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Communication vignettes
  1. Vicky Robinson
  1. Vicky Robinson, Consultant Nurse in Palliative Care, and Nathalie Asmall, Psychotherapist, Psycho-Oncology Support Team, Dimbleby Cancer Care, Guy’s and St Thomas’ NHS Foundation Trust, London. Emails: vicky.robinson@gstt.nhs.uk; nathalie.asmall@gstt.nhs.uk

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Introduction

Traditionally, palliative care emergencies are associated with physical, often reversible, clinical signs (e.g. spinal cord compression and hypercalcaemia). However, palliative care practitioners can sometimes find themselves in a situation where there is an urgent need to communicate with a family member or friend of a terminally ill patient (Pickering and George, 2007). Nurses working in hospitals, care homes and community settings are often involved in end-of-life conversations and thereby play an important role supporting families facing loss (Jeffreys, 2005). There is a paucity of information in the palliative care literature on how to talk to children when a parent is dying. According to Chowns (2009), healthcare professionals are often reluctant to engage in such conversations because:

  • ▶▶ The forthcoming death of a parent challenges the perception that childhood is a time of innocence and their instinct is to protect children from painful experiences

  • ▶▶ They lack confidence when it comes to relating to a child’s conception of the world

  • ▶▶ They worry that talking to a child about death will potentially cause more harm to the child.

However, the result is that children’s needs are ignored. It is not good practice to wait until the last moment before telling children that a loved one is dying (Silverman, 2000). If children are not included in end-of-life conversations, the family unit suffers, as individual members of the family are isolated within their own experience, grief reactions and perceptions of the situation (Silverman, 2000; Reith, 2007). Children of all ages will always sense that something is wrong. As Reith (2007) states: ‘Children will observe what is happening, overhear conversations, see adults distressed and know without being told.’

If adults try to protect the child and hide what is occurring the child may draw wrong conclusions and think that they are in some …

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