Communicating with Dying Patients and their Relatives
Authors: Carl Whitehouse
Journal: Journal of the Royal Society of Medicine (2002)

Jean Lugton is a nurse with long experience of research and training in palliative care. As such she has excellent understanding of the stresses and pressures that professionals feel when faced with dying patients and their relatives. It is appropriate therefore that, after a brief chapter defining terminal illness, she talks about the needs of staff caring for terminally ill people. Not many authors would have the courage to focus on our personal needs as professionals before addressing the practicalities of communication.

The need to reflect on our personal concerns, approaches and abilities is brought out further by the questions and exercises at the end of each chapter. These are often of the nature of ‘How can this be achieved in your clinical area?’. In the final chapter Lugton brings out the fact that patients may need different levels of communication and support and relates this to different levels of competence in palliative nursing, with further encouragement to reflect on personal capabilities.

This personal approach throughout implies a concern for the nurses for whom she is writing and a desire to encourage readers to provide their best in their own individual situation in the difficult area of palliative care. This is not a book of high-blown theory or of distant guidelines. Lugton provides a practical book made up of different insights and illustrated by many examples from the real world as she takes us through the breaking of bad news, assessment of needs, planning of support and preparation of relatives for bereavement.

All of us who have worked in this sphere will have benefited as much from the support of a peer (of whatever profession) as from knowing what we should do. The approach of this little book should encourage us to be more active in providing this support to each other. Here are questions that we should be looking at together as healthcare teams, especially when we lack the full support of a palliative care group or a hospice.

That is how the book came over to me, but at the same time I was often worried by the structure. The foreword tells us that research and theory have been woven together but the link between theory and practical advice is sometimes hard to find. Chapter headings do not always relate well to content. In the chapter on ‘Breaking Bad News’ the first three-quarters is given over to considering reactions and support after the news has been given rather than the actual process. Whilst the breaking of bad news is normally a medical responsibility, there is little input on how the different members of the team (including the nurses) might be involved: nurses often have to pick up the pieces after a bad experience, but this is addressed only by advice that ‘if one member of staff is continually untactful when breaking bad news to patients, it is a clinical governance issue.’ The area of spiritual care is limited to four pages; although this is seen as a communication problem, no real guidance is offered on how to open up the issue and see if help is needed. At times one feels that the author's desire to mention principles and theory is battling against the desire to make the book practical and helpful to the reader.

Although this book is intended for nurses, it would help all professions in the team to support one another. It offers many helpful insights—but look elsewhere for a clear exploration of the underlying theory.