Practical considerations including difficult conversations

Conversations about palliative care pose multiple challenges for patients, families, and clinicians. This chapter emphasizes the critical role of relationships in communication, highlights common practical challenges that arise in communication about palliative care issues, and proposes specific strategies for addressing them. Examples of language that expresses key clinician interventions is included. Patient-related communication challenges include dealing with anxiety, denial, anger, and grief and sadness. Approaches to family communication challenges focus on the desire to protect the patient, unexpressed grief, and unrealistic expectations, while those related to the clinician include attachment and grief, and discussing prognosis. The role of patient and family preparation, fostered through early, direct, and gentle conversations, is emphasized as a key practice that supports coping and adaptation. Clinicians are conceptualized as supporting patients through attention to the patient and family as persons, the use of skilful interpersonal communication, authenticity, and a commitment to ongoing self-reflection and flexibility.