Communication Strategies and Cultural Issues in the Delivery of Bad News

Abstract

Good communication is a fundamental skill for all palliative care clinicians. Patients present with varied desires, beliefs, and cultural practices, and navigating these issues presents clinicians with unique challenges. This article provides an overview of the evidence for communication strategies in delivering bad news and discussing advance care planning. In addition, it reviews the literature regarding cultural aspects of care for terminally ill patients and their families and offers strategies for engaging them. Through good communication practices, clinicians can help to avoid conflict and understand patients' desires for end of life care.

Cultural factors that influence the treatment of osteosarcoma in Zulu patients: Healthcare professionals’ perspectives and strategies

“…Proposed strategies for fast-tracking treatment decisionmaking included initiating cultural discussions, liaising directly with the cultural decision-makers regarding treatment (Barclay, Blackhall & Tulsky 2007;Broome & Broome 2007) and suggesting that family members come to the hospital rather than the patients going home. Most patients, using alternatives to Western medicine, may have had an expectation of the clinician to initiate the discussion regarding these practices (Shelley et al 2009).…”

Patients' diverse beliefs about what happens at the time of death

“…1 We believe, therefore, that competent, compassionate end-of-life care requires hospitalists and other health professionals who attend dying patients to address such beliefs. But people do not readily volunteer them, health professionals rarely elicit them, and little research describes them.…”

“…We assumed that culture-the values a group uses to interpret shared experiences and transmits across generations 2,3 -influences those beliefs. 1,[4][5][6][7][8][9][10] We reasoned that, because death is a universal human experience, every culture must address its meaning. 5 Prior studies showing ethnic cultural differences over advance care planning, life support, and other aspects of dying further supported our assumption.…”

“…Beliefs about what happens at death surely affect the whole dying experience 1 and may help guide end-of-life care. Yet for all the research on dying, the health professions literatures contain virtually no studies describing such beliefs.…”

Estimating and communicating prognosis in advanced neurologic disease

“…Communicating what to expect occurs in the context of broader communication tasks of building rapport, discussing treatment options, eliciting patient preferences, dealing with conflict, and running family meetings. 33 General principles of effective interpersonal communication between providers and patients/families (e.g., maintenance of eye contact, minimization of interruptions) are of key importance. 34 To deliver the prognostic message, we apply the Ecological Model of Prognostic Conversations, which contributes to effective information-seeking, comprehension, and deliberation.…”