The ability of a good communication with the patient and with relatives it’s an important clinical skill in oncology and it’s one of the most required tasks for a healthcare professional. The purpose of the course “End-of-life conversations and bad news’ communication in oncology and hematology” it’s to educate the operator to communicate “bad news” during the patient’s disease and to face the “end-of-life conversations”, to support the patient during the decision process through an open and loyal communication.
The course, helded in Rome the 23-24 of October, it’s insertend into the project of the Healthcare Ministry “Diseases Prevention and Control National Centre (CMM” also called Confine (Border): evaluation of mental well-being through the communication improvement in oncology and the end-of-life conversations.
Many interventions by the guest professors, like the one of Maria Giulia Marini, director of the Healthcare&Well-being area of ISTUD Foundation, with an essay entitled “Narrative medicine, a new paradigm to create well-being”.
At the following link it’s possible to wathc an interesting report of the FuoriTG of Rai3, connected to the event, entitled “Medicine: humanization of healthcare“.
Carola Traverso spoke about Therapy of Dignity; Therapy of Dignity is born in Canada, in end-of-life care, but it is applicable in any context. It is the therapy of dignity that helps to give a meaning of the continuity of the self as unique human being, even in these last days of life. The end of life, in fact, disrupts all the certainties and roles of the dying person: we are faced with the collapse of the role, until few days before, for instance, a person was the head of the family, the head of an enterprise, and with the therapy of dignity, the role is restored with a design in the last bit of life. There is the legacy. How? In a short time – one week, two weeks, a life balance, with the most beautiful and significant moments, the messages and words left to those who remain, left to those who ask questions with dignity and delicacy to the patient. Then a booklet is prepared, which goes into printing and that the patient offers to his chosen people. The therapist’s role is to be there, to listen, to gather, not to judge … to see things in a different light … to communicate to those whom are most important.
The whole thing is from Max Chocinov, Canadian psychiatrists, perhaps the cause is a study published on The Lancet on euthanasia and end-of-life choices: we are in Holland. In 57% people demand euthanasia as a loss of dignity, compared to only 3% who asks euthanasia for pain. Of course this study has a great bias because it is only the point of view of doctors and not of patients: but the data push us to think about how important the connection between Role and Dignity is.
Chocinov has developed the ABCD of dignity:
As Attitude, (Listening, No Prejudice, No Reading Reality with Our Filters). The way the patient feels, he/she is being seen by the physician impacts on the dignity … for the patient, the physician is a mirror; if I see that the patient has a fatal illness, the carer can convey the fact that he is already dead. What to do? A conscious effort to become part of our reflection. It may be that our attitude towards the patient is based on something that has to do with my own experiences and fears …
B as a Behavior; good Behaviour. Kindness and respect. Make it clear that we are dealing with the person and not just the disease. It’s a matter of quality of time, not anymore quantity of time. Just a phrase, a gesture: smiling, greeting, looking at the face, shaking hands, caressing, asking “how it is”, finding the beautiful detail (the positive side), being curious about the life of the other and his/her emotional thoughts, giving time, physical contact of hands without gloves with respect to the personal space of the person, valuing compliments, recognizing the social role, guaranteeing the physical look of the person, respecting privacy, explaining the actions you are doing, practicing silence, respectful use of the cell phone, and ask to respect the self determination of the patient.
C as Compassion, Compassion, the most appropriate word than empathy at this time.
D as Dialogue, Dialogue, not to work in the darkness, not to write things that the patient would never want.
