On this page
- Leading difficult conversations
- The 5 steps to delivering bad news
- The key principles of leading difficult conversations
- Talking about death and dying
- Examples of difficult conversations
- Using technology to communicate
- Communicating through PPE
- Communicating with people who are recently bereaved
- More resources on difficult conversations
- How we can help
We understand that difficult conversations are made even more difficult by the coronavirus (COVID-19) pandemic. They may have to be shorter, through personal protective equipment (PPE) or over the phone. This can be stressful, before you even consider the conversation you’re about to have. On this page, we have included lots of useful resources to help you to have these discussions sensitively and confidently.
This short animation produced by the Irish Hospice Foundation suggests a 5-step approach to delivering bad news. It’s recently been updated in response to the coronavirus pandemic.
- Prepare yourself and the environment as much as you can.
- If possible, find a comfortable and private place to have this conversation.
- Before the conversation, think about how will you end it – what advice or referral for support can you offer the person? What professional (doctor, nurse, registrar for death) do you anticipate they will speak to next?
- Support yourself – who can you talk with to debrief?
- Start the conversation with a clear outline of what is going to follow.
- Show empathy and compassion throughout. Show understanding without claiming you can possibly fully understand.
- Find out some of what the person you are talking to knows, expects, and feels.
- At this point and not before, find out if they are with someone, or have someone to talk to afterwards.
- Bring the person towards an understanding of the situation – how things are, what has happened or is likely to happen.
- Use clear terms: either die, dying, death. If you wish to use gentler terms, make sure they can’t be misunderstood.
- If they cry, acknowledge with a soft tone of voice and express sympathy: I’m sorry. If they apologise for crying, reassure them it’s OK and understandable. If you can, avoid giving further information until they’re slightly calmer.
- Move towards ending the conversation – check they have understood everything and answer any questions.
- Offer words of comfort and tell them what happens next.
This is a summary of a blog by Real Talk training.
It is important to talk to patients and their families using clear, sensitive and effective language, particularly during the coronavirus pandemic.
The RED-MAP approach
RED-MAP is a 6-step approach to conversations about planning care, deteriorating health and dying. It is suitable for all care settings.
Can we talk about your care and what coronavirus might mean for you?
What do you know? What do you want to ask?
What we know is…
What we don’t know is…
What we are not sure about is…
What matters to you? What is important to you and your family if you get very unwell?
What we can do to help is…
This does not work/help…
Let’s make a plan for good care for you and your family.
Always refer to the person by name when talking with their family or a close friend.
If you’re talking with people by phone:
- check you have the right person
- ask if it is a good time
- speak slowly in shorter sentences
- check what’s been understood and how people are.
Ask for help and support from colleagues, senior staff or a specialist. Seek a second opinion, if needed.
RED-MAP is part of the Building on the Best programme in Scotland, funded by Macmillan Cancer Support.
We have produced some recordings of fictional telephone and Skype calls that demonstrate good practice in these situations:
- An older patient who has co-morbidities but is currently well. Their GP phones to discuss advance care planning.
- A patient at home with multiple co-morbidities, who is older and has coronavirus symptoms, in a Skype conversation with their GP.
- The daughter of a patient in a care home phones her mother's GP on learning that her mother has coronavirus.
- A follow up phone call from a GP to a patient with advanced bowel cancer and liver metastases.
Each clip is between 12 and 17 minutes.
This is part of our Courageous Conversations package. These recordings provide some useful strategies, words and phrases. There are also learning points and links to other resources on this subject.
Below are a few things to think about when communicating using technology during this crisis:
- Planning and preparing your conversation is as important as it always has been, perhaps more so if unfamiliar technology is involved. Think about what you need to say and how you plan to say it.
- Try to make your environment as free of interruptions and distractions as possible.
- Technology is not always straightforward so be prepared for things like poor connection, distortion in sound, and not being able to access video.
- With some video conferencing technology there may be time delays, even if you can see the person’s face. Think about allowing longer pauses for the communication to reach the other person and for them to process what you’re saying.
- Check if the other person is alone or if others are going to potentially distract (or support) them.
- Find out what the person already knows and expects before you start.
- Deliver your message, clearly and unambiguously.
- Allow enough time to summarise and check they have understood, give them time to ask questions and clarify everything you’ve told them.
- Set out the next steps, and arrange a follow up if you think it is required.
Talking to relatives on the phone
Talking to relatives: A guide to compassionate phone communication during COVID-19 is a resource that has been developed by Dr Antonia Field-Smith and Dr Louise Robinson from the Palliative Care Team at West Middlesex Hospital. It is a guide for communicating with relatives with compassion during the coronavirus pandemic.
Delivering the news of a death by telephone
Breaking the news of a death can be particularly challenging when it has to be done over the phone. NHS Education for Scotland has produced a short film on this topic, which you can find on this web page. It was launched before the coronavirus pandemic, but many of the key points will still be relevant for health and social care professionals.
There are new ways of communication being developed very quickly during the coronavirus crisis.
Voice interface systems that can be worn under PPE and connect team members are being released and developed constantly. These make it easier to communicate clearly with your colleagues. Your organisation may decide to make use of one of these.
Cardmedic is a free app that has recently been released. It uses flashcards to share information and describe the plan of action through the PPE barrier. You can access the flashcards:
- via the website, cardmedic.com
- via an app (available on Apple, with Android pending)
- or by printing and laminating the cards.
It is currently available in 10 languages and has a read aloud function for patients who can’t read. They are currently integrating British Sign Language videos too.
When working in health and social care, it is inevitable that you will meet people who are bereaved. It is important to be aware of some ways to sensitively approach these interactions. This NHS Education for Scotland video about 'Discussing dying' aims to help health and social care professionals communicate with families in this situation. For more information on this video and other resources, please visit sad.scot.nhs.uk.
- NICE Guidance on communication with patients during coronavirus
- Macmillan Courageous Conversation useful words and phrases resource
- Royal College of Surgeons Guidance on Communication with patients during coronavirus
- Royal College of GPs Top 10 tips for coronavirus telephone consultations
- NHS Education Scotland provides an e-learning module for Palliative and End of Life Care and further resources for COVID-19. Registration is not needed for the TURAS e-learning platform.
- If you’re looking to have end of life or Palliative Care conversations, please see Palliative care, End of Life and Bereavement
- For specific guidance relating to cancer and its treatment see Cancer Treatments and Tumour Types
- If you’re working in the community and having specific conversations related to primary care please see Primary Care and Community
- If you’re looking for general COVID-19 resources go to General COVID-19 Resources
- For resources to support your emotional health and wellbeing please see Emotional Health and Wellbeing.