Thread by @CACEnotes

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How do expert communicators sensitively start and effectively handle important, tender conversations including those about the end of someone's life?

This podcast is about how Conversation Analysis #EMCA can show us precisely what they do & how they do it.
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https://twitter.com/ClareFuller17/status/1579375087303917569

In this thread I'll summarise the whole pod
speakformelpa.co.uk/podcast-episod…
Conversation analysis is a pioneering approach to studying communication directly. We don't ask people to recall what they do. We record + analyse in detail real life conversations, often healthcare convos.
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As @ClareFuller17 says, whilst you probably already employ a lot of the strategies I discuss, conversation analysis enables a lifting of the bonnet to look inside the engine, see how it works and hopefully better understand how to use your amazing conversational machinery
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I used to be an #NHS physio. I remember some bad communication mistakes I made, which likely caused pain to patients
I wish I'd known back then the evidence from conversation analysis on gently approaching difficult topics / bad news
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In the podcast, I start by talking about a couple of these communication mistakes of mine, and how I'd do things differently now, based on evidence on expert practice. One of my mistakes was delivering some very bad news to someone very bluntly, out of the blue as it were.
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Expert communicators bring the person they're talking to cautiously, gradually, step by step, turn by turn, towards recognising and engaging with matters that are very difficult, 'delicate' for them. They do this through several steps and strategies.
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A first cautious, sensitive step is to ask the person about their understandings, knowledge & feelings. This allows risk assessment: how distressed / shocked might they be? And also allows you to fit what you say to their understanding, perspectives, and also their vocabulary
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Getting their perspective first, then shaping what you say AND how you say it to that perspective, often results in the person themselves taking the initiative in engaging with the difficult and sensitive matter, & sometimes delivering the bad news for themselves
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Another strategy is 'forecasting' - by hinting at the news, telling the story thus far. This allows gradual realisation, an alternative to bluntly announcing the difficult topic/bad news. This makes it less likely that terrible distress or anger will derail the conversation.
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About 15 mins in, we discuss different ways of describing these conversations: sensitive? advance/d? tender? difficult?
We recorded the pod after the Women's Euro finals, I manage to bring in reference to whether women play football or whether they play women's football ⚽️⚽️
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At 20 minutes, we focus in upon advance care planning (ACP) conversations. What are the difficulties and challenges, and how can people skilfully avoid, limit, overcome, circumvent these?
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First, how experts start ACP conversations
Despite edicts from some guidance, experienced communicators don't start simply asking or inviting patients to talk about ACP
They go cautiously, step by step. 1st steps include highlighting the overall direction of someone's illness
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Experienced communicators don't bluntly tell patients they are moving (whether rapidly or slowly) towards the end of their life. Instead, they subtly draw from the patient their perspective, steering them towards recognising/articulating this themselves.
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Practitioners work towards conversational conditions where they and the patient are 'walking in the same direction', where they are 'in sync'. And once in some sync, practitioners often introduce the end of the patient's life and associated plans via hypotheticals
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Hypothetical scenarios 'Just say if things didn't go as well as we are hoping' plus follow up questions 'What might your thoughts be/where would you want to be?' often work v well . It's easier to talk about difficult delicate matters when they're 'cocooned' as hypothetical
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Practitioners steer, encourage but don't force patients to turn towards the sensitive topics. They forewarn and show empathy, eg 'Can I ask you something difficult about that?', and rather than point hard at the painful thing, they hint towards it or soften via hypotheticals
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In another strategy for starting difficult conversations without imposing or impelling is to refer to other events (such as having read something, heard a podcast, seen a TV programme) or something someone else has said as prompting you towards the conversation
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I mention in the pod a recent convo with my elderly Dad. I used another strategy, picking up on something he'd just said (hoping to die peacefully in his sleep), as an opportunity to talk about how dying in your sleep is rather rare, and about how ordinary dying tends to go
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A summary key message
Don't start by saying *you* want to have the conversation nor implying they *should* have it. Lead them gently towards it, step by step, ask questions, support them to be the one who actually brings the reality of the end of their lives to the surface
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Want to know more, want resources for self reflection or training? Here's info
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Lots of short pieces in blogs and 'in a nutshell' versions of research papers here
realtalktraining.co.uk
realtalktraining.co.uk/posts
realtalktraining.co.uk/in-a-nutshell
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With a great team, I designed training resources based on conversation analysis #RealTalkTraining. If you teach sensitive healthcare communication, RealTalk video clips & accompanying resources can raise your work's authenticity and evidence-base
treetopshospice.org.uk/our-services/f…
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