Hi everyone. My name is Taylor dire. As an undergraduate research opportunity program fellow, I've been working with one of my communications professors, Professor Maria and Evan, and we've been researching how medical professionals communicate end-of-life care. So in the summer of 2018, my father, Paul Dyer, was diagnosed with myelodysplastic syndrome, which is cancer of the bone marrow. And after a bone marrow transplant and six months of our mission, my father's cancer returned as acute myeloid leukemia and he did die from his Cantor in November of 2018. Thankfully, my father was provided with exceptional care and was able to have the important conversations about what he wanted at the end of his life with his medical providers. Unfortunately, not everyone is able to have these conversations until they're confronted with the end of their life. And many are not apart of successful critical conversations about what they want in their end-of-life experience. An experience that we're all going to be confronted with it some point in our lives. So this was the inspiration for my research for the undergraduate research opportunity program. Medical professionals receive extensive education and training, but many do not receive training or education and communication, especially about the end of life. Effective provider patient communication is essential to the formation of a strong medical trustworthy relationship. So participants for this research were recruited through emails sent by myself, the primary researcher. And this sampling method recruited medical professionals. Icom, specifically nurses, at least some clinical experience working with patients who are at the end of their life. This proposal sampling yielded a range of medical professionals from oncology to cardiothoracic surgery to palliative care and emergency room care. Irb approval to interview human subjects was obtained before. The interviews were conducted. In the semi-structured, one-on-one interviews with these four people from different medical setting served as a data for this qualitative study. These interviews range from 35 to 60 minutes and were all conducted on the Portland campus of the University of Southern mean. So my initial question of how to medical professionals communicate end-of-life care really evolved into what constitutes a successful conversation. When medical providers and their patients discuss end-of-life. Given that many medical professionals have had little formal training in this area. So my first interview was with a medical professional and a Cardiothoracic Surgery Unit. And although perhaps been a currently works in a way that does not have many deaths. The ability to engage in a professional but also empathetic conversation with the patient at the end of their life is essential for discipline. A had little to no formal training or education. I don't know how to have such a conversation. They learn from others over their extensive course career. So it ultimately came down to preceptor nurses or leader nurse's role modelling. The conversations and staff nurses observing. And I got an enacting similar conversations in with their patients. So having learned from preceptor nurses are to spin a believed that the end-of-life conversations must be patient-centered. That is, they communicate for the purpose of understanding what the patient wants and expects. In the article, delivering high-quality Cancer Care, charting a new course for a system in crisis. Patient-centered communication is defined as providing care that is respectful of and responsive to individual patient preferences, needs, and values Ensuring that patient values guide all clinical decisions. So patient-centered care includes fostering good communication between patients and their cancer care team or palliative care team. Developing and disseminating evidence-based information to inform patients, caregivers, and the care team about treatment options and practicing shared decision-making. So this conceptualization of patient-centered care underscores empathy. And it's a central role in patient care and patient-centered care. Medical professionals have an important role in improving patient centered communication, as well as shared decision-making by listening actively and communicating and empathy, both verbally and non-verbally. So the next participant was an ER nurse. And much like what it's been a participant. B had little formal training in end-of-life communication during nursing school. This works. Pitt did recall that they were taught to listen to the patient and include them in the planet treatment and care. While listening. Showing empathy to the patient is also critical in this setting. Giving the patient time to express feelings, concerns, and to ask questions is also essential. In these conversations are spent BY felt that relating topics backed her own experiences could be helpful to the patient, but also noted that professionalism was paramount in this setting. Relationship building is also essential for end of life communication, families and patients. Trust comes from the pride or patient communication relationship. And you know, one way to establish this is through family meeting. So according to communication as comfort, multiple voices in palliative care to standing relationships with patients and their families enables a health care provider or palliative care team to reach patient-centered care. And the teams or medical professionals ability to care for the family really rested on the fact that family trusted them. So this trustworthy one brings wonderful outcomes with a patient-provider relationship that's focused on trust, as well as successful information exchange, shared decision-making, and patient self-management. So participants see was a former nurse who now works in the administration side of and end-of-life care facility like both participant a and B. Participant See did not had training in school concerning end-of-life care or communication like part's been a participant see learned how to have therapeutic conversations with patients by modelling the communication enacted by the nurse pretty suffers. So participants see learned that active listening is essential when communicating end of life care. This participant also that, that the goal of active listening is not just a form of therapeutic relationship, but also to understand the goals of the patient and create a tree and plan that reflects these goals. So while establishing these goals, both the patient and the provider must be honest. This participant has seen what happens when providers really sugarcoat things. When really all the patient wants is to have their questions at the end of life to be truthfully answered. So it's never okay to be dishonest to the patient and confusion about the course of treatment may occur if there's not transparency. However, there are always trying to shrink the healthcare settings. We know