Table 2.

Empathic Communication Throughout the Illness Trajectory

Suggested Phrases	Rationale
At time of diagnosis:
“What did the team share with you today?”	Explore what the family heard and understands; allows for any clarification.
“Given what you’ve heard from the team, what makes you most hopeful?” “What worries you the most?”	Allows for a better understanding of what the family’s hopes and worries are, further clarifies the family’s perception of the information.
“I can see this is not what you expected to hear” or “I can see this is difficult news to hear.”	Naming the family’s emotion can help to develop trust and a relationship with the family.
“It is so clear how much you love her.”	Providing respect statements to the family shows empathy.
Silence	Allows time for the family to process the information shared and allow space for their emotions.
When curative treatments are no longer available:
“I wish there were therapies available to treat the cancer.”	Align with the family’s hopes and says “no” without saying “no.”
“I worry that doing more treatments will not allow him to stay out of the hospital like he’s wanting.”	Provides a level of concern without certainty to help align with the family’s hopes.
“I wonder if you’ve thought about what would happen if he doesn’t get better?”	A way of entering difficult conversations or to explore if a family has considered an option beyond cure.
“Given what you’ve heard today, I wonder if you could share with me what are you hoping for?” “What else are you hoping for?”	Allows for a better understanding of what the family’s hopes are, begins to identify the family’s goals of care and what is important to them if cure is not possible.
At end-of-life:
“I wish there was something we could do to change this. I’m going to continue to monitor him to make sure he is comfortable; would you like to hold him as he is dying?”	Helpful when the family is struggling to not initiate resuscitative efforts; allows the family to know the condition cannot be reversed, that the child is actively dying and provides them with an active plan of “doing something.”
“I can’t even begin to imagine how difficult this is. Is there something we can do to be helpful right now?”	Provides the family comfort in knowing they are not alone.
Phrases to avoid:	Phrases to use instead:
“Withdraw care” – we never stop caring for our patients.	Redirection of care
“There’s nothing more we can do.”	“We will focus on those interventions which provide comfort and maximizes his quality of life.”
“I understand how you feel.”	“I can see how difficult this is for you.”