Six-step Protocol for Breaking Bad News used widely by medical practitioners: http://www.cetl.org.uk/learning/feedback_opportunities/data/downloads/breaking_bad_news.pdf