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Teenage Cancer Trust shares advice on how to conduct difficult conversations digitally

Charity’s advice follows rapid digitalisation of many healthcare services during COVID-19 pandemic

Charitys advice follows rapid digitalisation of many healthcare services during the COVID-19 pandemic

Picture: Alamy

COVID-19 has led to the rapid digitalisation of many NHS services, transforming how healthcare teams communicate with patients, their families and each other. But whatever the crisis, they wont stop cant stop being there for young people with cancer. As Teenage Cancer Trust clinical nurse specialists, here is our advice on how to manage difficult conversations digitally.

Preparation is key

Difficult conversations are better suited to being delivered in person. The information being absorbed is easier to identify, body language is easily picked up and you can adapt your

Charity’s advice follows rapid digitalisation of many healthcare services during the COVID-19 pandemic

Picture shows young woman looking at her laptop screen. The Teenage Cancer Trust has shared advice on how to conduct difficult conversations digitally

Picture: Alamy

COVID-19 has led to the rapid digitalisation of many NHS services, transforming how healthcare teams communicate with patients, their families and each other. But whatever the crisis, they won’t stop – can’t stop – being there for young people with cancer. As Teenage Cancer Trust clinical nurse specialists, here is our advice on how to manage difficult conversations digitally.

Preparation is key

Difficult conversations are better suited to being delivered in person. The information being absorbed is easier to identify, body language is easily picked up and you can adapt your approach to conversations quickly depending on the signals young people give out.

When COVID-19 entered our lives, ‘best practice’ changed almost overnight. Telephone and video conversation became the norm and face-to-face interaction became a luxury. But just because the settings changed, the preparation for the conversation shouldn’t.

Treat it as a face-to-face meeting, have an agenda and ensure the date and time of the conversation is pre-arranged. Communication is integral in any clinical consultation. However, among teenagers and young adults it is important that there is a level of understanding of their specific needs and use of age appropriate language to develop a therapeutic relationship.

Consider the environment

  • Who is in the room? Introduce yourself and ask them to identify themselves – are they the patient or the relative? Your tone and use of language are likely to change depending on who you speak to
  • Explain – let them know why you are calling and not seeing them in person
  • Confidentiality – in line with the Nursing and Midwifery Council code of conduct, assure the young person of this
  • Support – make sure they have someone with them if they want them there

The conversation

  • Young people are generally unfamiliar with medical terminology and clinical aspects of consultation. Establish a rapport and explore important issues for the young person
  • Encourage them to make notes to help them retain the information
  • Share information in small doses, giving them the time to take notes and ask questions
  • Find out what they know and what they are expecting from the call. If you have different objectives, use this information as a starting point to navigate your way – if appropriate – to your intended conversation
  • If your reasons for the call do not align, and it isn’t appropriate to have your planned conversation, don’t be afraid to change course. Plan another meeting and make sure its purpose is known
  • Avoid medical jargon, use clear and simple language and speak slowly
  • Summarise your key points at the end of the conversation, giving the young person and their family another opportunity to digest the information and ask questions
  • Next steps – arrange a follow-up call and ensure they have your name and contact details

Picking up on cues

Cues can be difficult to pick up over the phone, but tone and pace of voice can be revealing. If someone is talking fast or loudly it could indicate concern or stress. Let them speak. If they are quiet or sound low, don’t be afraid to ask them about it. Allow for silence and use it to empathise with the young person.

Looking after yourself

Supporting each other is as important as supporting our patients. As nurses we all have a good level of self-awareness and we know when it’s time to reflect on a conversation. There are moments where tea and chocolate do the trick, but with face-to-face interactions less frequent it’s important you still make time to check-in with each other, formally or informally. Multidisciplinary team meetings are one way to do this and clinical supervision is another. If you have access to psychological support, it can be beneficial too.

Looking to the future

Although COVID-19 has reshaped the way we communicate with patients, there are aspects we should carry into the future. For some young people, being in hospital is a lengthy and challenging experience. Digital communication tends to affect young people’s lives less: it diminishes travel time, reduces interruptions to education and work and can help the young person maintain a sense of normality.

Providing the consultation is appropriate for a digital setting there is no reason why they cannot continue. However, the need for face-to-face consultations will be clinically necessary for some patients.

In the future, and when clinically appropriate, best practice will be to offer young people choices about the type of consultation they prefer, thereby helping them maintain a sense of control.

When it comes to digitalising peer support,Teenage Cancer Trust’s youth support coordinators have led the way. This has increased patient engagement and enabled the trust to continue getting young people through the toughest time of their lives. Without the need to travel, young people can participate from remote locations.

Resuming face-to-face events when it is safe to do so is important, but there is a permanent place for more regular digitalised support.

Further information

Teenage Cancer Trust (2020) End of Life Care and Bereavement: How Our Nurses Support Young People and Their Families


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