Good communication is a core part of palliative care and end of life care. It can help you understand what matters to a patient or the people supporting them, support shared decision-making and build trust.
This page has tips for having honest, compassionate and effective conversations. It also includes guidance on discussing prognosis and uncertainty.
Key points
- Every patient is different. Their communication preferences, priorities and needs may change during their illness.
- Try to tailor communication to the patient and the people supporting them.
- Have open, honest and compassionate conversations to help build trust.
- Understand that emotional distress can affect how people understand and remember information.
- Be open about uncertainty and signpost to support when talking about prognosis.
- You may not have much time to communicate. Use your clinical judgement and understanding to focus on what’s most important.
Having sensitive conversations
Sensitive conversations are a part of palliative care. You might need to talk about:
- changes in someone’s condition
- treatment decisions
- planning for future care
- worries about dying
- uncertainty about the future (see Communicating an uncertain prognosis below).
Prepare for the conversation
- Reflect on what you already know about the patient’s communication preferences, priorities and needs.
- Make sure you have the information you need.
- Choose an appropriate place, if possible.
- Think about who should be there. It may be family, friends or other healthcare professionals.
- Allow as much time as possible for the conversation and any questions.
Start the conversation
At the start of the conversation, check:
- that it’s still a good time to have the conversation
- what kinds of information people feel comfortable discussing
- whether they have prepared any questions and the best time to talk about those – for example, at the start or end of your conversation.
Find out how much information the patient wants
Some patients value honesty or want detailed information. Others prefer less detail or do not want to know certain things at all. Check:
- how much information they would like
- whether they want those close to them involved
- whether there are topics they do not want to discuss yet.
There is no single approach that works for everyone. Be guided by the person's needs, preferences and how ready for the conversation they are.
Find out what the patient already knows
Explore what the patient understands about their illness. You could ask:
- "Can you tell me what you understand about what is happening at the moment?"
- "What have you been told so far?"
- "What concerns do you have?"
Share information clearly
Patients often get a lot of information. It can be hard to take everything in. Try to:
- use plain language
- explain unfamiliar or medical terms
- give information in small chunks
- offer to repeat information
- give information in a format they prefer – for example, written information or a video
- explain what will happen next.
Your language and communication skills
Good communication is not just about giving information. It is important to:
- ask and encourage open questions
- listen carefully
- pay attention to the patient’s body language
- check that the patient, and the people supporting them, have understood everything correctly
- respect if somebody does not want to talk
- recognise when someone may need a break.
Communicating when wearing personal protective equipment (PPE)
Personal protective equipment (PPE) can make communication harder. It may also feel worrying or impersonal for patients and the people supporting them. You can help by:
- explaining why you need to wear PPE
- introducing yourself and speaking clearly
- wearing a name badge with a large font size.
Considering social and cultural needs when communicating
Someone’s culture, faith, spirituality, social experience and more can shape their communication needs and expectations. It may affect:
- how much a patient or the people supporting them want to know
- their decisions or preferences about care
- what’s most important to them.
Some people may talk openly about these things. Others may feel it’s private or be less likely to talk about it as part of usual conversation.
It’s important not to assume anything and be guided by the patient and the people supporting them. It’s OK to ask questions – if you get something wrong, you can apologise and move on.
Supporting patients experiencing emotional distress
Being diagnosed with a terminal illness and having conversations about care can be distressing for patients and the people supporting them. They may feel anxious, scared, overwhelmed or angry.
Emotional distress or anxiety may make it harder for someone to express what they are thinking or feeling. You can help by:
- providing a calm and private environment
- listening without judgement
- giving them time to talk
- acknowledging their feelings
- avoiding the urge to immediately solve problems
- arranging another conversation if they are too distressed or tired.
Supporting patients who have specific communication needs
Some patients may need extra support to communicate. This might be because of:
- hearing loss
- sight loss
- a learning disability
- dementia
- speech difficulties
- language differences.
Communication needs can affect how you share information and how your patients understand the information. They may also affect how patients express themselves.
Communicating an uncertain prognosis
Communicating about prognosis is a normal part of palliative care. You cannot be certain about the future, so this often involves discussing uncertainty.
It may feel hard to have a conversation without definite answers. But it’s important to talk about it with your patients and the people supporting them.
There is no single ‘right way’ to have a conversation about uncertainty. In this section, we share tips that you can use alongside your knowledge of your patients.
What is an uncertain prognosis?
An uncertain prognosis means there is uncertainty about how an illness may progress or what may happen in the future.
This is expected in palliative care, especially when someone has a complex illness or more than one serious health condition. You cannot always predict what will happen or when it will happen.
Why uncertainty can be difficult
Patients and the people supporting them often want information about the future. You may worry about discussing uncertainty in case you upset or lose trust with your patients. And you may feel less confident discussing it because you do not have all the answers.
But people often prefer open and honest conversations, even when there are no definite answers.
Talking about uncertainty openly and compassionately
The tips we’ve shared on this page can help you prepare for the conversation (see Having sensitive conversations above). This includes tailoring the conversation depending on how someone needs or likes to be communicated with, and checking that they understand what you say.
When discussing uncertainty, you should also try to make it clear:
- what is known about the illness and prognosis
- what is uncertain about the illness and prognosis
- what you will never know or cannot predict about the illness and prognosis.
It’s also important to avoid giving false certainty. For example, talk in broad terms like ‘weeks’ or ‘days’, rather than giving a specific timeframe.
It can help to acknowledge uncertainty directly. You could say something like, "Nobody can know exactly what will happen next. But we can talk about the different possibilities and how we can support you."
Normalising uncertainty
Some people find it helpful to know that uncertainty is a normal part of serious illness. Helping patients understand this can make uncertainty feel more manageable.
For some people, not knowing what might happen can be upsetting or scary. They may feel alone. It can help to explain the support people can get from their healthcare team. This may make people feel safe and supported, even with the uncertainty about the future.
Helping people feel supported despite uncertainty
People may need more than one conversation. It can help to:
- offer follow-up discussions
- give them a named contact, if possible
- encourage them to write down any questions, to bring to the next conversation
- document conversations clearly
- share agreed information with their wider healthcare team
- check that messages are consistent.
Clear support and ongoing communication can help people feel safer despite uncertainty.
Planning for different possibilities
Even when the future is uncertain, planning can help the patient and those close to them understand what support they need or may need.
You could help the patient plan for a range of possibilities, including what can be done now. Your conversation could include:
- what support is available now
- what matters most to the patient – and what kind of care will help them with this
- who to contact with questions
- what decisions you may need to review later.
Support for yourself
Good communication can be rewarding, but it can also be emotionally demanding. You may find it helpful to:
- attend training, if it’s offered
- reflect on difficult conversations
- talk to colleagues
- ask your manager for support
- access professional support when needed.
Health and social care professionals may find conversations about dying emotionally challenging. This may be especially true when they relate to experiences in their own lives. If your feelings are affecting your work or personal life, it's important to get support.