Communication difficulties

Please be aware - this information is for healthcare professionals

There are many reasons why communication can be difficult in palliative and end of life care. Language barriers and existing issues such as deafness, confusion or condition-related issues can make it harder to communicate effectively.  However, because communication is such an important part of high-quality person-centred care, it is an area that should be considered carefully.

I don’t understand the patient’s language, what should I do?

This can be a difficult situation and it can be easy to cause offence if a calm approach isn’t taken. As a healthcare professional, there may be an expectation that you will understand what the patient or their family are saying, so it can be useful to learn key words or phrases from the patient’s relative or friend. Having them written out will allow you to point at them when needed.

You could also consider using pictures as a communication aid. Asking a friend or relative of the patient to translate may be helpful, but it’s important to be aware that they may not always translate exactly what you say, particularly if the conversation is difficult or sensitive. Where you can, plan ahead and organise a professional translator for difficult conversations rather than relying on someone close to the patient. The local hospice may have a list of people who are able to help.

Language barriers can be frustrating for both you and the patient, but try to remain calm and avoid speaking loudly. This will not help the patient or their family understand you. Some cultures have strict rules around inter-gender communication and it may not be appropriate for a woman to respond to a male carer directly. Also, there may be strict rules around touch, so offering your hand may cause offence.

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The patient is profoundly deaf but won’t or can’t wear their hearing aids. What shall I do?

 There could be a number of reasons why the patient is not wearing their hearing aids and it might be straightforward to resolve. You could start by checking:

  • if the batteries are dead
  • if the aids fit properly
  • whether the patient is able to put them in correctly (sometimes poor manual dexterity can prevent this)
  • whether they are on the correct setting
  • how the person feels about wearing them

Some people affected by hearing loss can lip read, so make sure you’re facing the patient when you’re talking to them. They may not realise how much they rely on this. You could also find out whether they use British Sign Language (BSL) or Makaton. If they do, you could find a ’speaker’ to help you communicate with the patient.  Another option is writing messages down, though you should consider how well the patient understands written English before doing this. 

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The patient is unable to speak, how will I understand what they want?

This can be a problem for people who have neurological illnesses such as motor neurone disease or multiple sclerosis. People who have head and neck cancers can also lose the ability to speak. There are a variety of communication aides available such as picture boards, portable voice output communication aids and iris recognition equipment that may help.

To access this type of equipment, it may be necessary to refer the patient to an occupational therapist or a speech and language therapist, as it is a highly specialised area. If you’re unable to refer patients, speak to your manager. Losing the ability to express thoughts and needs verbally can be one of the most frustrating symptoms of their condition, so it’s important to support the patient emotionally too. 

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How can I effectively communicate with blind and partially sighted patients?

There are a number of ways to ensure you’re communicating effectively with people who have sight loss.

It’s best to start by introducing yourself, even if you have met before. Depending on their level of sight loss, the patient may not recognise your voice straight away.

You should ask the patient how they like to be guided and allow them to take your arm, rather than you holding or grabbing theirs. Point out any steps as you approach them and say whether they go up or down. Mention any potential hazards that lie ahead and say where they are. It’s worth explaining the route you are taking too.

When guiding someone into a seat, place their hand on the back of the seat before they sit down, so they can orientate themselves.

You must also say when you have finished providing assistance and are leaving them - make sure they know where they are, where they are going and which way they are facing.

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I keep saying the same thing but I don’t seem to be understood by the patient. Why is this?

We all use words and terms in daily life that may not transfer easily to people outside our own circle. Listen carefully to the patient to understand the level you should pitch your conversation. Try to avoid using complicated language or being too familiar, as this may cause confusion or offence.

Consider whether there is another barrier preventing your patient from understanding you, such as dementia, confusion or a learning disability. Remember that when a person is distressed they might not hear what you’re saying or remember what you’ve said, so you may need to tell them things more than once.

You may find your questions or conversation are met with silence. Try not to be too concerned by this. Patients or their carers may be considering what or how to tell you something that is very important to them. If you try to fill the silence you may prevent them from being open and honest about their wishes or concerns. 

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Why is body language important?

We communicate with others around us through our body language without realising we are doing it. For example, folded arms may be seen as a barrier, while leaning forward slightly and facing someone will indicate that you are listening. Nodding occasionally can also demonstrate that you are paying attention.

It’s also important to be aware of the patient’s body language, particularly if they have trouble communicating, as it could indicate that they are in pain, distressed or uncomfortable. Things to look out for include:

  • facial expressions
  • body posture
  • gestures
  • eye movement

Some people are more sensitive to body language than others and it is important to think about how you are sitting and standing. Remember that personal space is very important to some people and always try to gain consent before touching someone as it may be culturally inappropriate or they may not like to be touched. This includes shaking hands as a greeting. In some cultures, people do not make eye contact with members of the opposite gender so do not be offended if this occurs.  

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Who else should I talk to?

  • A speech and language therapist
  • An occupational therapist
  • The patient’s GP
  • A district nurse
  • The specialist palliative care team
  • Education team

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Points to remember

  • Keep calm and try to be patient. You may find communication difficulties frustrating, but the patient is likely to be more distressed.
  • Ask the patient’s friends and family to help you. They may appreciate this as a way of being included their loved one’s care.
  • Be well prepared before your visit. Think about what you can take with you that might help to improve communication and whether you will need to organise a professional translator.
  • Avoid raising your voice. This can be upsetting and frustrating for your patient and their family.

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