How do we talk about serious illness?
Sep 14, 2018
Photo: Dr. Patricia Strachan
It’s not surprising that health care professionals can first find it hard to discuss declining health and the possibility of death with patients. It’s an emotional subject.
Surprisingly, though, even after years of experience, and hundreds of encounters, many doctors, nurses and other clinicians still feel ill-prepared to deal with the subject.
However, that could change with better training, says nursing professor Dr. Patricia Strachan. “There is a growing trend in the health profession to help nurses, doctors and other practitioners to get more comfortable with difficult conversations. There’s a lot of money and time being spent right now on post-licensure serious illness communication education.”
Over the past year, Strachan has been part of workshops to promote the art of “serious illness conversations” (SIC for short). Attendees include physicians, nurses, physiotherapists, occupational therapists, and paramedics. She is now turning towards helping to prepare student nurses, with support from a grant from the McPherson Institute.
“Research shows that clinicians and students really struggle with this. We could do a better job in our undergraduate education to prepare our nursing students for what they are going to encounter,” says Strachan.
“The Ariadne Lab is a group that formed out of Harvard and Boston Women’s hospital and they have developed a Serious Illness Conversations Guide and training program,” Strachan notes. Some of the language in that original training was more suited to physicians, so last year Strachan worked with a group from British Columbia and modified the workshop material so that the language would be more relevant for other health professionals. She’s been using the material with health care professionals and it’s been well-received.
“We will be taking that workshop and testing it with students,” she says. “The grant will allow us to train some faculty facilitators and then implement the workshop with a group of about twenty nursing students at the beginning of their final term. Our plan is to get feedback from them about the suitability and if they use it in practice.” Attendees will learn by engaging in role-playing with standardized patients.
If the students find the workshops useful, the training could be rolled out to all final year students in the BScN program at McMaster eventually.
The workshops teach practitioners “how to begin to have the conversations and how to really be present for people,” says Strachan. “It is about how to listen to and explore patients’ beliefs, fears, wishes about the future and their understanding of their illness and its implications. We offer some words and phrases, but it’s not scripted. It’s really about listening and promoting earlier conversations so that care is consistent with a patient's values and goals."
Strachan P, Pierazzo J. Engaging nursing students in serious illness conversation training. McPherson Institute (ELAP grant). $3,164. Aug 2018- Mar 2019