Reflection on Communication Skills in Palliative Care Practice

This assignment presents a reflection on a role-play activity focused on improving communication skills in palliative care, specifically concerning delivering difficult news to patients. The student identifies weaknesses in verbal and non-verbal communication, such as poor listening and lack of eye contact, and describes how these issues were addressed. The reflection highlights the impact of these changes on the 'client's' responses, emphasizing the importance of active listening, empathy, and cultural sensitivity. The student discusses the challenges encountered, such as the cultural context and the patient's awareness of their condition. Comparisons are made to existing literature on therapeutic communication, with the student outlining how they plan to further develop their communication skills through self-evaluation, classroom activities, and additional reading. The assignment concludes by highlighting the practical application of these skills in future healthcare practice and the importance of patient-centered care.

Running head: PALLIATIVE CARE PRACTICE
Palliative Care Practice
Name
Institutional Affiliation

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Palliative Care Practice
What skill(s) or situation did you identify for your practice?
Communication plays a significant role in health care profession. Each time, a health
care professional will be required communicate either good news or bad news to the patient or
the family of the patient. Information is considered to be bad when it can change the perception
of the patient about their future life. Sometimes bad news is heartbreaking and it can attract
emotional response from the patient and the family, considering that people want to stay healthy.
From the assigned role play activity, I discovered that I need to focus on verbal and non-verbal
skills.
What I wanted to achieve in this role play
My primary goal of participating in this role play was to understand my weaknesses and
the limitations I have in breaking bad news so that I can strengthen them. I understand that in my
future career practice, I will be working with people of diverse cultures. Some of them will be
patients, professionals, and clients that seek my professional services. I also wanted to learn the
effective methods of delivering bad news to people and factors that can affect my efficiency as a
speaker. Even though my focus was on clinical profession in communication practice, I sought
to learn more about interpersonal skills in communicating bad news and how I can improve on
my limitations in communication in my future practice.
The Feedback I received
This role play activity made me aware of communication skills I need to improve on in
my future interactive sessions. I realized that I am poor in listening and verbal skills. My
colleague noted that I did not give him time to speak. During the conversation, I wanted to speak
throughout and whenever he tried to speak, I interrupted him with questions without considering

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that he could contribute to the topic. I was curious about culture of the client, so I asked him
about the Luo tradition of cleansing widows and wife inheritance after the death of the husband.
I had read from the research article in Perry, Oluoch, Agot, Taylor, Onyango, and Corneli
(2014) that Luo women should engage in unprotected sex with after losing their husband for
cleansing. When I interrupted the client with a question on this tradition, he became irritated and
asked me about something else. I also lacked self-confidence when I was speaking with him.
Each time he tried to look at my face, I tended to avoid eye contact. He told me that this could
affect my profession because I will appear to be telling lies even when I am speaking the truth.
The other weakness that my colleague highlighted was on open-mindedness. I was not ready to
be convinced to view the problem from another angle. This is a weakness that I needed to
address because it could affect my relationship with other people.
Even though I had some weaknesses as highlighted above, I also received some positive
complements about my verbal and non-verbal communication skills. For instance, when it was
my turn to lead the role play, I started by introducing myself, explaining the purpose of what we
were going to talk about, and asking the client if he had any fears that he needed to be addressed.
I also appeared knowledgeable in the topic because I was clear in my responses to what the
client asked. In spite of the positive feedback I received from the second activity, my colleague
noted that I was a bit interruptive and was not consistent with my answers. I was questioning
him each time and did not allow him enough time to respond. Sometimes I appeared to know too
much about the topic and took the conversation to a different direction.
What I changed in response to the feedback in a way of doing it more effectively
I made significant changes based on the responses I received. I realized that self-
confidence and ability to understand the topic is what undermined my verbal and non-verbal

