crucial conversations to clarify meaning

Crucial conversations to clarify meaning professional#

The purpose of this article is to provide a framework for having a difficult conversation with an oncology patient and to clarify the role of the AP in the initiation of this critical communication. In fact, the AP often has the time and the one-on-one interaction opportunity that encourages growth of the therapeutic relationship required to initiate a difficult conversation with a patient. The AP and physician should build a therapeutic relationship with the patient, laying the foundation for critical conversations. The majority of the research on communicating bad news has been focused primarily on medical oncology fellows.īecause research is largely physician-focused, there is a need for a wider examination of the role of the AP in initiating and having difficult conversations. Some institutions are participating in the End-of-Life Nursing Education Consortium (ELNEC), administered by the American Association of Colleges of Nursing (2012) the Education in Palliative and End-of-Life Care (EPEC) curriculum (Robinson et al., 2004) and ONCOTALK programs (Back et al., 2007) to teach these communication skills however, there is little preparation or review for those already practicing.

Crucial conversations to clarify meaning professional#

Unfortunately, the communication skills required for an effective difficult conversation go beyond the basic interviewing techniques that are taught in health-care professional training schools.

The conversation is best conducted when a therapeutic relationship based on trust and mutual respect has already been established (Back et al., 2008). This turning point or transition conversation can be a part of an introduction to a larger discussion about what the patient wants to accomplish or avoid at the end of life (Back, Bauer-Wu, Rushton, & Halifax, 2009).

When an AP raises the possibility of discontinuing chemotherapy for a patient with advanced cancer, a turning point occurs between the AP and the patient (Back et al., 2010)-one that most often necessitates a difficult conversation. Goals of care are defined and reevaluated throughout the disease trajectory. It also provides a forum for setting realistic goals and sustaining hope. A well-conducted difficult conversation can aid in establishing the multifaceted goals of care to include the physical, spiritual, and psychosocial domains. Clinicians and researchers widely acknowledge the importance of addressing not only physical but also emotional and spiritual suffering at the end of life (Steinhauser et al., 2008). Because patients are living longer than ever before, the communication challenges faced by oncology clinicians have become ever more complex, involving uncertainty, hope, and even discussion of widely available anecdotes of patients who 'beat the odds' (Back et al., 2008).Ī difficult conversation can be defined as one that takes place between the AP and the patient at transition points on the disease trajectory. Over the past century, developments in public heath and new medical therapies have led to an exponential increase in the longevity of cancer patients (Goldstein, Back, & Morrison, 2008). Patients with advanced and incurable cancers struggle with the emotional impact of a life-limiting illness, complex treatment decisions (often involving clinical trials), and the challenge of sustaining hope while maintaining realistic goals (Back et al., 2008). Throughout the disease trajectory, patients and their families look to the AP for support and guidance. The oncology advanced practitioner (AP) needs to be equipped to answer patients’ questions in an honest and empathic manner, to consider the varied informational and emotional needs of their patients, and to provide patient-centered recommendations for future treatments (Saraiya, Arnold, & Tulsky, 2010). Patients with cancer report unmet needs for communication of information about the extent of their disease, prognosis, treatment options, intent, and adverse effects (Kissane et al., 2012).