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Palliative cancer care - general issues - Management
What communication issues are important?

  • Health and social care professionals should have the skills to communicate effectively with the person, their carers, and each other. Those who must communicate particularly complex or distressing information should have enhanced skills, or be supported by someone who has those skills.
    • Peoples' preferences regarding involvement in making decisions about their own care should be assessed on an ongoing basis.
    • Peoples' and carers' needs and preferences for information should be assessed on an ongoing basis, and the provision of materials tailored accordingly.
  • Suitably trained and skilled interpreters should be available for people who may otherwise find it difficult to communicate in their preferred language.
  • The Gold Standards Framework also includes advance care planning and has developed an advance statement of wishes template to support discussion and recording of a person's preference for place of care. For more information, see www.goldstandardsframework.nhs.uk.
Clarification / Additional information
  • The person should be offered the opportunity to discuss topics which are important to them at that time, for example:
    • Treatment options and preferences.
    • Disease status, progression and estimated prognosis.
    • Social implications (e.g. work, income).
    • Issues relating to those important to the person (e.g. partner, family).
    • Spiritual and religious issues.
    • Advance care planning issues, including preferences, hopes, and wishes (e.g. preferred place of care and issues around dying, including cardiopulmonary resuscitation, and whether they have any expressed views about organ or tissue donation). If advance care plans are made, they need to be reviewed and updated as the person's situation or views change [GMC, 2010].
      • The NHS End of Life Care Programme discusses advance care planning and documentation of the wishes of people with a life-limiting condition, including advance care plans, statements of wishes and preferences, and advance decisions. For more information, see www.endoflifecareforadults.nhs.uk/eolc [End of Life Care Programme, 2007].
      • The Gold Standards Framework also includes advance care planning and has developed an advance statement of wishes template to support discussion and recording of a person's preference for place of care [Gold Standards Framework, 2006b]. For more information, see www.goldstandardsframework.nhs.uk.
      • The General Medical Council's guidance for doctors, Treatment and care towards the end of life: good practice in decision making has more detailed information regarding issues of advance care planning, advance requests and refusals for treatment, recording and communicating decisions, and discussions about whether to attempt cardiopulmonary resuscitation [GMC, 2010].
  • Information should be given verbally to the person and their family, but written materials may be useful for some.
    • It is not recommended that children be asked to interpret for parents or other family members [NICE, 2004].
    • A clinician may wish to offer a palliative care patient a written record of consultations they have had with them.
  • Effective communication with other healthcare professionals is also very important. This enables professionals to:
    • Exchange information.
    • Plan interventions.
    • Share responsibility for the person's care.
  • Documentation, especially using multidisciplinary records and clinic letters, facilitates communication between professionals [Doyle et al, 2004].
  • An example of a multidisciplinary record is the Liverpool Care Pathway which offers a framework for caring for people at the end of life. For further information, see www.mcpcil.org.uk/liverpool-care-pathway.
Basis for recommendation
  • This recommendation is based on guidance from the National Institute for Health and Clinical Excellence [NICE, 2004], expert opinion from palliative care literature in a textbook [Doyle et al, 2004], and General Medical Council guidance for doctors, Treatment and care towards the end of life: good practice in decision making [GMC, 2010].
    • Most people wish to know their diagnosis and what is happening with their treatment and disease [Faulkner, 1998].
    • Realistic hopes and aspirations can only be achieved by honest discussions [Doyle et al, 2004].
    • Attempts to protect people from the reality of what is happening to them can lead to inconsistent messages being given by different members of the healthcare team [Doyle et al, 2004].
    • Establishing and documenting a management plan in advance can help to ensure that a person's wishes and preferences about treatment can be taken into account, including a Do Not Attempt CPR (DNACPR) decision, if appropriate [GMC, 2010].

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