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Section 4
GUIDANCE AND RESOURCES The four areas which were identified as areas in which staff would benefit from guidance on facilitating discussions on future and end-of-life care are introduced below and are outlined in further detail in the subsequent four sections of this document. These are as follows:
1. Communication skills. 2. Capitalising on informal opportunities. 3. Facilitating discussions. 4. Hosting formal family meetings.
What follows in each section is guidance for staff on how best to approach each of these areas. Each guidance is followed by relevant resources to support learning, development and practice in that area.
4. 1 Communication skills
Getting communication right is essential when discussing and delivering quality end-of-life care. Successful communication is dependent on two people sharing a common language or system of communication, an understanding and ability to interact using that system by both partners and a motivation, reason and opportunity to communicate. As illustrated in section 3, communication is about much more than words. People with dementia may communicate in lots of different ways using facial expression, eye contact, body language, vocalisations, responsive behaviours, writing and speech. The person with dementia may need additional time to process information and find the correct words to formulate a response. They may benefit from additional communication supports such as a pen and paper (writing down key words) / pictures and/or photographs. Some people with advanced dementia may communicate through responsive behaviours and subtle nonverbal cues. Staff should be attentive to the person’s verbal and nonverbal communication in addition to the communication environment they are in in order to understand what the person is communicating and formulate an appropriate response. Communication with people with dementia should take a person-centred approach. Knowing someone’s life history is essential in helping staff to get to know a person, their family, their values and their wishes in order to build relationships with them. It is within this context that purposeful discussions about future and end-of-life care take place. Conversations about end of life often arise in informal everyday situations such as on the corridor, on the phone or by the bedside and are often directed at staff who have the most contact with the person with dementia and their family. All staff including healthcare assistants, catering and housekeeping staff need to be able to acknowledge and respond appropriately when a person makes a comment, asks a question or gives a cue to open a discussion relating to their wishes (8, 40, 48–50).
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Facilitating discussions on future and end-of-life care with a person with dementia
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