that doctors and nurses are super busy. So to deal with this, MC assign searches to no more than five patients per day. Furthermore, participants see believes that education about end of life care communication is getting better. Report from the American Journal of Hospice and Palliative Medicine entitled palliative care and undergraduate medical education. How far have become confirms this trend, stating that curriculum more often includes end-of-life care and communication with a medical schools, including added to attitudes to death and dying, communication skills, and pain management. Unlike medical schools and rolling in and end of life care facility automatically start these conversations that establish the goal of patients as well as what the patient wants after they die. So participants, he also noted that using specific medical terminology, medical terminology such as dy and not pass away can really take the mystique away from death that is so prevalent today in western cultures. We don't talk about death until it's right around the corner. And this can really hinder the quality of the end of someone's life. This ideology is discuss in the book Communication is comfort, multiple voices, and palliative care. The american way of dying is really dying in silence. And barriers to communication and communicating openly about that result. From a lack of experience with death or societies high expectations, and the emphasis on health and life and our materialistic culture, as well as the fear of death. So the use of euphemism such as pass away and no longer with us that are expensed. See discussed in our interview are examples of how our thoughts and mortality are. Thoughts about mortality and the dying process are really denied in our culture. And though these phrases may give comfort to some family and friends, these euphemisms also manifest our cultures failure to view mortality as normal and natural. So in end-of-life care, health care professionals and dying patients often experience miscommunication as a result of undisclosed fears and anxieties over an end-stage diagnosis and feeling of mortality. So one and a person enrolls and end-of-life care programs. The conversation about end up life's already happening, but this really isn't always the case. And hospitals a steady from the American Journal of Hospice and Palliative Medicine titled Exploring healthcare providers views about initiating end-of-life care communication. Notes that numerous factors that impede effective and timely end-of-life care communication. The biggest one being that healthcare providers have difficulty introducing end-of-life care discussions with seriously ill patients. This often stems from providers not knowing the right time and the right person with whom to engage end-of-life care discussions. Palliative care teams, which usually include a doctor, nurse, social worker, a chaplain, have difficulty in distinguishing who actually has a role of initiating such conversations with patients. So this leads to providers and missing opportunities to introduce end-of-life care discussions on critical topics such as poor prognosis, medical futility, and advanced care planning. So within this study, providers specify physicians as leaders of end of life care communication and are responsible for initiating discussions with patients and families. However, as my interviews and research shows, non-physicians also hold a very important role in moving end-of-life care dialogue forward when the physician is not present. So initiating early end-of-life care communication is really essential because delayed communication leads to miss opportunities to help patients plan for they ended their lives. Finally, I was able to interview a nurse if my father, an oncology nurse, I'd broken and Women's Hospital and Boston participant D actually traveled to Colorado to study at a theorist, theorist Institute, Jean Watson's Karen Science Institute, where she learned to use Watson's language to make end-of-life care conversations meaningful and authentic. Gene Watson's carrying Science Institute relieves, fosters a theory that is a humanistic, relational, moral, ethical theory that's grounded in the discipline of nursing and informed by related fields. Carrying science is built upon compassionate conversation and carrying language. And these have the power to authenticate the end-of-life experience. So to participant deep, meaningful, and authentic conversations. Concerning ended air consist of multiple factors including being present with the patient and also being present enhances mindfulness with the opposite, which is the opposite of multitasking. So another doctor that constitutes a meaningful conversation is a relaxed the relational care for herself and for others. So when participant D cares for herself and deals with what's going on inside of her heart in mind. This really translates into her care for others. She also strives for a trans personal caring relationship that she's committed herself to caring for others. And a heart centered way that honors every aspect of the patient that makes them them. So while doing this, participant D also tries to have a reflective approach to care. And we know that reflection allows us to raise our consciousness by asking questions about, you know, what's going on within our own heart and selves so that we're able to connect with others more deeply and fully. So this in turn promotes kindness and love. And this is something that everyone should be doing while communicating with others. But it's so essential when talking with someone who's at the end of their life. They should receive exceptional care while also feeling love and a personal connection. But their provider, gene Watson's Program, top-ranked spin the to be an anchor for her patients while also embracing the truth of self-care. It helped her to become a more compassionate, empathetic patient advocate, all the while lessening the fear and uncertainty surrounding the end-of-life itself. So effective communication is really at the heart of health care. Taking time to actively listen with empathy and process not only the words and facts that are coming from the patient, but also the feelings and meaning is the exemplary task of communication. At the end of life, palliative and end of life care should be introduced early in the education of all health-related trainees. This adequate training and continued support is important to help health care professionals communicate sensitively and effectively, only through this kind of communication campaign. And distress be alleviated. And decisions concerning treatment and advanced care and end-of-life care planning can be made. So because the reality of a patient's death is typically very difficult for patients and families. Honest, sensitive, and empathetic communication is essential to a fair medical treatment and a death with dignity. Thanks so much for listening.