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78 Chapter 7
There are a wide variety of CST models and approaches.
These range from verbal or written feedback, video, or
audio recordings of simulated or real encounters, observa-
tion of practice, small group or one to one learning as well
as being incorporated into degree or diploma studies, short
sessions under one hour, a few hours, one, two, three, five‐
day workshops, and the use of actors as simulated patients
[6, 29, 30]. CST can also be discipline or role specific,
multi-disciplinary, have a focus on E‐learning or blended
learning (face‐to‐face training and online education) [6].
CST should foster:
self-awareness and situational awareness related to emotions,
attitudes, and underlying beliefs that may impact communi-
cation, as well as awareness of implicit biases that may affect
decision making. [29, p. 42]
There is evidence that CST helps practitioners to be less
likely to give facts only without individualising their
responses to the patient’s emotions or offering support [6].
However, the evidence remains unclear if the effects of
CST are sustained over time, if consolidation sessions are
necessary, which types of CST programmes are most likely
to work and the benefits of CST on practitioner burn out
[6]. Furthermore, patients and families are infrequently
involved in developing or evaluating training programmes
[31] and this should be addressed in the design and evalu-
ation of CST programmes.
Facilitative Communication Skills
Facilitative communication skills are conversation cata-
lysts with a variety of specific behaviours and characteris-
tics [1]. They include conveying interest in the conversation
and person through verbal and nonverbal behaviours e.g.,
physical position, facial expression, not being distracted.
Also relevant is clarifying the purpose of the conversation
e.g., what shall we start with … today we are … what do you
want to discuss? Consider the tone, speed, volume, and
pitch of your voice (paralanguage), language (English as
first language or not as well as literacy), cultural norms for
Active listening or giving the person your full attention
and listening empathically can provide an avenue for
expression and reassurance [24]. The benefits of facilitative
behaviours, attitudes, and traits of; empathy, genuineness,
respect, unconditional positive regard, and reflexivity reg-
ularly feature in the communication skills research litera-
ture [10]. Sensitive truth telling, balancing hope and
honesty is also present [25]. Clinicians are valued who
listen, show empathy and honesty, encourage questions,
clarify, and negotiate individual’s information needs and
level of understanding, as well as take a personalised
approach to a persons’ individual information preferences
and differences in reactions to prognostic communication
[25, 26]. Kathryn Mannix [27] reminds of the importance
of the relevance of getting
alongside another person and gain their confidence and
trust, to begin the process of discovering their current posi-
tion. [27, p. 4]
Furthermore, while the terms compassion, sympathy, and
empathy are often used interchangeably in clinical prac-
tice, there are reminders to consider each construct sepa-
rately [28] (Figure 3).
Communication Skills Training and
Education
An individual’s communication skills are not innate or
fixed characteristics [29, 30], and good interpersonal skills
alone are not a substitute for strong health-care communi-
cation [29, 30]. Most approaches to teaching communica-
tion in health care incorporate cognitive, affective, and
behavioural components [6], and ongoing communication
skills training (CST) plus reflection is necessary to transfer
(and sustain) skills in practice [31, 32]. CST should be
based upon sound educational principles including reflec-
tive practice with the opportunity to practice skills, directly
observe patient encounters, use of experiential, interactive
learning, and role-play scenarios which reflect the specific
nature of the actual real-life practice interactions [29–31].
Sympathy: an unwanted, pity-based response to a distressing situation, characterized by a lack of understanding and self-
preservation of the observer.
Empathy: an affective response that acknowledges and attempts to understand individual’s suffering through emotional resonance.
Compassion: enhances the key facets of empathy while adding distinct features of being motivated by love, the altruistic role of the
responder, action, and small, supererogatory acts of kindness.
Figure 3 The constructs of sympathy, empathy, and compassion [28, p. 437].
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Conversations and Communication 79
Hearing and Sight Loss
Few studies have examined hearing and sight loss in palli-
ative and end-of-life care with some evidence that people
with sensory loss report less satisfaction with communica-
tion and symptom control [36]. Reducing background
noise, assessing the environment, increasing visual signage,
considering sign language, visual/audio aids and providing
sensory competence education to staff about the commu-
nication needs of patients or family members with sensory
loss is important [36, 37].
Dementia
For people living with dementia, the
ability to communicate with others (expressive aphasia) and
to receive the communication of others (receptive aphasia)
becomes increasingly difficult as the condition progresses.
