Categories: medicinemedicine psychologypsychology

Aims and Rationale


Санкт-Петербургский Государственный Университет
Медицинский факультет
Кафедра факультетской терапии
Communication with Patients Suffering from Serious Physical Illness
Наталия Юрьевна Басанцова
Saint-Petersburg, 2019


Aims and Rationale
Communication is the corner stone of the relationship
with the patient
Main aims:
• creating a good inter-personal relationship,
• exchanging information,
• making treatment-related decisions
“doctors knowing best”
and decide what
should be done for a
shared decision-making
approach, with patients being
advised to educate
themselves, ask questions and
influence the course of the
discussion with their doctors


Emotional needs of the patient
at least 30–40% of patients with serious medical illness present
symptoms of emotional distress, anxiety, depression.
need help with overcoming their fears (51%),
finding hope (42%),
finding meaning in life (40%),
finding spiritual resources (39%),
finding someone to talk to about finding peace of mind (43%).
feeling of being a burden to others (87.1%),
feeling of not making a meaningful and/or lasting contribution in
one’s own life (83.7%),
not feeling worthwhile or valued (81.4%).


Barriers due to patient and families


Barriers due to healthcare provides


Good vs bad doctor
Among 9,344 healthy subjects, 73.9% of respondents endorsed the view of always being informed
when in the scenario of having a serious illness with less than 1 year to live
Preferred attitude
Hopeless attitude
to establish eye contact
tendency to
attend to only the physical aspects of
the disease
show interest by using ‘active
and open questions
to offer advice and reassurance
before the main
problems have been identified
ask about psychosocial and
to switch topics
discuss treatment options, and to
give support
to use medical jargon and to be
technical and detached


Preserving the sense of dignity


Coping styles
Some patients need to know all of the details about their situation, as a way of coping with the event
(‘monitors’), while others tend to adopt an avoidant style by passing the management of their own situation
to family members or supportive figures (‘blunters’).
Patients with fighting coping styles tend to perceive communication that centres on how to deal with the
situation as hopeful, while patients with fatalistic or stoic coping tend to regard a paternalistic communication
style that is based on physician-centred decision-making as more hopeful.


Defence mechanisms


Attachment styles


What to do: the SPIKES protocol
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