Advanced Effective Communication, Cultural Competence, and ...

A Roadmap for Hospitals
Chapter Four: End-of-Life-Care
• Make sure that appropriate auxiliary aids and services
are available during treatment of patients who have
sensory impairments.
• Provide augmentative and alternative communication
(AAC) resources to help with treatment of patients
with communication impairments.
• Note the use of communication assistance in the
medical record and communicate needed aids and
services to staff.
• Provide communication assistance to surrogate
decision-makers whose preferred language is not
English or have sensory or communication needs to
involve the patient’s surrogate decision-maker in care
discussions.
❑ Monitor changes in the patient’s
communication status during end-of-life
care.
A change in health status or a result of medical treatment
or procedures can impair the patient’s ability to
communicate. Patients may develop new or more severe
communication impairments at the end of life, and staff
should be aware of any changes in the patient’s
communication status.
• Determine if the patient has developed new or more
severe communication impairments during end-of-life
care and contact the Speech Language Pathology
Department, if available. Provide AAC resources, as
needed, to help during treatment.
• Anticipate the communication needs of the patient
who is expected to develop communication
impairments from scheduled treatment or procedures
during end-of-life care (for example, as a result of
intubation, tracheostomy, sedation, or other
interventions that may compromise the patient’s
ability to communicate).
• Note any changes in the patient’s communication
status in the medical record and communicate new
needs to staff.
❑ Involve the patient’s surrogate decisionmaker
and family in end-of-life care.
Both the surrogate decision-maker and the patient’s
family must be involved (per the patient’s wishes) to
tailor end-of-life care to the patient’s unique needs. Staff
should make sure that the patient’s surrogate decisionmaker
and family have an opportunity to ask questions
and provide opportunities for them to participate in
care discussions.
• Remind the patient of his or her right to designate a
surrogate decision-maker.* If the patient does not have
a surrogate decision-maker, encourage the patient to
identify such an individual during end-of-life care.
• Ask the patient which, if any, family members he or
she would like to involve in end-of-life care. Family
members may be broadly defined to include friends
and same-sex partners. †
• Many cultural groups prefer that the patient’s family,
in addition to or rather than the patient, participate in
decision making. This situation may seem to
contradict an emphasis on patient autonomy and
consent; however, staff need to respect the patient’s
desire to use a surrogate decision-maker even if the
patient is competent. In such instances, staff should
note that the patient has deferred decision-making for
cultural reasons and identify the surrogate decisionmaker
in the medical record.
• Educate the patient and surrogate decision-maker and
family regarding the dying process.
• Allow family to participate in end-of-life care by
providing comfort during the dying process by
touching, talking, playing favorite music, or
participating in care activities such as washing.
• Adapt existing hospital procedures to better involve
the surrogate decision-maker and family in care
discussions. For example, consider rescheduling patient
rounds or making sure the information provided
during rounds is available to the patient’s surrogate
decision-maker and family members at a later time.
• Provide communication assistance to surrogate
* See Chapter 1: Admission (page 10) for additional information on the patient’s right to designate a surrogate decision-maker.
† Family involvement is a critical issue for lesbian, gay, bisexual, and transgender (LGBT) patients and families. In some cases, biological family
members may disapprove of the patient’s same-sex relationship and may try to exclude the patient’s partner from visitation or decision making.
Exclusion of a primary caregiver may compromise treatment. When treating children with same-sex parents, staff should include both parents in
discussions about the child’s health care, even if both do not have legal custody. See the April 15, 2010 presidential memorandum respecting the
rights of hospital patients to receive visitors and to designate surrogate decision-makers for medical emergencies regardless of their status of
legally recognized immediate family members at http://www.whitehouse.gov/the-press-office/presidential-memorandum-hospital-visitation.
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