Communication in palliative medicine-aspects of existential encounter

Communicating with the incurable patient is one of the most challenging tasks a doctor may have to undertake. This paper deals with the basics of how doctors should conduct conversations with incurable patients; it describes a practice-oriented model for the delivery of bad news and finally examines communication within the team caring for such patients. The ability to give space for questions and emotions has an enormous impact on the quality of the encounter. Decisive importance is also attached to the health professionals insight of his or her own ability to cope with suffering. In breaking bad news the 'SPIKES' protocol (Setting, Perception, Information needs, Knowledge, Exploration of emotions and empathy, Summary and Strategy) developed by Buckman and Baile has proved valuable in day-to-day clinical practice. Open and structured communication within the team is an essential prerequisite in order to permit good patient care as well as to maintain team stability and to allow team-members to cope with the emotional impact of palliative care. © Springer Medizin Verlag 2005.