It is important to maintain hope when dealing with patients with serious illness and one can often be surprised by their determination to survive and their capacity for hope. Also important is the support from the health professional(s), who should not destroy hope even when being truthful-the manner/style/words should still convey the sense that things could improve, yet be honest and truthful. Thus not only mechanical support and assistance, but also warm, devoted caring is required.

The patient is often emotionally traumatised and/or grieving for the “healthy” self and need to trust the health professionals expertise and commitment to, and judgement in his/her well-being. Professional manner and personal style reflect the health professionals unique personality, a product of communication skill that responds to the special needs and personality of the patient. Fear of saying the wrong thing or revealing too much can have a worse effect, that of avoidance, leaving the patient feeling isolated and rejected. The gesture of reaching out is far more important than the actual words. Flomenhoft, a physiotherapist and cancer survivor, suggests the following in Gabard and Martin (2010):

• View the illness as a chronic disease – e.g. “living with cancer” not “not dying of cancer”
• Use a confident bedside manner – body language, eye contact, firm touch
• Be aware of own feelings that may disrupt and/or interfere with helping-own anger, irritation, frustrations, fear, self-doubt, are all normal
• Listen attentively and sympathetically – rhetorical questions often express grief, frustrations and/or anger (“Why me?”)
• Ask what the person is feeling (don’t assume) – remember Kubler-Ross’s stages of grief / mourning (denial, anger, bargaining, depression, acceptance), but these are not universal or sequential
• Pick up conversational cues from the patient about when/what/how to discuss the situation
• Touch matters – but demonstrativeness is unique to each person in the situations
• Be honest/hopeful/realistic/positive, all at the same time
• Do not isolate the patient as death approaches. Even when active treatment stops, maintain contact, especially if there is a longstanding relationship, to prevent a feeling of abandonment

References

Gabard, D.L. & Martin, M.W (2010). Physical therapy ethics. F.A. Davis Company, Philadelphia.

Professional Ethics in Physiotherapy by the University of the Western Cape is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.