[38, p. 6]
Considerations of loss of capacity to make decisions in the
future, imagine and envisage a future self can be problem-
atic [38, 39]. Decision-making may be left to families and
practitioners when the person does not have capacity to
decide for themselves [38–40]. A recent applied model for
making decisions towards the end-of-life [40] shows
promise providing a framework for conversations and sup-
porting decisions by carers. Figure 4 illustrates some
conversation considerations for people living and dying
with dementia.
Intellectual Disability
Chapter 19 (Palliative Care for People Living with Mental
Illness and People with Intellectual Disabilities) covers in
detail this specific consideration. Noorlandt et al. [42]
however, point out that people with intellectual disabilities
are often not actively involved in end-of-life decision-mak-
ing processes due to communication challenges, assump-
tions of lack of capacity, and that they will not be able to
carry out difficult conversations. People with severe or
profound disability are also more likely to need support in
conversations including different types of written material
or ways to facilitate communication. A recent shared deci-
sion-making conversation aid developed through a Delphi
panel shows promise with four themes, who are you, ill-
ness/end-of-life, making choices, and application [42].
that person or the cultural background they belong to as
well as individual sensory needs (e.g., sight, hearing,
speech, touch). Checking joint understanding of the
purpose or goal of the conversation is important, as are
open questions, inviting the person to express their con-
cerns, questions, or thoughts e.g., how are you today?.
Questions that focus on specific aspects e.g., can you tell
me what has been happening in the last few … or you men-
tioned earlier about … can you tell me more? help to facili-
tate conversations.
Other characteristics include a psychological focus on
questions rather than just physical emphasis e.g. You men-
tioned …., as well as empathic statements and prompts to
encourage further expressions or questions e.g., What I’m
hearing is … have I got that right?, nods, umms, say more
and go on. Screening questions enable exploration to
ensure all concerns have been mentioned e.g., is there
something else/anything else that we should discuss … what
have we not talked about? Prioritising questions help
maintain a focus on the individual e.g., what is the most
important thing for you right now? or you mentioned several
things … what would be most helpful to start with?
Summarising the discussion is useful to conclude and sign-
post to agreed next steps.
The use of pauses and silence enable, encourage, and
facilitate the person to say more, clarify their thoughts or
express their feelings. Silence is an underused skill despite
there being evidence that connectional silences (pauses in
conversations of two seconds or more) are associated with
improved decision-making and patients’ quality of life
[33]. Basset et al [34] reminds that silence is an element of
care fostering a connection that goes beyond the power of
words. Silence has the potential to support therapeutic
communication by facilitating listening, bearing witness,
conveying empathy, and providing a consoling presence
[34]. Moreover, silence can indicate a mental shift from
doing something for the patient to a focus on being with
[35]. Silence is a purposeful intervention rather than
simply an absence of speech [34].
Specific Considerations
Not everyone is likely to receive good care because of diag-
nosis, age, ethnic background, sexual orientation, gender
identity, disability, or social circumstances [13]. It is not
possible to list all the considerations for every scenario or
group of people, however it is relevant to highlight a few
ones. The core principles of facilitative communication
remain.
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80 Chapter 7
Piers et al. [41] Russell [23] Harrison-Denning[38, 39]
Start early in the disease Be prepared for parallel advance care planning – or when
different members of the family or team are at different
stages of their thinking and actions
It may take longer to process
what you are saying – give the
person sufficient time to
respond
Evaluate mental capacity including
fluctuating capacity
Be person-centred. How does the person like to make
decisions, who else might need to be involved?
Adjust communication style and content
to the persons own level and rhythm
Consider the physical environment: noise, distractions,
and a temperature that is too high or too low can be
confusing
Ensure the space chosen to
have the conversation is quiet
and calm
Be aware and maximise upon
your non-verbal communication.
Use active listening
Focus on one question at a time
When is the best time of day to carry out conversations:
when is the person most alert and comfortable? Fatigue
or hunger may inhibit conversations
Face the person directly and make
good eye contact, ensure you give
every opportunity to understand
you are focussed on them
Do not see every conversation as a decision and
document-making one. Sometimes, the conversation is a
contemplative one – a time for the person to share what
matters to them, what is bothering them or what they
want to do next
Use short, clear sentences that
are free of clinical jargon. Use
language and words that are
familiar to them
Cover values, fears, and what is important
to the person, as well as specific decisions
Encourage the person to talk with their family or friends;
there may be important things they want to say to each
other
Find out what their values and
preferences are, what is
important to them, their history,
likes, strengths, beliefs etc.
