• Try not to rush
  
• Listen – aim to talk less than 50 per cent of the time
• Allow parents to express their emotions
• Ensure a ‘quiet’ parent is given opportunities to speak
• Demonstrate that you care about what is happening
• Demonstrate that you understand how much they love their child
• Sit with silence – families often say something important at the end of a pause.

It can be difficult to slow down when there are so many competing pressures, but an investment of time during advance care planning discussions is worthwhile.

Dedicating time to a discussion sends a signal to parents that you care about what is happening to them.

It’s also important to allow for periods of silence during the meeting. Families often provide profound insights after a long silence.

Check regularly that the parents are following what you are saying.

Things you can say:

‘I’ve just given you a lot of information. I just want to check I am not going too fast. Can you tell me what you understand of what I have said so far?’

Advance care planning is usually highly emotional for both families and staff. Parents will struggle to focus and think clearly when they are very sad, angry or afraid. It is important to allow some time for them to express these emotions.

Things you can say:

‘I can’t imagine how difficult this must be. Can you tell me what you are feeling right now?’ ‘I can see how sad you are feeling.’

‘This must be so hard to hear.’

It is not uncommon for one parent to be quiet or even silent during the discussion. Ensuring they are given opportunities to contribute is important. In some cases, it may be that one parent is better able to communicate in English than the other.

Things you can say:

‘Sometimes it is hard to talk about these things. (Parent), I just want to make sure we give you the chance to ask questions or let us know what is on your mind.’

One of the most common complaints from parents is that doctors, nurses and other professionals often seem ‘unmoved’ by these discussions. This is probably because health professionals wish to convey a sense of calm and professionalism. It is possible and appropriate, even helpful, to show genuine emotion while remaining strong for the family.

You may find yourself talking quickly or a lot, perhaps taking refuge in long-winded medical explanations, particularly if the family is very quiet or very distressed.
Talking can help you manage your own anxiety and can provide a distraction from powerful emotion – but you may miss something important. Remember also that patients and parents often say something crucial after a long period of silence.