Talking to Loved Ones About Difficult Health Issues

Reviewed Aug 14, 2016

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Summary

  • Get together.
  • Be open.
  • Acknowledge each other's emotions.
  • Learn about the disease.
  • Strategize future talks.

No matter how difficult conversations between doctors and the persons they are caring for can be, they are not the same as conversations between those under their care and partners, relatives, and other loved ones.

Alexander Marmé, MD, of the University of Heidelberg, Germany, developed a program to help those with cancer discuss their diagnosis and prognosis with family, friends, and colleagues. Says Dr. Marmé, “The patient is afraid of talking about their illness with relatives. They don’t know how to deal with it. The lack of communication causes additional stress in personal relationships.”

Prior to Dr. Marmé's program, which he calls GOALS, there had been no program for those who need to convey distressing news. The GOALS protocol, says Marmé, “will improve interaction and help people gain more knowledge.”

Interaction is one of the most difficult issues in health communication, says Marmé. “It happens every day—I’ll talk to a patient, and the patient will say ‘Don’t tell my spouse/parent/child that! The fear of hurting somebody is the biggest obstacle in these conversations. Patients don’t want to hurt their loved ones with the truth, and relatives don’t want to harm patients with negative information.”

However, Marmé points out that there are other issues, too. “Often partners feel that patients ‘use’ their diseases; we have preconceived notions about not telling people with illnesses, especially terminal illnesses, that they’re wrong, or ‘You’re bad.’ The GOALS Protocol is designed to open communication up so that what needs to be said can be said.”

Key principles for tough conversations

While it is currently offered as a one-day workshop in Heidelberg, the principles can be applied to communication between people under care and loved ones anywhere. GOALS stands for:

  • G—Getting together: The time and space should indicate that this is an important conversation and should not be disturbed by daily life.
  • O—Opening: Both sides should indicate that there is a need or a desire to talk.
  • A—Acknowledging each other’s emotions is very important in supporting your relative.
  • L—Learning about the disease and exchanging ideas where new questions might arise.
  • S—Strategy to develop open discussion and arrange the next conversation.

Dr. Marmé points out that in a doctor-patient conversation, many rituals are observed, from setting an appointment, to determining who sits where, etc. “When patients talk to their loved ones, they should also find certain rituals to help them maintain the flow and openness of communication. Each patient will find things that work for him or her individually.”

Universal needs

Dr. Marmé is keenly aware that the success of the GOALS Protocol as it moves in to different countries and to different groups depends in part on how carefully it is adapted to cultural mores and manners.

Joanne Lynn, MD, Director of the Arlington, VA-based Center to Improve Care of the Dying, says that while cultural sensitivity is very important, there is one thing relatives can all do that cuts across boundaries. “Most terminally ill patients have to plan for the more likely eventuality that they will die, and the key to talking with terminally ill patients is ‘to say very little and listen a lot,’ about how a patient wants to handle death.”

By Bethanne Kelly Patrick
Source: Alexander Marmé, MD, University of Heidelberg, Germany; Joanne Lynn, MD, Director of the Center to Improve Care for the Dying, Arlington, Va.; European Society for Medical Oncology; American Medical Association; How to Break Bad News: A Guide for Health Care Professionals by Robert Buckman. Johns Hopkins University Press, 1992

Summary

  • Get together.
  • Be open.
  • Acknowledge each other's emotions.
  • Learn about the disease.
  • Strategize future talks.

No matter how difficult conversations between doctors and the persons they are caring for can be, they are not the same as conversations between those under their care and partners, relatives, and other loved ones.

Alexander Marmé, MD, of the University of Heidelberg, Germany, developed a program to help those with cancer discuss their diagnosis and prognosis with family, friends, and colleagues. Says Dr. Marmé, “The patient is afraid of talking about their illness with relatives. They don’t know how to deal with it. The lack of communication causes additional stress in personal relationships.”

Prior to Dr. Marmé's program, which he calls GOALS, there had been no program for those who need to convey distressing news. The GOALS protocol, says Marmé, “will improve interaction and help people gain more knowledge.”

Interaction is one of the most difficult issues in health communication, says Marmé. “It happens every day—I’ll talk to a patient, and the patient will say ‘Don’t tell my spouse/parent/child that! The fear of hurting somebody is the biggest obstacle in these conversations. Patients don’t want to hurt their loved ones with the truth, and relatives don’t want to harm patients with negative information.”

However, Marmé points out that there are other issues, too. “Often partners feel that patients ‘use’ their diseases; we have preconceived notions about not telling people with illnesses, especially terminal illnesses, that they’re wrong, or ‘You’re bad.’ The GOALS Protocol is designed to open communication up so that what needs to be said can be said.”