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skills. I decided that I will become an effective communicator by focusing on strengthening
these skills. I started by maintaining eye contact with the client. I realized that lack of
maintaining eye contact could affect my client’s trust. For instance, when I realized that it could
be challenging to tell the patient bad news about their end stage of life disease. If the patient
became emotional, I decided that I will focus on becoming supportive to win the attention of the
patient.
Apart from the change on eye contact, I also decided to address my weakness in exposing
the client to unnecessary interruptions during the conversation. This had a lot to do with the
culture and beliefs of the patient. For instance, the client told me that unnecessary interruptions
made him uncomfortable and unwilling to talk because he feared that I had pre-conceived
judgments about his future. Additionally, I decided to remain calm and instead of interrupting, I
started nodding and maintaining eye contact with the client. Whenever the client appeared
nervous, I became supportive by assuring him of his strengths and using the words like “all will
be well…do not fear…” Additionally, instead of imposing my thought and beliefs on the client,
I decided to involve him in the talk by seeking his views and thoughts about the topic. I started
using questions like “Are we together?
How did this change affect my “client’s” response? Did it?
The changes I made had a significant impact on my client’s responses. I realized that
after I had become a good listener, the client became less emotional when speaking.
Additionally, even though were talking about palliative care at the end of life, he appeared
composed and assured that his immune system was doing a lot to keep him alive. When I
decided to involve the client in the conversation, it he became free with me in the conversation
and was free to discuss or respond to everything I asked him to explain.

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What I learned, what was a challenge, and what surprised me
This role play had a significant impact on my learning on communication skills. The first
thing I noted is that I had some interpersonal communication weaknesses that could affect my
relationship with people. I learned that I am not good at maintaining eye contact when
communicating with people. This was essentially applicable when communicating to the client
about bad news regarding their end of life stage. I tended to avoid the topic, especially when the
client appeared to become emotional and worried about what was going to happen in to them in
future. According to Archer, Latif, and Faull (2017), active communication skills create a
collaborative environment for speakers to engage in a productive conversation. This is especially
important when one is to convey bad news to another person. The person should maintain eye
contact with the other person to gauge how the recipient will respond before conveying the
news.
Apart from learning from the weaknesses of my communication skills, I also learned that
self-confidence can improve therapeutic relationships, especially when the healthcare
professional wins the trust of the patient. I noted that once I had become confident to talk with
the client, easy to communicate with the client about his condition and how we could help
improve his condition. Nevertheless, I noted that some factors affected the effective
communication with the client in a different manner. One of the limitations was the culture of
the patient, where it was not easy to convey the bad news directly because this would make the
client to lose hope of living. The World Health Organization explains that every patient has a
right to information about their health, even if the information may convey bad news. It is the
responsibility of the healthcare professional to prepare the patient emotionally and
psychologically so that they can receive the information.

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Even though this activity was a learning experience, I have to admit that there were some
challenges I encountered. One of the challenges was how to be honest with the client. I
understand that I had to be honest in expressing myself, but sometimes it was difficult to tell the
client directly about their health status and what he could anticipate, considering that he was in
the third stage of HIV/AIDS. How could I face the client and tell him that this was irreversible
stage in their life? It was even more challenging, considering that the client had information
about the disease. I was surprised that the client was prepared psychologically to receive the
news. This made me to rethink the challenges of dealing with informed patients. Some of them
are already aware of what is expected, and when the physician fails to be honest, the client can
notice it.
Comparison to the Literature
I find that this learning activity has some similarities with published literature on
therapeutic communication. The learning activity was about conveying bad news to a patient in
stage three of HIV/AIDS, but it ended up to be captivating and educative at the same time.
According to Viale (2015), physicians that lack proper communication skills can trigger adverse
consequences in patients. This is true compared to the role play activity, where I failed to
maintain eye contact with the patient. Parry, Land, and Seymour (2014) explain that physicians
need to be prepared to deliver bad news to patients because the manner in which they
communicate will affect the emotional state of their patients. A study conducted by Monden,
Gentry, and Cox (2016) found that physicians that are equipped with proper communication
skills found it easy to convey bad news to patients compared to the ones that had not developed
good communication skills. I think that this is specifically applicable to the role play activity,

