Introduction

In palliative care settings, when patients are dealing with life-limiting illnesses and need specialised care to guarantee their physical, emotional, and psychological well-being, effective nurse-patient communication is of the utmost significance (Hui & Bruera, 2020). Through comprehensive support and symptom management, palliative care aims to improve the quality of life for patients and their families. As a result, during this fragile stage of life, communication is essential for fostering understanding, empathy, and compassion between nurses and patients (Fan et al., 2017). The purpose of this review is to examine the value of nurse-patient interaction and how it affects patient outcomes in palliative care settings. The review will discuss the background which will also include the search strategy. In addition to this critical analysis of the chosen topic will be done which will include different themes.

Background

The goal of palliative care is to enhance the quality of life for patients with life-limiting illnesses, such as advanced cancer, end-stage organ failure, or chronic, incurable diseases (Montgomery et al., 2017). In these situations, the emphasis moves from curative treatments to symptom relief, pain management, and offering patients and their family emotional and psychological support (World Health Organization, 2020). For a number of reasons, good communication between the nurses and patients is crucial in palliative care. First of all, it promotes a relationship of trust and comprehension between patients and their carers, promoting improved collaboration and patient participation in decision-making (Etkind et al., 2020). Second, open and kind communication aids in addressing patients' worries, fears, and anxieties regarding their prognosis. In order to provide patients a sense of control and dignity during their end-of-life journey, nurses can help them in making knowledgeable decisions about their care by encouraging open and compassionate communication (Molina-Mula & Gallo-Estrada, 2020). Nurses are the front-line providers of patient care and are in a special position to build trusting therapeutic bonds with patients and their families (Roodbeen et al., 2020). The nurses must be skilled at active listening, empathy, and cultural sensitivity to comprehend the various backgrounds of their patients and adjust their communication style accordingly (Kwame & Petrucka, 2021).

Search Strategy

Relevant peer reviewed articles were taken using databases like PubMed, Google Scholar and PubMed Central to investigate the subject of nurse-patient communication in palliative care settings. Important search key terms were "nurse-patient communication," "palliative care," "end-of-life communication," "nursing practice," "empathy," "cultural sensitivity," "communication barriers," and "patient outcomes." The papers are included from the last five years and the language preferred in English.

Critical Analysis

Theme 1: The Impact of Effective Communication on Patient Outcomes

Swami & Case (2018) conducted a literature review to explore the various aspects involved in effective palliative care. The paper emphasises how palliative care has changed from being a form of end-of-life care to a holistic paradigm that takes into account the physical, emotional, psychological, and spiritual requirements of patients with terminal illnesses. The paper is a review of the literature that means that the author has created a thorough overview of the subject, they searched databases, journals, and other pertinent sources systematically. Research on communication, symptom management, patient choices, carer support, interdisciplinary collaboration, and palliative care-related ethical issues may be part of these studies. The authors point out some recurring elements in the literature on efficient palliative care (Radbruch et al., 2020). The authors have undoubtedly covered a wide variety of palliative care-related issues in the literature review. These involve questions about the best ways to have end-of-life conversations, the effects of palliative care interventions on patients' quality of life and the difficulties in providing care.

Theme 2: Cultural Sensitivity in Communication

The study conducted by Givler et al. (2020) presents a comprehensive exploration of the significance of cultural competence in pain and palliative care by the nurses. 

The authors give a historical backdrop for how cultural competency has changed over time in pain and palliative care. The authors used a thorough literature review to get their information on cultural competency in pain and palliative care. This review included pertinent research papers, studies, and expert opinions. The authors used the results of numerous research that looked at how cultural competency affected pain and palliative treatment. There is a significant relevance of communication and language barriers are seen in providing culturally competent care, the necessity of cultural sensitivity when discussing end-of-life care. For improving cultural competence among healthcare professionals, the impact of cultural beliefs on pain perception and reaction to pain therapies, and the implications of cultural competence for fair and patient-centred care is emphasised by the authors in the paper

Another study conducted by Cain et al. (2018) presents a comprehensive examination of culture's influence on palliative care. The authors' examination of the development of cultural factors in palliative care probably provides historical perspective. The paper is a research article and the methods employed aren't specifically stated in the summary. The authors have studied patient preferences for care at the end of life, how cultural norms and beliefs affect how patients, families, and healthcare professionals communicate. Culturally-based patient preferences for end-of-life care, effective communication techniques that take cultural norms into account and the role of culturally appropriate decision-making in palliative care are few themes which have been focused upon. The authors undoubtedly address important queries about the nexus between culture and palliative care throughout the paper. The impact of culturally competent communication on patient satisfaction and trust are a few examples of these questions.