Consider the role and importance of
those close to the person with dementia
including surrogate decision maker
They may or may not wish
their family carer/member to
be present; ensure you ask
When it is difficult or no longer possible
to communicate verbally, keep a
connection to the person
Be prepared for many conversations. This may be due to
short-term memory loss, fatigue, or the desire of the
person to talk about something that matters or worries
them. See multiple conversations as an opportunity to
connect and engage
Use other ways to
communicate if helpful, written
word, pictures etc.
Be attentive to their emotions, non-verbal
communication and their behaviour
Be opportunistic: sometimes fundamental care can trigger
conversations, for example reminiscence activities may be
the catalyst for someone to remember a funeral in the past
and think about their own, similarly helping someone
bath and dress can make them realise their increased
dependency on you and what that means for them
Do not be afraid of emotions such as tears or anger, see it
as providing them with a safe space to express themselves
The values, wishes, or care goals of the
person need to be documented, including
information transfer to other teams and
services
When appropriate, offer to help document decisions and
involve and inform others when relevant, such as the
multi professional health and social care team. Make sure
you know what documentation you use in your
organisation and that the documents that have been
produced make sense. Have a system to inquire again
about a person’s wishes and decisions to check they are
still what they want
End-of-life decision-making should be
implemented, including the use of the best
interests process, and consultation with the
people close to the person as well as
health-care practitioners needs to take place
Figure 4 Recommendations for conversations for people living with dementia.
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Conversations and Communication 81
Figure 5 Communication considerations. Adapted from Tackling Inequalities in End-of-Life Care for Minority Groups VCSE Health and
Wellbeing Alliance Project Group 2018 [46]
Gypsies, Roma, and
Travellers (GRT)
• Hospitals and hospices generally rely on written distribution of information. This shows a presumption about
literacy levels.
• Positive and clear communication (without the use of jargon, which can be intimidating) would change the
experience of hospital/end-of-life care.
• Families may be wary of disclosing their Gypsy/Traveller identity for fear of discrimination, but this means
that staff might not be aware that additional support might be required (e.g., access to literature).
• End-of-life rituals are very important to Gypsy and Traveller communities. Funeral poverty can also be an issue.
• There is cultural resistance to discussing end-of-life care or long-term illness in general.
• A negative experience with a hospice/hospital/service will be shared among the communities.
• Consider “The care I provide” and “The care I commission.”
Homelessness
• In view of uncertainty and complexity, shift the focus from trying to identify people at the end-of-life and
make the point at which someone’s health is a cause for concern the trigger for action [47].
• Parallel planning–incorporating uncertainty and promoting well-being, dignity, and choice.
• The importance of training hostel staff on communications skills and end-of-life care conversations.
• Hostel staff upskilling palliative care staff and supporting people experiencing homelessness.
• Consider “The care I provide” and “The care I commission.”
Lesbian, gay,
bisexual,
transgender (or
trans), queer people
(LGBTQ)
• Consciously engage and be visible in LGBTQ inclusive practice and language, education, policy, and practice
development and delivery.
• Make existing services accessible and inclusive.
• Consider “The care I provide” and “The care I commission.”
• It is highly recommended to read Recommendations to reduce inequalities for LGBT people facing advanced
illness [48]
Culture, Ethnicity, and Language
Consideration must be given to the different cultural,
ethnic, and linguistic needs of people as well as practi-
tioners confidence, knowledge, and skills in providing cul-
turally sensitive end-of-life care for ethnic minority
patients [43]. This can include accommodating different
beliefs about the sanctity of life, death, and dying, consid-
ering individual autonomy and family dynamics, language
difficulties, formal or family interpreters, understanding
spiritual and religious practices, the challenge of some
groups accessing the health system and the impact of
migration experiences [43, 44].
The use of formal interpreters is recommended. A 2016
systematic review regarding black and minority ethnic
groups report that family members (including children)
were often used as interpreters to deliver information
about prognosis, diagnosis, and assess symptom
management [45]. When professional interpreters were
not used, there was inadequate understanding about diag-
nosis and prognosis during goals of care conversations,
and patients had worse symptom management at the end-
of-life, including pain and anxiety [45].