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because once I had rectified my weaknesses; it became easy to win trust and confidence of the
client.
What I would do or how would I respond differently, as a consequence of these reflections?
These reflections have highlighted my strengths and weaknesses in communication skills.
As a consequence of these reflections, I will need to read more on how to strengthen my
communication skills. As a result of this role play activity, I will do self-evaluation in
communication skills with another colleague who will rate my performance. I am planning to
play an active role in classroom activities to develop better communication skills. I also intend to
read more about how to develop my verbal and non-verbal communication skills. I have
identified some research articles that I intend to focus on to understand the need for developing
effective communication skills. Just as discussed in Bumb, Keefe, and Miller (2019), effective
listening skills will help me win support from not only my colleagues and teammates, but also in
delivering therapeutic services to clients. I want to become a better person in helping my clients
in future.
The skills will now continue to practice and develop
The skills I have acquired from this role play activity will go a long way to help me not
only in my studies, but also in my career practice and the real world environment. By the end of
the activity, I discovered that I had become an active listener by allowing my colleague to speak
with minimal distractions. I think that this skill will help me in my future career practice because
I have understood the importance of listening to others when they speak. I have also become
more empathetic, especially from learning on how to convey bad news to people in palliative
care. According to Sobczak, Leoniuk, and Janaszczyk, (2018), patient-centered care allows the
caregiver to understand that patients are experts in areas of their own care. They understand what

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affects them and can contribute to their own care when given a chance to speak. Pfeifer and
Head (2018) further explain that patient-centered care through active listening skills improves
quality of life in patients. I am glad that the skills I have gathered from this activity will help me
during my clinical placement in future.

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References
Archer, W., Latif, A., & Faull, C. (2017). Communicating with palliative care patients nearing
the end of life, their families and carers. The Pharmaceutical Journal. Retrieved from
https://www.pharmaceutical-journal.com/learning/learning-article/communicating-with-
palliative-care-patients-nearing-the-end-of-life-their-families-and-carers/
20202154.article?firstPass=false
Bumb, M., Keefe, J., & Miller, L. (2019). Oncology Journal of Nursing. Retrieved from
https://cjon.ons.org/file/35926/download
Monden, K. R., Gentry, L., & Cox, T. R. (2016). Delivering bad news to patients. Proceedings
(Baylor University. Medical Center), 29(1), 101–102. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4677873/
Perry, B., Oluoch, L., Agot, K., Taylor, J., Onyango, J., and Corneli, A. (2014). Widow
cleansing and inheritance among the Luo in Kenya: the need for additional women-
centred HIV prevention options. Journal of the International AIDS Society, 17(1).
Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4074366/
Parry, R., Land, V., & Seymour, J. (2014). How to communicate with patients about future
illness progression and end of life: a systematic review. BMJ Supportive and Palliative
Care. Retrieved from https://spcare.bmj.com/content/4/4/331

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Pfeifer, M. & Head, A., B. (2018).Which critical communication skills are essential for
interdisciplinary end-of-life discussions? AMA Journal of Ethics. Retrieved from
https://journalofethics.ama-assn.org/article/which-critical-communication-skills-are-
essential-interdisciplinary-end-life-discussions/2018-08
Sobczak, K., Leoniuk, K., & Janaszczyk, A. (2018). Delivering bad news: patient's perspective
and opinions. Patient Preference and Adherence, 12, 2397–2404. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6239094/
Viale P. H. (2015). Communication of bad news to patients: is honesty the best policy?. Journal
of the Advanced Practitioner in Oncology, 6(3), 189–190. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4625625/
World Health Organization (n.d.). To err is human. Retrieved from
https://www.who.int/patientsafety/education/curriculum/course8_handout.pdf