
Contents
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Introduction Introduction
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Barriers to effective communication Barriers to effective communication
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Healthcare professional-led barriers Healthcare professional-led barriers
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Fears Fears
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Beliefs Beliefs
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Inadequate skills Inadequate skills
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Lack of support Lack of support
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Patient-led barriers Patient-led barriers
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Fears Fears
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Beliefs Beliefs
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Other difficulties Other difficulties
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Specific communication issues Specific communication issues
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Breaking bad news Breaking bad news
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A strategy for breaking bad news A strategy for breaking bad news
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The goals of breaking bad news The goals of breaking bad news
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Prepare to tell bad news Prepare to tell bad news
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Read the patient’s notes Read the patient’s notes
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Check Check
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Plan Plan
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Set the context Set the context
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Assess Assess
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Acquire empathy with the patient Acquire empathy with the patient
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Respond to non-verbal as well as verbal clues Respond to non-verbal as well as verbal clues
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Share information Share information
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Remember Remember
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Response Response
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Use open questions Use open questions
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Make concrete plans for the next step Make concrete plans for the next step
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Immediate plans Immediate plans
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Summarize Summarize
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Deal with questions Deal with questions
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Contract for the future Contract for the future
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Handling difficult questions Handling difficult questions
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Key points Key points
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If the patient gives no other reason or changes the subject If the patient gives no other reason or changes the subject
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If the patient gives other reasons If the patient gives other reasons
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Collusion Collusion
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Key points Key points
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Dealing with anger Dealing with anger
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Key points Key points
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Exploration of feelings (e.g. anxiety) Exploration of feelings (e.g. anxiety)
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Key points Key points
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Patients who do not want to talk Patients who do not want to talk
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Handling denial Handling denial
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Key points in exploring denial Key points in exploring denial
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Unrealistic expectations Unrealistic expectations
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Key points Key points
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Working with ethnically diverse patients Working with ethnically diverse patients
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Useful strategies Useful strategies
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Greeting Greeting
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Language style Language style
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Paralinguistic features (tone, pitch, etc.) Paralinguistic features (tone, pitch, etc.)
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Understanding the patient Understanding the patient
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Checking the patient understands you Checking the patient understands you
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Backing up Backing up
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Strategies for working with an interpreter Strategies for working with an interpreter
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Things to remember Things to remember
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Points to check if things seem to be going wrong in the consultation Points to check if things seem to be going wrong in the consultation
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Further reading Further reading
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Further reading Further reading
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Cite
Abstract
This chapter describes the crucial relevance of palliative care in today’s healthcare environment, as well as the extent and reasons for the inequities in its accessibility globally. It depicts the ongoing efforts by international agencies worldwide to improve the availability of essential palliative care services. The chapter provides examples of activities to develop palliative care and innovative initiatives from a few countries with widely varying socio-economic backgrounds. Resources are provided that could support the initiation of new palliative care services in regions where there is a need. It is hoped that the reader, besides becoming a competent palliative care clinician, also gets inspired to initiate activities to enhance access to palliative care services.
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