"COMMUNICATING IN COMPLEX SITUATIONS"

A PRACTICAL GUIDE FOR SOCIAL AND HEALTHCARE PROFESSIONALS 

The development of the booklet involved researchers, associations of patients, family carers and volunteering, foundations, public and private healthcare services, and scientific societies to support professionals in difficult communication scenarios.

The booklet shows the most common and difficult communication scenarios that unfold over four clinical cases in different care contexts:

1. Carlo, 77 years old, with advanced dementia in nursing home;

2. Giovanni, 80 years old, with lung cancer in intensive care unit;

3. Ottavio, 47 years old, with acute lymphoblastic leukemia in hematology;

4. Anna, 85 years old, transferred to long-term care services after in-hospital stay for heart failure.

Communication scenarios included unawareness of disease trajectory or prognosis, turbulent emotions and prolonged silences, preferences for aggressive care, ambivalent care preferences, family carers with different care preferences, choosing care treatments when the person’s preferences are unknown, unrealistic expectations, balancing hope and realism, and remote communication.

Each scenario is accompanied by:

i) practical hints to deal with serious illness conversations;

ii) good examples of communication scripts based on the most known communication protocols (i.e., CONNECT, PREPARED, REMAP, SPIKES) and methods (i.e., ADAPT, NURSE, TUVERI);

iii) infographics summarizing the main evidence-based indications.

An introductory text, a section on the basic communication skills, and additional resources complete the booklet.

Three educational videos were developed based on Mr. Carlo clinical case, a person with advanced dementia in nursing home:

• Dealing with anger and conflict

• Dealing with bewilderment 

• Dealing with care choices 

For each scenario, a "good example" with professionals using appropriate communication strategies and a "bad example" with poor quality interactions were developed.

In the educational intervention, the "bad example" is shown first to stimulate reflection on what could have been handled differently.