Leading difficult conversations

We understand that difficult conversations are made even more difficult by the coronavirus (COVID-19) pandemic. They may have to be shorter, or take place 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.

The key principles of leading difficult conversations

We have produced a 13 minute recorded PowerPoint presentation to support you when having difficult conversations at work, during the Coronavirus pandemic. We have provided some general principles around effective communication and have looked specifically at how you might use cues to provide more focus to your conversations. We also consider the importance of body language and use of your voice when wearing personal protective equipment (PPE).

 
  • 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?
  • Engage and empathise with the person you are talking to from the outset.
  • Start the conversation with a clear outline of what is going to follow.
  • 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.

Examples of difficult conversations

We have produced some recordings of fictional telephone and Skype calls that demonstrate good practice in these situations:

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.

Using technology to communicate

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 see below. It was launched before the coronavirus pandemic, but many of the key points will still be relevant for health and social care professionals.

Communicating using PPE

There are new ways of communication being developed very quickly during the coronavirus crisis. 

Voice interface systems that can be worn under personal protective equipment (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. 

The 5 steps to delivering bad news

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.

Talking about death and dying

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.

Ready

Can we talk about your care and what coronavirus might mean for you?

Expect

What do you know? What do you want to ask?

Diagnosis

What we know is…

What we don’t know is…

What we are not sure about is…

Matters

What matters to you? What is important to you and your family if you get very unwell?

Actions

What we can do to help is…

This does not work/help…

Plan

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.

In the video below Dr Lara Mitchell, discusses talking about dying during the Covid-19 and demonstrates the use of the RED-MAP Framework

Find out more about RED-MAP and RED-MAP guides for Professionals.

Communicating with people who are recently bereaved

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 'Talking and being with those who are recently bereaved' 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.

More resources on difficult conversations

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