The 2018 report, Care committed to me. Delivering high
quality, personalised palliative and end-of-life care for Gypsies
& Travellers, LGBT people and people experiencing homeless-
ness [46] provides recommendations to improve person-
alised end-of-life care for Gypsies and Travellers, LGBT
people and people experiencing homelessness. There are
several recommendations relevant to how and what conver-
sations may contain or how they are experienced (Figure 5).
Virtual Communication
Prior to the COVID-19 pandemic, telemedicine (e.g.,
video and telephone consultations) was still emerging as
part of routine palliative and end-of-life care [49], with
arguments that palliative care was “too high-touch to be
delivered via telehealth” [50, p. 17]. The pandemic identi-
fied the necessity and potential of virtual consultations,
assessments, and conversations. There are challenges e.g.
accessibility and preference disparities, logistical and tech-
nological barriers, as well as cultural and personal prefer-
ences. However, telemedicine enabled the reduction of
exposure risk to vulnerable patients, their families and the
https://t.me/med1917
82 Chapter 7
Figure 6 Communication resources examples.
AFIRM is an acronym which provides professional carers with a
framework to guide informal conversations and uses these as
opportunities to pick up on any underlying apprehensions or
queries the person with dementia (and/or their family member)
may have.
Acknowledge the person’s concern or questions.
Find out what the person knows about the condition.
Immediate concern(s) addressed by providing adequate
information within the scope of your work.
Respond to subsequent questions by providing accurate
information within the scope of your work.
Meeting suggested to discuss their concerns with significant
people [38, 39].
AMBER care bundle
https://www.guysandstthomas.nhs.uk/our-services/palliative-care
A hospital tool for managing uncertain recovery over the next
two months. It includes the development and documentation of a
medical plan, consideration of outcomes, resuscitation and
escalation status and daily plan revisiting.
Assessment
Management
Best practice
Engagement
Recovery uncertain
The emphasis on “clinical uncertainty” prompts health-care
professional awareness of often-overlooked patients [57]. However,
to be successfully normalised in clinical practice, the wider context
in which AMBER operates should be considered [58].
workforce as well as offering an effective, accessible,
acceptable, and cost-effective alternative to face-to-face
contacts [51, 52]. Helpful guides and resources being pro-
duced include:
Academic Health Science Network www.ahsnnetwork.
com/helping-break-unwelcome-news A variety of
resources.
Real Talk Training http://www.realtalktraining.co.uk
Giving news of a death to a loved one: Telephone call
checklist for health-care staff
Evidence based advice for difficult conversations
Prompt list for phone and in-person urgent conversa-
tions about withdrawing or withholding life-sustain-
ing treatments in UK critical care
A-Z index of digital flashcards covering a wide range of
topics www.cardmedic.com/flashcards
Royal College of Nursing Having courageous conversa-
tions by telephone or video during the COVID-19
pandemic www.rcn.org.uk
Stanford Medicine, Serious Illness Programme A
Resource for Conducting Conversations Virtually
http://med.stanford.edu/advancecareplanning
The University of Edinburgh Supportive and Palliative
Care Indicators Tool (SPICT): www.spict.org.uk
Talking with people over the phone.
University of Oxford, Department of Psychiatry
Helpful resources including animation and guide on
informing of a death over the phone. www.psych.
ox.ac.uk/research/covid_comms_support
Communication Resources
Self-awareness and understanding of one’s own communi-
cation skills enhance the confidence and competence of
clinicians in discussions. There are a variety of communi-
cation models and resources available drawn from expert
opinion, best practice, or the evidence base [32]. While
“one size does not fit all,” and skills used should be indi-
vidualised to each person and conversation, there is a
common emphasis on a person-centred approach which
explores their perspective, conveys visible empathy, in
both information giving and the hearing of their story, as
well as summarizes and plans at the end of the conversation
[32]. These resources can be used to help identity the need
for conversations or provide a guide for discussions
(Figure 6).
Conversation Trigger Cards and Tools
There are online and/or physical tools to trigger discus-
sions e.g., conversation cards, games, and website guides
(Figure 7), with emerging evidence that they do have a
place in advance care planning and end-of-life conversa-
tions [66]. The Dying Matters website https://www.
hospiceuk.org/our-campaigns/dying-matters hosted by
Hospice UK also has a number of useful resources as well
as local, regional, national, or international websites.
