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. 2021 Jan 1;12(1):89–95. doi: 10.6004/jadpro.2021.12.1.7

Table 3. Nonverbal and Verbal Communication Strategies.

Nonverbal strategies
• Create an appropriate environment to help the patient feel safe and comfortable.
 » Ensure privacy.
 » Prevent interruptions (silence call notifications, electronic devices, television, etc.).
 » Ensure adequate time.
 » Remove physical barriers (e.g., tables, chairs) between you and the patient.
• Maintain a relaxed and non-hurried, open posture, paying undivided attention and conveying a sense of respect for personal space.
 » Sit down and face the patient at eye level. Place your hands on your lap or on the arms of the chair.
 » Do not fidget or multitask.
• Make appropriate eye contact. This denotes emotional connection and helps patients engage. Watch for cues indicating a patient is uncomfortable with eye contact (e.g., gazing away).
• Observe the patient’s level of comfort.
 » Address any discomfort, such as pain or anxiety.
• Use appropriate touch: Gently touch arms, hands, or shoulders, as it demonstrates empathy.
 » Watch for cues that a patient is uncomfortable with touch.
 » If a patient starts crying, move closer to them, offer a tissue, and if they are comfortable with touch and closeness, gently touch them.
• Practice active listening.
 » Lean in towards the patient.
 » Nod.
 » Say “hm” or “uh-huh.”
• Listen without interrupting. This allows the patient to respond at their pace.
 » Be comfortable with silence.
Verbal strategies
• Speak slowly and clearly using simple, everyday language. This helps the patient to understand and digest what is being said.
 » Use short words and sentences.
 » Use a friendly and comforting tone.
 » Use the patient’s preferred language (with language translator).
• Speak honestly and in a straightforward manner. Patients value open and honest communication.
• Avoid medical jargon, as it may cause confusion.
• Avoid saying “if” or “but,” as it may cause fear and confusion.
• Pause often. This helps the patient to reflect on what is been said, ask questions, or make comments.
• Use open-ended questions. This elicits responses that are often descriptive and elaborative, allowing better understanding and providing opportunities from which to draw further questions.
• Respond to emotions by verbalizing empathy. This conveys respect and compassion.
 » “I can’t imagine how difficult that must have been for you and your family.”
 » “I admire your willpower to fight this.”
• Explore the meaning of ambiguous words and phrases.
 » In response to “I don’t want to be a vegetable,” ask, “What does being a vegetable mean to you?”
 » In response to “I want to die with dignity,” ask, “What does dying with dignity look like to you?”
• Use screening questions. This allows the patient to add additional information before the next question.
 » “Is there something else you are afraid of?”
• Paraphrase what you have heard. This shows that you were listening and provides the patient an opportunity to clarify any misunderstanding and/or provide further information.
• Check for understanding. This ensures that the patient understands what has been said.
 » “Now that you’ve heard about the responsibilities of a surrogate decision maker, who would you like to trust in this role to make decisions for you if you are unable to yourself?”
 » “I understand that you do not want to be like a vegetable. Do you mean a do not resuscitate order?”
• Summarize the conversation to ensure a mutual understanding of what has been discussed.
 » “Now that you understand your disease status, am I correct in understanding that your goal for treatment is…?”
 » “As you mentioned, your goal is to be comfortable and to be able to go home. Would you like me to get our palliative team on board to help you with managing your pain and symptoms?”
 » “Would you like to discuss this with anyone else in your family before you make final decisions and advance directives?”