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> Difficult conversations
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What are the best ways to approach a difficult conversation?

Dr Graham Stokes, Director of Dementia Care, Bupa Care Homes

You will no doubt have had to manage some difficult discussions during your time as a carer. This may have been to deliver bad news to someone, maybe family members or close friends of the person you care for. Some conversations can be difficult to approach and emotions often run high.

Delivering bad news can be equally as distressing and upsetting for you as it is to the people receiving it. Knowing how to handle difficult conversations can make a tough job a little easier. Here are my thoughts on the best ways to approach such a discussion.

1. Don’t rush in

Beginning a difficult conversation is often the hardest part. Try not to go straight into the bad news, but instead start with a few open-ended questions, such as “How are you?” or “How are you feeling this week?” Always listen and stay quiet when they are talking – this helps to build trust.

2. Sit down

Try to be relaxed when you talk and get your eyes on the same level as the person’s you are talking to. A good way of doing this is to both sit down. Being seated can also reduce the chance of the family member getting emotionally out of control

3. Set the tone

It’s often better to have a difficult conversation in person. Arrange a time and place that’s appropriate, and maybe forewarn them what it’s about. For example: “I need to talk to you about John and how he’s doing.” Don’t deliver bad news suddenly or without warning, as this can cause distress.

4. Try to be calm, clear and take it slowly

Be as clear as possible about the news you deliver – it’s a good idea to deliver the information in small chunks. Try to stay calm, even if the family member reacts badly. Face the person when you talk, be empathic and patient, and respond as best you can to any questions they may ask. If the person starts to cry, stop talking about the issue at hand, offer verbal comfort or give them some time before you carry on.

5. If possible take some support

It may be a good idea for more than one person to be present – this not only offers the family member support, but will also help you.

Equally, you need support in your role. Carers often have to fight and battle for the support they get. Try to talk regularly to family members of the people you care for – this will help you to discuss future issues more easily. Don’t be afraid to seek help or advice. There are support groups and local trusts that offer help when the going gets tough.

Many of these are standard practice for Doctors, but what have been your experiences of handling difficult conversations? Do you have any techniques which work well?

Please post any questions or responses in the difficult conversations thread

Produced in collaboration with Bupa’s Health Information Team, April 2012.

Sources

• Jurkovich GJ, Pierce B, Pananen L, et al. Giving bad news: the family perspective. J Trauma, 2000; 48(5): 865-73
• Walter F, Baile A, Buckman R, et al. SPIKES – a six-step protocol for delivering bad news: application to the patient with cancer. The Oncologist, 2000; 5: 302-11
• Looking after your health. Carers UK. www.carersuk.org, accessed 12 April 2012
• Getting care and support. Carers UK. www.carersuk.org, accessed 12 April 2012

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