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Conversations and Communication 83
Calgary-Cambridge [53]
A generic model for structuring a consultation.
Initiating the session: establish initial rapport; identify reason for
consultation with open questions; listen without interrupting;
confirm and screen for further problems; negotiate agenda.
Gathering information: explore patient’s problems; open to
closed questions; listen attentively; facilitate patient responses;
pick up cues; clarify unclear statements; summarize periodically;
use clear questions; establish sequence of events; explore patient’s
ideas, concerns, expectations, and feelings.
Providing structure: summarize appropriately, signpost, use
logical sequence, keep to time.
Building a relationship: appropriate non-verbal behaviour;
develop rapport, use empathy, provide support; involve patient.
Explanation and planning: correct amount and type of
information; aid recall and understanding; shared understanding;
shared decision-making.
Closing and planning: forward planning; summary; final check.
Psychosocial Assessment and Communication Evaluation
(PACE)
An interventional tool that has the potential to improve
communication, information consistency, and family perceptions
of symptom control [59]. Commenced within 24 hours of
admission and continued use until discharge. A documented
script includes:
• Family details including key relationships
• Social details
• Patient Preferences
• Communication and information
• Any other concerns/issues
• Communication update to family
Five questions [60]
1. What is your understanding of your current health or
condition?
2. If your current condition worsens, what are your goals?
3. What are your fears?
4. Are there any trade-offs you are willing to make or not?
5. What would a good day be like?
PREPARED
Prepare for the discussion
Relate to the person
Elicit patient and caregiver preference
Provide information
Acknowledge emotions and concerns
Realistic hope
Encourage questions
Document
There is evidence that this model is helpful in communication
skills training [54].
Listen [27]
Opening the box
Towards change
Building bridges
Towards connection
REAL Talk
https://www.realtalktraining.co.uk
Resources supporting experiential and reflective learning,
focused on a range of communication problems and practices, for
trainees from a wide range of backgrounds [30].
Five Recommendations for communicating with patients or
family members about illness progression and end-of-life [61]
1. Ascertain patient or family member’s perspective before
offering your own.
2. Where possible, mirror the language of the patient or family.
3. Create opportunities to discuss the future.
4. Be clear about uncertainty.
5. Display sensitivity.
REDMAP Framework
www.spict.org.uk or www.ec4h.org.uk
A 6-step guide to future care planning conversations with people
whose health is deteriorating and their families, which can be
used in a variety of settings.
Ready—Expect—Diagnosis—Matters—Action—Plan
Figure 6 (Continued)
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84 Chapter 7
SAGE & THYME
www.sageandthymetraining.org.uk
A mnemonic that provides a memorable structure for
conversations.
Setting create privacy and a comfortable environment.
Ask about their concerns
Gather all the concerns
Empathy, respond sensitively
Talk, discuss their worries
Help, find out who can help
You, establish what they can do themselves
Me, establish what you can do for them
End the conversation
A promising model for improving communication skills when
working with cancer patients [55].
Shared decision-making using DECIDE from NHS Scotland
www.ec4h.org.uk
Define decision
Explain situation
Consider options
Invite views
Decide together
Evaluate Decision
Serious Illness Conversation Guide (SICG):
www.ariadnelabs.org/serious-illness-care
A structured conversation guide part of the Serious Illness Care
Programme from Ariadne Labs. Provides a framework to structure
meaningful, realistic, and focused conversations about a patient’s
wishes, fears and worries for the future with their illness [62].
Includes:
• Set up the conversation
• Assess understanding and preferences
• Share prognosis
• Explore key topics
• Close the conversation
• Document your conversation
• Communicate with key clinicians
There is evidence that SICG helps to promote patient-centred
health care that aligns with patient values and wishes [63].
Talk CPR
www.talkcpr.wales
Training tools to encourage conversations about CPR for people
affected by life-limiting and palliative illnesses.
The Second Conversation Project
www.rcplondon.ac.uk/projects/
second-conversation-improving-training-around-end-life-care-
conversations
Encourages junior clinicians to return to a conversation started
by their seniors. It gives patients, carers, and family members the
time and space to reflect on information they have received, while
providing doctors in training with a valuable educational
opportunity that builds their skills and confidence in handling
end-of-life care discussions. Of most value to newly qualified
doctors and worked well on wards where length of stay was
longer, and end-of-life conversations frequently happen [64].
