Managing Difficult Conversations at the End of Life

1. Preparing for Difficult Conversations

Some conversations are just going to be difficult, but each difficult conversation increases the clinician's experience and preparedness for the next one. This chapter reviews barriers and facilitators to effective communication as well as ways to minimize our own personal bias and assumptions when engaging in these conversations. Finally, this chapter will look at how to balance empathy with professional boundaries to avoid compassion fatigue.

2. Patient and Family Perspectives About Communicating

Patients and families want to be heard, but clinicians want to have answers. This chapter will help the clinician bridge this gap in goals of communication. Patient-centered communication will be examined so power and responsibility can effectively be shared. This chapter also discusses facilitating difficult conversations between the terminally ill and their family members.

3. Four Case Studies in Difficult Conversations

This chapter will present four actual cases for review. Topics in this course will include pain management, refusal of care, pediatric issues, family disagreements, and suicidal ideations. Each case will examine the conversations that occurred and the outcomes of those conversations.

4. Reflecting After a Difficult Conversation

In any difficult conversation, there are things that went well and things that could have been handled better. This chapter looks at professional growth through meaningful reflection and after-action reviews. There is an opportunity to learn from each experience and be even better prepared for the next time.