TORONTO, Ontario-Communication in palliative care is vital for
two overlapping reasons, Robert Buckman, MD, said in his presentation
at the pain management in palliative care workshop.
"If you aren't able to communicate with your patients, you
can't find out how bad their pain is," he said, "and
if you can't find out how bad their pain is, there is zero chance
of your being able to relieve it effectively."
Dr. Buckman, a medical oncologist at Toronto Bayview Regional
Cancer Center, views communication as a set of practical skills
that health care professionals can learn and that can dramatically
improve their ability to assess pain and other factors impacting
on the patient's quality of life.
However, such skills are often difficult to teach. "It's
hard to explain your own personal skills and experiences to other
people," he said.
To provide a framework for teaching communication, Dr. Buckman
has developed a model known as SCANS-Setting, Communication Skills,
Acknowledgment, Negotiation, Summary.
Getting the setting right involves simple things, like sitting
down, turning off the TV, shutting the door, and drawing the screen
around a hospital bed. Maintaining eye contact is especially important,
he said, "except when the patient is crying or deeply distressed,
because in this situation, eye contact can be interpreted as aggression."
The most basic communication skill is silence: "When the
patient is talking, you don't talk," Dr. Buckman said. When
it is the professional's turn to talk, he advises use of the three
R's: repetition (picking up one word from the patient's
last sentence to use in your next sentence); reflection
("What I seem to be hearing from you is . . ."); and
reiteration (paraphrasing what the patient says).