Along with the control of painand symptoms, and interdisciplinary teamwork, the adequate use of communicationskills and interpersonal relationships constitutes the triad foundation thatsustains palliative care. In situations of uncertainty, pain and suffering,relationships are re-signified and contact with people, either with relativesor healthcare professionals, starts to represent the essence of care thatsustains faith and hope, supporting the experience of difficult moments.First of all, while assistingmy client, I used active listening strategies which are powerful therapeuticinterventions. It involved ways of listening, giving full attention, expressingempathy, and responding to another person that improves mutual understanding.
People’s way of thinking, seeing, hearing, and interpreting the world isinfluenced by their beliefs, values, fears, and social and culturalbackgrounds. Active listening is best done without interpretation orevaluation. Itwas of paramount significance to involve my client in facilitatingconversations which included open-ended questions that allowed my client theopportunity to describe and express her feelings, thoughts, and concerns morefully (examples: “How are you feeling today?”, “What has been worrying youmost?”, “How have you been coping with these experiences?”, “I understand thatyou have some questions and concerns about your care.
Can you tell me moreabout that?”, “How do you see things going from here?”)Clarifying responses were alsoused in order to get a better understanding about the facts and my client’sfeelings, attitudes, beliefs and values (example: “Can you give me an exampleof what you are talking about?”, “Tell me more about …”, “As you were talking Inoticed … in your body language. I am wondering if you are feeling/experiencing…?”)Besides, while leading aconversation I used paraphrasing and summarizing. It helped my client understandthat she was being listened to and her experiences are taken into account. Italso provided an opportunity to get further clarification (example: “What Ihear you saying is that you have been experiencing … which has been making youfeel … Have I understood that correctly?”, “What would be most helpful? Isthere anything else you need?”).As I have noticed, nonverbalcommunication played an important role in the context of palliative care. Itgoes without saying that how people communicate is rooted in cultural andsocial traditions, values and beliefs. Observing my client’s body language,posture, gestures and facial expressions provided clues to her feelings,emotions and capacities for coping.
When communicating withpatients and relatives about incurable and life threatening disease, I gaveattention to the environment and the physical comfort of all concerned. Forinstance, standing in a corridor or a waiting room is unsatisfactory foreveryone. Taking relatives to a “quiet room” to discuss painful and difficultissues has the advantage of signaling the importance of the meeting and thefact that the news may be bad. My client, however, preferred to be in her ownbed space, with the illusion of privacy given by drawn curtains. This isbecause the bed and surrounding space is the client’s territory, where she feltmost in control.
