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A,B,D,C,Es of Good Communication

Adapted from NHSBT’s Deceased Donation Course for Intensive Care Medicine Trainees, which has provided end of life communication training to over 350 delegates and faculty. Download.

Accuracy #

  • say truth, admit if you don’t know
  • it is ok to mention resource constraints and its decision impact

Brevity #

  • don’t fill the silence with your voice
  • in grief thinking slows, even on the phone allow silence
  • listen and give time for questions, “What questions do you have?

Clarity #

  • use unambiguous language, simple non-medical words
  • “can’t save, going to die, dying, won’t suffer”

Delivery #

  • structure as a narrative - warning shot (sets scene), circumstances (explains reasons, telegraphs decision), decision then silence
  • use appropriate non-verbal technique, if phone tone of voice

Empathy #

  • explicitly state your sympathy “I am so sorry” “it is awful”
  • give comfort

#

Additional Hints

  • If an ethical framework was used to guide the decision, use the identified facts and relevant outcomes to help communicate the reason and decision and aid documentation.
  • Think of the When (right time), Who (right people), Where (right place), What and Why (right content), How (right structure, right delivery).
  • Prioritise trust (listener trusts your judgement) over knowledge (listener has a detailed understanding of the facts and reasons).