Theme 3: Communication and Ethical Considerations in Palliative Care

The study conducted by Collins et al. (2018) presents a phenomenological study that delves into communication about palliative care from the perspective of patients. To investigate patient perceptions and reactions to information regarding palliative care, the authors use a phenomenological study design. The goal of phenomenological research is to comprehend people's perceptions and living experiences. To better grasp patients' perspectives on palliative care conversations, the study in this instance probably featured in-depth interviews or focus groups with people who were sick. Previous research has looked at patient preferences for talking about palliative care, their experiences with such conversations. The summary omits a list of the various themes found in the literature. Patients' perceptions on communication about palliative care are likely at the centre of the study's main open-ended questions.

Another study conducted by Wallace et al., (2020) presents a timely article that explores grief experiences during the COVID-19 pandemic, with a focus on considerations for palliative care providers. To gather their conclusions and recommendations for palliative care professionals, the authors probably used a literature review approach. The review may have included a thorough search of the body of literature, professional judgements, and pertinent studies concerning the pandemic's effects on bereavement and the implications for palliative care practice. The article refers to earlier research that looked at how people dealt with bereavement during the COVID-19 pandemic. The summary omits a list of the various themes found in the literature. However, potential themes in the article include the various grief experiences and emotional reactions during the pandemic, The authors investigate issues such as the effects of pandemic-related limitations on customary grieving practises.

Theme 4: Overcoming Communication Barriers and Challenges

The study conducted by Mayeda & Ward (2019) conduct a systematic review that focuses on methods for addressing barriers to palliative care for ethnic/racial minorities.The systematic review's authors situate it within the longer historical framework of disparities and inequities in healthcare access and quality faced by ethnic and racial minority communities in palliative care settings. Since this article is a systematic review, the authors conducted their research using a strict, predetermined methodology. These studies have looked into things like linguistic difficulties, cultural differences, lack of knowledge about palliative care options The summary omits a list of the various themes found in the literature. Finding practical ways to remove obstacles in palliative care for ethnic/racial minorities is perhaps the main issue that the systematic review addresses. The effectiveness of community-based palliative care programmes aimed at minorities and the potential contribution of patient navigators to enhancing access to palliative care services are among the issues that the authors may examine.

In this domain another study was conducted by Sue et al. (2019) presenting a valuable article focused on palliative care for patients with communication and cognitive difficulties. The authors presumably place their work in the broader historical framework of palliative care. In addition to this the growing understanding of the special difficulties experienced by patients with communication and cognitive impairments during the end-of-life process were also focused. The authors most likely conducted a thorough literature analysis to compile data and thoughts on the subject of palliative care for patients with communicative and cognitive impairments from a variety of sources. The summary omits a list of the various themes found in the literature. The use of alternative communication techniques (such as visual aids and assistive devices) to improve patient-provider communication, methods for evaluating and managing symptoms in patients with cognitive impairments were considered. The authors examine issues such as the influence of individualised communication strategies on patient comfort and satisfaction.

Conclusion

Nurse-patient interaction in palliative care settings is essential for improving patients' quality of life and overall experience receiving treatment. In order to actively engage in their treatment and voice their end-of-life desires, patients must be able to communicate with their nurses in a way that develops trust, empathy, and understanding. Nursing professionals need to possess a variety of abilities to meet the different needs of patients and their families, including active listening, cultural awareness, and compassionate communication. Furthermore, interdisciplinary cooperation and communication are essential for delivering all-encompassing and holistic palliative care. However, there may be difficulties in communicating, necessitating that nurses change their approach and use techniques to encourage frank and open dialogue. In future, Healthcare professionals can provide patient-centred, culturally competent, and compassionate care that respects patients' autonomy and dignity while assisting them in navigating their end-of-life journey with peace and dignity by understanding the importance of nurse-patient communication in palliative care.

