When a patient is dying, it can be difficult to know what to say to them. Here are a few tips and approaches that I have gathered from experts that I hope will help you get through those hard conversations while continuing to provide the best possible care to your patient.
When a patient is dying, it can be difficult to know what to say to them. And, when your patient—a person that you helped, cared for, and developed a relationship with—is dealing with a terminal illness, it can be tempting to hide your emotions and “turn-off” your empathy to avoid any awkwardness.
Nothing I could say in this blog, and no amount of experience, will ever make you feel completely at ease when speaking with a dying patient. It will always be difficult, uncomfortable, and, sometimes, painful.
But, here are a few tips and approaches that I have gathered from experts that I hope will help you get through those hard conversations while continuing to provide the best possible care to your patient:
1. Find balance
When caring for a dying patient, it is important that you balance truthfulness with the need to minimize psychological harm. The trick here is to try to assess your patient’s tolerance for frank conversation; if your patient has a history of becoming very upset, you might try to provide minimal information at first and allow the patient to ask you additional questions if they wish.
2. Follow the patient’s lead
It might be helpful to ask the patient how much he or she knows about his or her medical condition, and ask if there is any additional information that you can provide. If the patient asks further questions, be sure to answer honestly. Be careful to avoid overloading the patient with information, and tune in to signs that the patient may have had enough for right now.
3. Put yourself in the patient’s shoes
In order to tap into your empathy, ask yourself how you would feel if you were in your patient’s shoes. This will help you to better anticipate your patient’s questions and prepare for reactions of grief, anger, surprise, or shock.
4. Follow up
Understandably, your patient may not be able to think clearly after receiving bad news, and may have good days and bad days after receiving a terminal diagnosis. If you sense that your patient is not in full possession of his or her wits, start by delivering minimal information and arranging a follow up appointment a few days later so the patient can have an opportunity to ask questions.
5. Call upon Kübler-Ross
Depending on a number of factors, dying patients will fall somewhere on the spectrum of "The Five Stages of Grief," as identified by Swiss-born psychiatrist Elizabeth Kübler-Ross. Figuring out where your patient is in the grieving process (denial, anger, bargaining, depression, or acceptance) can help you to understand what they are feeling and interact with them more effectively.
6. Be prepared with resources
Although it is not wise to trot out an unsolicited list of social and spiritual support services, you should have them ready in the event that your patient asks for information. Again, it is a good idea to start slowly by asking the patient if he or she has an advance directive or care plan and allow the patient to take the lead. You should avoid overwhelming the patient with a huge amount of resources; instead, offer appropriate referrals during the course of your conversation.
7. Don’t forget the family
Providing that the patient has authorized you to share information with his or her family, be sure to keep everyone informed. Also, be sure to have a list of caregiver and family resources at hand in the event that a family member identifies any needs.
8. Discuss end-of-life options
When a patient is ready to talk, don’t avoid or postpone conversations about end-of-life options. And, if you feel that these conversations are out of your realm of expertise, don’t hesitate to call in a palliative care specialist or a hospice representative.
Because conversations with dying patients can be emotionally taxing, doctors often try to hide or ignore their emotions. If you are upset by a conversation with a patient, it is best to express those feelings by debriefing with a trusted, sympathetic colleague.
I hope this information proves useful for readers who are treating terminally ill patients. Any additional insights, advice, or commentary that you would like to contribute would be most welcome.