Chapter 1: Building a relationship

A team approach

My culture says
Pastor Efrem emphasizes the importance of understanding the patient's wishes. (3:22)Video transcript

In palliative care, the patient and family are a critical component of the care team. Embracing this team approach can assist in assessment; building trusting relationships; understanding expectations and goals; and providing support that meets individual needs. Engaging both the patient, where possible, and family is fundamental to a successful call.

The family as the expert

Families are a valuable source of information. This is particularly true when you don’t have access to the patient’s medical record or history. Through necessity, many caregivers become experts in the patient’s disease. Further, they know the patient best and are often acutely attuned to physiological, cognitive and emotional changes. Spending time reviewing the patient’s status and goals of care with the person providing the majority of the care can streamline your assessment and foster a team approach to care.

Including the patient

There’s a tendency in palliative care cases for discussions to occur between a family member and a healthcare provider. When this happens, the underlying message to the patient is that they don’t matter. 

Conversation Prompts

Ask the patient if they want to be part of the conversation. They may decide to participate or defer to a family member.  

Mr. Smith, would you like to be involved in this conversation or would you prefer that I discuss this with your wife? 

 Mr. Smith, do you have any questions or comments about what your son and I have been discussing?

The patient may be too tired to talk or might not want to participate for other reasons. Respect that decision.

For more information, see Module 4, Decision-making.