Answering Difficult Questions

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Answering Difficult Questions Some thoughts

• Ciara Savage, Palliative Care Social Worker.
• 18th September, 2014

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Why is it so hard?

• personal feelings
• helplessness
• fears we hold
• awkwardness
• the environment
• bearing witness to pain

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Palliative Care and End of Life Care

• touches, pervades and provokes primeval fears
  and feelings.
• (McSherry, 2013)

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Our Fears

• What energises them?
• WISE FEAR it is scary
• LEARNING how to notice (in our patients and
  ourselves)

uncertainty
unknown
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DIGNITY

• Actioning Dignity
• otherwise it remains rhetorical
• (Magee et al, 2008)

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Dignity
CULTURE
ENVIRONMENT
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Dignity of Personal Identity

• Integrity, Autonomy, Inclusion
• shapes and preserves us.
• Our actions, attitudes and behaviours can either
  preserve or compromise our patients Dignity.

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DIGNITY

• Disease, illness can strip Dignity away,
• Leaving patients vulnerable exposed.
• Our Role to safeguard and preserve Dignity

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ABCD of Dignity Conserving Care (Cochinov,2002)

• Attitudes
• Behaviours
• Compassion
• Dialogue

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EMPATHY

• Einfuhlung (Lipps, 1880s)
• consideration of another persons feelings and
  readiness to respond to his/her needs without
  making his/her burden ones own (Szalita, 1976)
• a balanced curiosity leading to a deeper
  understanding of another human being (Bellet
  Maloney, 1991)

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EMPATHY

• Recognising presence of strong feeling
• Pausing to reflect on this
• Stating your perceptions on what has been
  described
• Legitimising these feelings
• Respecting effort to cope with difficulty
• Offer of support

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Emotional Attunement

• The point of Empathy
• to focus attention on the patient (not on
  introspection)
• Need not be awkward or exhausting

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• Skillful Attunement
• reading non-verbal cues, tone of voice, body
  language.
• use in ordinary clinical and non-clinical
  interactions

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When the question is asked

• our patients take a chance on us.
• How we respond is critical.
• Ground our response honouring the patients
  personal dignity, using skills of empathy and
  emotional attunement.

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Simple Ideas

• Take a breath dont rush it
• Avoid the temptation to placate
• Really listen what is actually being asked?
• why is it happening now?
• why am I being asked?

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Communicating in stressful circumstances

• HOW?
• Use natural strengths but have awareness of
  limitations
• KNOWLEDGE
• (translate)
• STYLE using repetoire, skills
• GRACE feel, generosity of spirit

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Using Questions Effectively

• Broad, Open Encourages story/ narrative
• (How, what, Tell me)
• Open Directive Targeting specific issue/point
• (How did you feel when you heard that?)
• Directive Important when seeking factual
  information. (Where is the pain?)
• Closed When you need a YES/NO Are you sleeping?

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Pitfalls to Avoid

• Leading Questions
• Can assume an answer, or restrict expression. (I
  expect you were worried)
• Multiple Questions
• Without pause for response
• Premature/False reassurance
• Need to explore fully
• Normalising
• Be careful in use

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Responding to Anger

• Speak to FEAR not to ANGER
• (Cancer Tales, 2002)

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Diffusing Anger

• Acknowledge
• Invite explanation of cause
• LISTEN to story
• Focus on THEIR stress/feelings
• Apologise if appropriate
• Clarify if appropriate
• Negotiate a solution

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Family Focus

• Helping families understand End of Life Symptoms.
• Specific Information
• Reduces Anxiety and potential misunderstanding

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becoming a,

• Fellow Traveller
• (Holloway, 2010)

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References

• McSherry, Wilf, Dignity in end of life care,in
  Spirituality and End of Life Care, Gilbert, P
  (ed.)2014 Pavillion
• Cancer Tales, (2002) also online learning
  resource www.cancertales.org
• http//realbalance.com/the-role-of-empathy-in-heal
  thcare/Print
• Charon, Rita Narrative Medicine AModel for
  Empathy, Reflection, Profession, and Trust, JAMA,
  2001286(15)1897-1902
• Moss, Bernard, The Caring Professions (Ths Social
  Worker)in Spirituality and End of Life Care,
  Gilbert, P (ed.)2014 Pavillion