One concept on which all parties living with life limiting illness- ill persons, family members and health care team members – strongly agree is the importance of a therapeutic relationship (Farber, Egnew and Herman-Bertsch, 1999; 2002). This agreement provides the most effective avenue for providing optimal medical care in general and palliative/hospice care in particular.
Clinicians identified the following domains as necessary for a therapeutic relationship:
- Commitment : Stressing she/he will care for the patient and family through and beyond death.
- Connection : Creating a special relationship that allows any topic of importance to the patient and family to be discussed regardless of whether or not it is medical. This aspect of relationship is similar to Carl Roger’s concept of unconditional positive regard (Rogers, 1951).
- Consciousness : Understanding the patient’s and family’s personal experience as well as the personal and professional meaning for the clinician within the ever changing context of illness.
With definitions unique to their perspective, ill people and their families identified similar domains (Farber, et al, 2003):
- Commitment : Actions that demonstrate commitment beyond traditional medical care; receiving help out to the car, a home visit, special foods while in the hospital, or a call between visits were perceived examples of commitment.
- Connection : Empathic/supportive clinicians who listen and allow the patient and family to express their personal concerns. They also spoke about clinicians who do not listen or ignore their personal concerns in strongly negative terms. Family members especially appreciate being listened to and having their perspective elicited and valued.
- Personal Caring : Patients appreciated clinicians who treat them as “persons” and not as “diseases.” Communicating a sense of caring and openness to the ill person’s experience was a fundamental need expressed and universally valued.
How does this look in clinical practice?
- Demonstrated Commitment:
- Clinician stressed she/he will care for the patient and family through and beyond death
- Clinician provided care to pt/family beyond traditional medical role.
- Helping pt to their car
- Home visit
- Unexpected visit in hospital
- Phone call between visits
Were perceived examples of commitment by pts and families.
- Demonstrated Connection: Unconditional positive regard
- Creating a special relationship that allows any topic of importance to the patient and family to be discussed regardless of whether it is medical
- Empathic/supportive clinicians who listen and allow pts/families to express their personal concerns
- Demonstrated Consciousness: Personal/professional empathy/understanding
- Treated pt/family as “persons” and not as a “disease.”
- Communicated a sense of caring and openness to the pt/family experience
- Acknowledged Suffering
- Acknowledged patient suffering
- Acknowledged family suffering
- Acknowledged clinician suffering
- Compassionate Witness: In the face of unsolvable body (biomedical), mind (psychosocial), spirit (spiritual) problems:
- Clinician stays emotionally connected to pt/family
- Clinician uses therapeutic relationship to support pt/family
- Clinician uses therapeutic relationship to allow pt/family and medical care team to support him/her
Next –> Setting the Context