What are Difficult Conversations in Health and Social Care?

Nell Hendy

February 9, 2022

5 min read

Communication in health and social care is vital and an invaluable skill regardless of your job role. However, communication skills do not always come naturally and some individuals may require more training than others. It is also harder to communicate during stressful and difficult situations, which are very common within the sector.

This article explains what difficult conversations in health and social care are, as well as example scenarios. We will outline tips on how to prepare for difficult conversations, and provide further guidance on how best to communicate in these situations.

What are Difficult Conversations in Healthcare?

Breaking bad news and having difficult conversations with patients and their families, is expected in health and social care and an integral part of the job. In a single day, you may have to hold difficult conversations with a multitude of people with a variety of educational, cultural and social backgrounds.

It is important you communicate effectively, and in a caring and professional manner. There is a high possibility that you will be dealing with someone who is very emotional. This can sometimes lead to aggression, anger, abuse, hostility and confrontation.

Examples of difficult conversations include informing someone of their diagnosis or worsening health, delivering the news of death to loved ones, organising arrangements for end-of-life care, or responding to a conflict situation. No matter the situation, the conversation is often emotionally charged as the individual may be worried, scared, in pain or distressed.

Ineffective communication when having a difficult conversation can lead to:

An inappropriate choice of words or phrases.
A lack of planned structure in delivering difficult news.
Delivering the news in an inappropriate environment.
Not involving the patient in the decision-making process.
Rushing the patient to agree to a proposed treatment plan.
Not referring the patient to any appropriate support services or resources.

Communication skills can help de-escalate aggression, and can even prevent it from arising in the first place. Therefore, familiarising yourself with the scenarios you may be faced with can help you to prepare and best handle all possible situations.

Communication Scenarios in Healthcare

By understanding the possible situations in which you may have to have a difficult conversation, you are one step closer to being able to prepare for, and handle them, effectively. However, communication is a transitional, dynamic and constantly changing process, so it can be difficult to prepare for every potential scenario.

Below are some examples of situations in which you may have to have a difficult conversation:

Your patient has dementia and can’t fully understand what is happening to them, making them and their family feel anxious.
Your patient is coming to the end of their life and you need to discuss their care options.
You have to inform someone of their diagnosis or worsening health.
You have to deliver the news of death to loved ones.

The following are common reactions you may be faced with when delivering difficult or hard to hear news, with some suggested appropriate responses:

Avoidance – ‘it is important we acknowledge what’s happening’, ‘let’s try to discuss the issue at hand’.

Blame – ‘I understand there may be other people involved, but right now I’d like to keep focused on you and I’.

Silence – ‘it’s important we talk about this as it’s serious’, ‘let’s try and reflect on what’s happened’, ‘I’m keen to hear your view and how we can move forward’.

Anger – ‘it seems you are angry, could you explain to me what you’re feeling so I can understand and try to help you?’.

Crying – ‘let’s take a moment before we continue’, ‘take your time, I know it’s a lot to process’.

Being aware of the possible reactions and situations in which you may need to have a difficult conversation can help you prepare. Also, it is important to keep in mind that poor communication is the primary cause of patient complaints.

How to Prepare for Difficult Conversations

Preparing yourself and the environment before having a difficult conversation is highly important.

When preparing, consider the following:

Ensure you know all the facts about the situation.
Consider where you are going to have the conversation.
Consider how you are going to start the conversation and what you are going to say.
Identify what the person you are talking to already knows.
Consider how they may feel.
How are you going to show compassion and empathy? (Through tone of voice, phrases etc.).
Are you going to talk to them individually or with their family present?
How are you going to help them understand the situation?
Do you know what support is available? For example, contact details to any referrals.
How will you react to crying or any distress they may show?
Are you prepared to answer any questions they may have?
Perhaps find someone you can debrief with before and after a difficult conversation.

Looking to Learn More?

Our Communication Skills in Health and Social Care course covers a variety of communication methods, including barriers to communication and how to overcome them. It also covers how to respond to conflict and hold difficult conversations appropriately and efficiently.

No matter how you prepare before having a difficult conversation, one of the most important elements is showing empathy and compassion throughout. This is part of your duty of care, and central to person-centred care.

Furthermore, the NHS provide a challenging conversations model that outlines six steps. The steps are: prepare, state intention, tell your story, listen to their story, manage reactions and agree next steps. It works on the principle that your job is to deliver the news, hold the discussion and help the individual to understand, as well as addressing and resolving any issues.

How to Communicate in Difficult Situations

As we have already mentioned, preparation is crucial for holding difficult conversations. Once you have prepared yourself and the environment, it is helpful to familiarise yourself with the following steps for communicating.

Follow this ten-step approach when you need to have difficult conversations:

Prepare yourself and the environment as much as you can:
- If possible, find a comfortable and private place to have the conversation.
- Before the conversation, think about how you will end it. Can you offer any advice or referral information for support? Do you know which professional (doctor, nurse, registrar for death) they will speak to next?
- Support yourself, for example who can you talk with to debrief?
Engage and empathise with the person you are talking to from the outset.
Start the conversation with a clear outline of what is going to follow.
Find out some of what the person you are talking to knows, expects, and feels.
At this point and not before, find out if they are with someone, or have someone to talk to afterwards.
Bring the person towards an understanding of the facts, for example, what has happened or is likely to happen.
Use clear terms: either die, dying, death. If you wish to use gentler terms, make sure they can’t be misunderstood.
If they cry, acknowledge with a soft tone of voice and express sympathy. If they apologise for crying, reassure them it’s OK and understandable. If you can, avoid giving further information until they’re slightly calmer.
Move towards ending the conversation – check they have understood everything and answer any questions.
Offer words of comfort and tell them what will happen next.

Poor communication in these situations can lead to confusion and distress, especially when delivering bad news. To further your knowledge, the NHS provide some guidelines for breaking bad news. These guidelines include information on admitting adverse events and potential pitfalls in communication.

Effective communication in health and social care is paramount. Regardless of your job role, you will have to have difficult conversations and ensuring they are carried out appropriately is crucial. Preparation is of the utmost importance to ensure you can communicate everything you need to efficiently, whilst supporting the person you are speaking with.