Difficult conversations have a crucial role in effective care planning

According to the General Medical Council’s report, The state of medical education and practice in the UK 2016, doctors at all levels are feeling under pressure and in need of support. Pressured work environments can have a negative impact on professional standards and on the wellbeing of doctors. The level of dissatisfaction among doctors seems to be higher than ever before. Furthermore, 12% of GMC cases leading to sanction or a warning in 2011-2015 related to some form of communication failure.

It’s heartening then to read the latest Care Quality Commission Adult inpatient survey 2016 report which indicates that there have been small, but statistically significant improvements in a number of areas, compared with results dating back to previous surveys.

One improvement is the perception of the quality of communication between doctors and nurses and their patients. However, the results also indicate that some areas have been less positive, including patients’ perceptions of being involved in decisions about their care and treatment. 

This finding is particularly pertinent when it comes to care planning at the end of life. Good planning with an emphasis on clear communication and an understanding of the relevant legal issues is essential for high-quality care, particularly for discussions around serious illness and end of life care.

The NICE quality standard for adult end of life care remains a useful benchmarking tool for all settings in which care is provided by health and social care staff to adults approaching the end of life. Both communications and care planning are key quality markers. 

Professionals play a central role in initiating conversations with people who are nearing the end of their lives. Our role is to recognise the blocks and challenges in having essential conversations and to develop the confidence and internal resilience to start a conversation, and do it really well. As clinicians, the quality of our care is directly related to the quality of the conversations we have with our patients and those close to them.

We all need to refresh our communication skills from time to time. Improving knowledge, skills and confidence in having effective and compassionate conversations can in turn help our own wellbeing and personal resilience. 

Telling someone that they are seriously ill or even dying is never easy. By improving our skills we can get these conversations right for our patients, their loved ones and ourselves.

Difficult Conversations GMC-endorsed End of Life Care Planning and Communication Skills Masterclass provides training for professionals aiming to master compassionate and effective care planning and communication at the end of life. 

Dr Catherine Millington-Sanders is Co-Founder and National Clinical Lead for Difficult Conversations.