Tackling the difficult conversation with empathy

Although the hope is that trips to a pediatric health care provider will only be for well-child visits and good outcomes, the reality is that there will be times when a practitioner has to deliver difficult news. That’s when empathetic communication can make all the difference. The session, “Empathic Communication 101: How to Approach Difficult Conversations in Any Setting” was presented by Amy Hatton, MSN, RN, CPNP-PC, CHPPN, at the 2021 virtual conference for the National Association of Pediatric Nurse Practitioners to address just those situations.

Hatton first discussed why empathic communication was important in providing care. She noted that many families and patients receive difficult news, which often provokes an emotional response. When delivering bad news, a health care provider might offer an onslaught of information, ignoring the emotional response the patient might be having, making it difficult for them to process what the health care provider is saying. It’s better, said Hatton, to give the patients some time to digest what was said, and acknowledge the array of feelings they might be going through. Hatton then briefly discussed 2 of the major models of communication: transmission, where one party is sending information to the other with little feedback from the recipient, and transactional, where all parties are both sending and receiving information during the interaction. The transactional model of communication is the one that will allow a clinician to provide empathetic care.

Then Hatton discussed what empathy is versus what it isn’t, citing understanding another person’s viewpoint and being nonjudgmental as hallmarks of empathy, while presenting silver linings or using the phrase “at least” are not empathy. She then described some acronyms that can be used as tools to provide empathetic care, such as the ones below.

NURSES:

• Name the emotion – when speaking to patients and families say things like “you sound like you’re relieved” that name the emotion they are displaying
• Understand the emotion – show patients and families that you understand the emotion they are going through, using phrases such as “what you’re telling me helps me understand how you feel about this treatment”
• Respect the patient and family – show the patient and family that you’re on the same level of respect by using phrases like “I can tell that you’ve been trying to exactly follow the treatment plan’
• Support the patient and family – ensure that the patient and family understand that you’re on the same team and want the best outcomes for the child. Use phrases like “We're here to help you with any symptoms, treatments, or decisions”
• Explore the emotion – ask patients and families about what their emotions are, which can be as simple as saying “tell me more”
• Silence – there are times when silence and merely being there are the best option

When called on to discuss bad news with a patient or family, Hatton recommended thinking back to a time when you yourself were given bad news and ask yourself what was helpful, what wasn’t, how did you feel, and who was with you. In this instance, Hatton suggested remembering the acronym, SPIKES.

• Setting – Ensure that the space is private and won’t be interrupted. Make sure that there is enough setting and time to discuss the news. Be sure to have important support people available.
• Perception – Use open-ended questions to ask what the patient and family know
• Invitation – Ask the patient and family if it’s okay to talk about the news and support them
• Knowledge – Discuss the fact and knowledge about the situation, ensuring that you’re using clear language and pause frequently so that questions can be asked
• Emotions – Expect an emotional response from the family and provide an empathetic response, using the NURSES acronym
• Summary and strategy – Give a concise summary of the conversation and then discuss the next steps with the family.

Hatton also offered some do’s and don'ts for giving bad news:

• Don’t stand up when giving the news.
• Do sit down with the family
• Don’t give information without asking if they want it.
• Do ask if they are understanding what you’re saying.
• Don’t keep talking, lecture, or correct the family.
• Do allow for periods of silence.
• Don’t use jargon or medical lingo when discussing the news.
• Do be concise and direct.