References

Cain, C. L., Surbone, A., Elk, R., & Kagawa-Singer, M. (2018). Culture and palliative care: preferences, communication, meaning, and mutual decision making. Journal of pain and symptom management, 55(5), 1408-1419. https://doi.org/10.1016/j.jpainsymman.2018.01.0077

Collins, A., McLachlan, S. A., & Philip, J. (2018). Communication about palliative care: a phenomenological study exploring patient views and responses to its discussion. Palliative medicine, 32(1), 133-142. https://doi.org/10.1177/026921631773524

Etkind, S. N., Bone, A. E., Lovell, N., Cripps, R. L., Harding, R., Higginson, I. J., & Sleeman, K. E. (2020). The role and response of palliative care and hospice services in epidemics and pandemics: a rapid review to inform practice during the COVID-19 pandemic. Journal of pain and symptom management, 60(1), e31-e40. https://doi.org/10.1016/j.jpainsymman.2020.03.029

Fan, S. Y., Lin, I. M., Hsieh, J. G., & Chang, C. J. (2017). Psychosocial care provided by physicians and nurses in palliative care: A mixed methods study. Journal of pain and symptom management, 53(2), 216-223. https://doi.org/10.1016/j.jpainsymman.2016.08.019

Givler, A., Bhatt, H., & Maani-Fogelman, P. A. (2020). The importance of cultural competence in pain and palliative care. StatPearls. https://europepmc.org/books/n/statpearls/article-41271/?extid=30521222&src=med

Hui, D., & Bruera, E. (2020). Models of palliative care delivery for patients with cancer. Journal of Clinical Oncology, 38(9), 852. https://doi.org/10.1200%2FJCO.18.02123

Kwame, A., & Petrucka, P. M. (2021). A literature-based study of patient-centred care and communication in nurse-patient interactions: barriers, facilitators, and the way forward. BMC Nursing, 20(1), 1-10. https://doi.org/10.1186/s12912-021-00684-2

Mayeda, D. P., & Ward, K. T. (2019). Methods for overcoming barriers in palliative care for ethnic/racial minorities: a systematic review. Palliative & Supportive Care, 17(6), 697-706. https://doi.org/10.1017/S1478951519000403

Molina-Mula, J., & Gallo-Estrada, J. (2020). Impact of Nurse-Patient Relationship on Quality of Care and Patient Autonomy in Decision-Making. International Journal of Environmental Research and Public Health, 17(3), 835. https://doi.org/10.3390/ijerph17030835

Montgomery, K. E., Sawin, K. J., & Hendricks-Ferguson, V. (2017). Communication during palliative care and end of life: Perceptions of experienced pediatric oncology nurses. Cancer Nursing, 40(2), E47-E57. 10.1097/NCC.0000000000000363

Roodbeen, R., Vreke, A., Boland, G., Rademakers, J., van den Muijsenbergh, M., Noordman, J., & van Dulmen, S. (2020). Communication and shared decision-making with patients with limited health literacy; helpful strategies, barriers and suggestions for improvement reported by hospital-based palliative care providers. PloS One, 15(6), e0234926. https://doi.org/10.1371/journal.pone.0234926

Radbruch, L., De Lima, L., Knaul, F., Wenk, R., Ali, Z., Bhatnaghar, S., ... & Pastrana, T. (2020). Redefining palliative care—a new consensus-based definition. Journal of pain and symptom management, 60(4), 754-764. https://doi.org/10.1016/j.jpainsymman.2020.04.027

Sue, K., Mazzotta, P., & Grier, E. (2019). Palliative care for patients with communication and cognitive difficulties. Canadian Family Physician, 65(Suppl 1), S19-S24. https://www.cfp.ca/content/65/Suppl_1/S19.short

Swami, M., & Case, A. A. (2018). Effective palliative care: what is involved?. Oncology. 32(4). https://search.ebscohost.com/login.aspx?direct=true&profile=ehost&scope=site&authtype=cr

Wallace, C. L., Wladkowski, S. P., Gibson, A., & White, P. (2020). Grief during the COVID-19 pandemic: considerations for palliative care providers. Journal of pain and symptom management, 60(1), e70-e76. https://doi.org/10.1016/j.jpainsymman.2020.04.012

WHO. (2020). Palliative care. https://www.who.int/news-room/fact-sheets/detail/palliative-care

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