My experience in the palliative care world.

Gauging what a patient knows about their diagnosis is one of the most important foundations of compassionate communication. As clinicians, we often enter a conversation fully aware of the diagnosis and plan of care. For our patients, the picture isn’t so clear. Fragmented information, varying information from specialists, medical jargon, fear, or avoidance may shape their understanding. Before we can effectively educate or plan, we have to pause and listen.

An empathetic approach begins with openness rather than instruction. Instead of leading with the facts and checking boxes, start by inviting the patient to share their perspective. As Boyd et al. (2012) and the Maryland Department of Health (n.d.) note, starting with a question such as “Can you tell me what you understand about what’s been going on with your health?” allows patients to express their current understanding in their own words.  These kinds of prompts shift the focus from delivering information to creating dialogue, helping you discover what they know, what is medically important to them, and how they feel.

When listening, attend to emotion as much as content. Patients often share their fears and medical misconceptions covertly. Comments like, “I’m scared this might not get better,” or “They said it’s a less aggressive cancer,” carry meaning beyond the surface. Listening without interruption allows emotion to surface—and that expression of emotion is the foundation of trust. Reflecting what you hear, such as “It sounds like you’re worried about how this will affect your daily life,” signals empathy and understanding.

It can be tempting to lay out all of the facts, but doing so too quickly can create defensiveness and mistrust, both of which can hinder future communication. It’s often more effective to acknowledge the patient’s perspective first.  A helpful tool I have adopted from the Vital Talk platform is the “Ask-Tell-Ask” framework (VitalTalk, n.d.): first, ask what the patient knows or wants to know; then tell them relevant information in clear, compassionate terms; finally, ask again to confirm their understanding and invite their questions. This approach keeps the exchange collaborative and paced to the patient’s emotional state (VitalTalk, n.d.).

When we take time to gauge what the patient knows, powerful things occur. The conversation shifts from merely delivering news to building a connection. Patients feel less overwhelmed and more empowered to participate in their care. For clinicians, it clarifies where to focus in future meetings, whether on education, advocacy, or emotional support. In many ways, this practice is not just about communication—it is about care in its most human form.

Morris DA, Johnson KS, Ammarell N, Arnold RM, Tulsky JA, Steinhauser KE. What is your understanding of your illness? A communication tool to explore patients’ perspectives of living with advanced illness. J Gen Intern Med. 2012 Nov;27(11):1460-6. doi: 10.1007/s11606-012-2109-2. Epub 2012 May 26. PMID: 22638605; PMCID: PMC3475827.

VitalTalk. (n.d.). VitalTalk: Serious illness communication skills for clinicians. Retrieved from https://vitaltalk.org

Boyd, E. A., Lo, B., Evans, L. R., Malvar, G., Apatira, L., Luce, J. M., & White, D. B. (2012). What is your understanding of your illness? A communication tool to explore patients’ perceptions of their illness. Journal of General Internal Medicine, 27(11), 1460–1466.

Maryland Department of Health. (n.d.). Serious Illness Conversation Guide. https://health.maryland.gov/phpa/ccdb/ADP/Documents/Serious-Illness-Conversation-Guide.pdf