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).