Using Communication Skills for Difficult Conversations in Palliative Care: 'Suffering is Not a Question Which Demands an Answer, It is Not a Problem Which Demands a Solution, It is a Mystery Which Demands a "Presence".' (Anonymous‪)‬

Palliative care is a field that is rich with opportunity and the need for clear, unambiguous and direct communication. The nature of the illness that brings a palliative care team into the management of a patient and family -- the 'unit of care' -- makes it all the more likely that difficult conversations will already have taken place. The breaking of bad news, such as the diagnosis of metastatic cancer or WHO stage 4 HIV/AIDS, has often taken place in suboptimal circumstances and the palliative care team sometimes has to revisit the conversation to assist the patient to come to terms with the diagnosis and the way the diagnosis was given. The general practitioner is sometimes the doctor who conveys bad news, but also receives the patient back from specialist investigation with the diagnosis of a life-threatening condition. Both situations require excellent communication, which the GP is well placed to offer, as the patient feels secure with the doctor who has been responsible for the care until then and who will continue with that care in the future. This principle of continuing care is well established in family medicine and primary care. The GP cares for the patient in context and also for other members of the family who are affected by the diagnosis.