University of Edinburgh and NHS Scotland: Supportive and
Palliative Care Indicators Tool (SPICT)
www.spict.org.uk
Identifies people with one or multiple advanced conditions who
are at risk of deteriorating and dying. It offers case-by-case
assessment and advice on communication and how to record
plans for holistic, palliative care needs. Use as a guide to recognise
that somebody has an advanced progressive illness, rather than as
a prognostication tool [14].
VITAL Talk [65]
www.vitaltalk.org
1. Serious illness communication skills training and resources
based upon three principles:Dealing with emotion is more
important than giving lots of information
2. Information is best delivered in small packets that start with a
headline
3. Patient values should be at the heart of medical treatment plans
SPIKES [56]
Originally intended as a protocol for breaking bad news.
Setting: includes privacy, involving significant others, listening
mode, and body language.
Perception: the “before you tell, ask” principle; you should glean a
fairly accurate picture of the patient’s perception of their medical
condition.
Invitation: check how much patient wants to know about
diagnosis and treatment; obtaining overt permission respects the
patient’s right to know (or not to know).
Knowledge: give information at patient’s pace using the same
language as them; “chunk and check.”
Empathy: listen for, identify, acknowledge and validate emotions.
Strategy and Summary: summarize discussion, give chance for
questions or concerns; clarify next steps.
Figure 6 (Continued)
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Conversations and Communication 85
Figure 7 Examples of conversation trigger cards and tools.
Fink Advance Care Planning CardsTM
Developed in the UK. Includes a deck of cards divided into four
categories (how I like to talk about things, who and what matters to
me, advance care planning/still to do, and as I die/celebrating my
life). Cards are used to start, share, or continue advance care
planning conversations. www.finkcards.com
Grave Talk CardsTM
A resource from the Church of England (UK) of 50 unique cards
for use in small groups, each with a thought-provoking question
to get the conversation started. Topics covered include: Life,
Death, Society, Funerals, Grief. Also used in death café scenarios.
www.chpublishing.co.uk/books/9780715147030/grave-talk-cards
Marie Curie Talkabout Conversation CardsTM
Developed in the UK. Conversation cards designed to help share
wishes and learn more about family and friends. www.mariecurie.
org.uk
Talking Mats
™
Developed in Scotland, an image-based aid to support people with
communication difficulties to communicate effectively about
things that matter to them. A Talking Mat has been developed to
support advance care planning and help people to think ahead
and plan for the future. www.talkingmats.com/category/
advance-care-planning
The Conversation ProjectTM
An initiative of the Institute for Healthcare Improvement
www.theconversationproject.org
Conversation startersTM
Conversation starters for advance care planning from Speak Up
(Canada). www.advancecareplanning.ca/resource/
conversation-starters
Dying to Talk CardsTM
Online card game developed in Australia (guided by Coda
Alliance’s Go Wish card game) to help talk about wishes and
preferences for care at the end-of-life. www.dyingtotalk.org.au/
card-game
Go Wish CardsTM
A deck of 36 cards developed by the CODA alliance in the USA to
help start end-of-life discussions. www.codaalliance.org/go-wish
DöBra cardsTM
Swedish adaptation of the GoWish cards www.dobra.se/en/
dobra-toolbox/dobra-card-game
My Gift of Grace or HelloTM
A conversation game (USA) with 47 Question Cards, and 32
Thank You Chips. Players have a chance to share their answers to
the same question, trading chips as part of the game play.
www.mygiftofgrace.com
Heart2Hearts: Advance Care Planning CardsTM
Developed in the USA, a deck of cards invented to provide 52
conversation starters about end-of-life health-care issues.
www.discussdirectives.com/heart2hearts-acp.html
The Conversation GameTM
Originally developed by the CODA Alliance (USA). Includes a deck of 36 cards and instruction leaflet. Objective is to be an easy and
entertaining way to think and talk about how you want to be treated if you became seriously ill. www.conversationsforlife.co.uk
Summary
Conversations matter in palliative and end-of-life care.
There are many resources, models, and frameworks to aid
practitioners in person centred discussions. One size does
not meet all and an individualised approach should always
be taken. As practitioners we have the responsibility to pay
attention to our skills, ability, competence in, and reflec-
tion on conversations in order to provide, facilitate and
enable the best possible palliative and end-of-life experi-
ence to people and those that matter to them.
References
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