Communication as Advocacy
Betty Ferrell found herself at the center of "incredible havoc" when she arrived at the inpatient hospice house where she volunteers one evening a week. A man had been admitted after deciding to forgo active treatment for his aggressive gastrointestinal cancer. Ferrell found eight visitors for "George" scattered around the house, with some on their cell phones in far corners of the yard and others parked in different spots inside. "Nobody was talking to each other," she found.
Ferrell, a scientist from the Department of Nursing Research and Education at the City of Hope National Medical Center, Duarte, Calif., reflected on the chaotic family scene: "It was a typical crisis situation in which everyone had an opinion and no one was talking to the patient. There was tremendous tension." Ferrell gathered the group around a conference table, as family members glared at one another. She began, "Every one of us is here because we care about George. Let's have a conversation to show that we can continue the same compassionate care during the last weeks of his life."
As the discussion progressed, George's daughter, who had been yelling into her cell phone at his oncologist to authorize another round of chemotherapy, listened patiently to her father's brother. George, he explained, had confided to him, repeatedly voicing his wish to stop treatment when it reached its therapeutic limit. Her father wanted to face the end of his life peacefully.
"Getting people to talk together and working actively with families is an area of eldercare that needs tremendous work," stated Ferrell, who spoke last spring at the 2006 Joint Conference of the National Council on Aging and American Society on Aging. "We should think of communication as not only basic sharing of information or a clinical skill, but also as one of the key ways that we have to advocate for the vulnerable," she said. She introduced key principles related to communication and end-of-life care.
Professionals working in end-of-life care, she said, should keep in mind that they are entering a brief moment in the lives of patients and families. A 10-minute conversation with adult children about their mother's declining health is only a brief moment in decades of complex relationships. Ferrell stressed that family dynamics and histories exert profound influences on immediate healthcare and decisions.
Furthermore, Ferrell said, family dynamics, whether positive or negative, often become more intense at the end of life. "Care is always about relations," she continued, "and while one person may be dying, there are unique relationships between that person and everyone else involved. Thus, the communication that we have with a spouse may be very different than that with a daughter or another family member."
LISTENING AND PRESENCE
Additionally, Ferrell emphasized that communication is about listening and presence. "Most of us enter our professional careers believing that skill in communication is about our saying the right things and that communication is 90% of our information sharing and 10% listening to the response of others," she said. …