Key principles for tough conversations

While it is currently offered as a one-day workshop in Heidelberg, the principles can be applied to communication between people under care and loved ones anywhere. GOALS stands for:

  • G—Getting together: The time and space should indicate that this is an important conversation and should not be disturbed by daily life.
  • O—Opening: Both sides should indicate that there is a need or a desire to talk.
  • A—Acknowledging each other’s emotions is very important in supporting your relative.
  • L—Learning about the disease and exchanging ideas where new questions might arise.
  • S—Strategy to develop open discussion and arrange the next conversation.

Dr. Marmé points out that in a doctor-patient conversation, many rituals are observed, from setting an appointment, to determining who sits where, etc. “When patients talk to their loved ones, they should also find certain rituals to help them maintain the flow and openness of communication. Each patient will find things that work for him or her individually.”

Universal needs

Dr. Marmé is keenly aware that the success of the GOALS Protocol as it moves in to different countries and to different groups depends in part on how carefully it is adapted to cultural mores and manners.

Joanne Lynn, MD, Director of the Arlington, VA-based Center to Improve Care of the Dying, says that while cultural sensitivity is very important, there is one thing relatives can all do that cuts across boundaries. “Most terminally ill patients have to plan for the more likely eventuality that they will die, and the key to talking with terminally ill patients is ‘to say very little and listen a lot,’ about how a patient wants to handle death.”

By Bethanne Kelly Patrick
Source: Alexander Marmé, MD, University of Heidelberg, Germany; Joanne Lynn, MD, Director of the Center to Improve Care for the Dying, Arlington, Va.; European Society for Medical Oncology; American Medical Association; How to Break Bad News: A Guide for Health Care Professionals by Robert Buckman. Johns Hopkins University Press, 1992

Summary

  • Get together.
  • Be open.
  • Acknowledge each other's emotions.
  • Learn about the disease.
  • Strategize future talks.

No matter how difficult conversations between doctors and the persons they are caring for can be, they are not the same as conversations between those under their care and partners, relatives, and other loved ones.

Alexander Marmé, MD, of the University of Heidelberg, Germany, developed a program to help those with cancer discuss their diagnosis and prognosis with family, friends, and colleagues. Says Dr. Marmé, “The patient is afraid of talking about their illness with relatives. They don’t know how to deal with it. The lack of communication causes additional stress in personal relationships.”

Prior to Dr. Marmé's program, which he calls GOALS, there had been no program for those who need to convey distressing news. The GOALS protocol, says Marmé, “will improve interaction and help people gain more knowledge.”

Interaction is one of the most difficult issues in health communication, says Marmé. “It happens every day—I’ll talk to a patient, and the patient will say ‘Don’t tell my spouse/parent/child that! The fear of hurting somebody is the biggest obstacle in these conversations. Patients don’t want to hurt their loved ones with the truth, and relatives don’t want to harm patients with negative information.”

However, Marmé points out that there are other issues, too. “Often partners feel that patients ‘use’ their diseases; we have preconceived notions about not telling people with illnesses, especially terminal illnesses, that they’re wrong, or ‘You’re bad.’ The GOALS Protocol is designed to open communication up so that what needs to be said can be said.”

Key principles for tough conversations

While it is currently offered as a one-day workshop in Heidelberg, the principles can be applied to communication between people under care and loved ones anywhere. GOALS stands for:

  • G—Getting together: The time and space should indicate that this is an important conversation and should not be disturbed by daily life.
  • O—Opening: Both sides should indicate that there is a need or a desire to talk.
  • A—Acknowledging each other’s emotions is very important in supporting your relative.
  • L—Learning about the disease and exchanging ideas where new questions might arise.
  • S—Strategy to develop open discussion and arrange the next conversation.

Dr. Marmé points out that in a doctor-patient conversation, many rituals are observed, from setting an appointment, to determining who sits where, etc. “When patients talk to their loved ones, they should also find certain rituals to help them maintain the flow and openness of communication. Each patient will find things that work for him or her individually.”

Universal needs

Dr. Marmé is keenly aware that the success of the GOALS Protocol as it moves in to different countries and to different groups depends in part on how carefully it is adapted to cultural mores and manners.

Joanne Lynn, MD, Director of the Arlington, VA-based Center to Improve Care of the Dying, says that while cultural sensitivity is very important, there is one thing relatives can all do that cuts across boundaries. “Most terminally ill patients have to plan for the more likely eventuality that they will die, and the key to talking with terminally ill patients is ‘to say very little and listen a lot,’ about how a patient wants to handle death.”

By Bethanne Kelly Patrick
Source: Alexander Marmé, MD, University of Heidelberg, Germany; Joanne Lynn, MD, Director of the Center to Improve Care for the Dying, Arlington, Va.; European Society for Medical Oncology; American Medical Association; How to Break Bad News: A Guide for Health Care Professionals by Robert Buckman. Johns Hopkins University Press, 1992

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