The importance of language in palliative care is paramount, as it is a fundamental therapeutic tool. Therefore, it must be clear, empathetic, compassionate, adapted to the patient’s pace, and person-centered, in order to preserve their dignity, foster their trust, and facilitate decision-making without false expectations or technical jargon. Complementing this language with nonverbal communication (our gaze, our smile, our presence, etc.) intensifies its therapeutic effectiveness.

The key pillars of communication and language are four:

1. Clarity and sincerity are key. Confusing euphemisms and medical jargon should be avoided. Information should be provided gradually and tailored to the patient’s wishes.
2. Empathy and active listening are essential. It’s necessary to validate the patient’s emotions. Using open-ended questions allows you to identify their true concerns and needs.
3. Non-verbal language. Eye contact, smile, tone of voice, physical closeness, and touch are fundamental expressions of support and emotional validation, and are very useful when the patient suffers from dementia or speaks a different language.
4. Realistic hope. At this stage, hope is not focused on a cure, but on comfort, quality of life, and emotional well-being.

We must be very careful with our language when we are with a patient in such a vulnerable situation as being close to death. We must avoid certain types of language, such as those I will mention below.

Expressions of struggle and war, such as “we have to fight,” “it’s a battle you have to win,” or “we’ve lost the war against cancer,” should not be used. These expressions convey the idea that death or deterioration represents a failure or a lack of will on the part of the patient.

Nor should false encouragement or clichés be used, such as: “everything happens for a reason,” “you have to be strong,” “you’ll see, you’ll get through this.” Expressions like these tend to invalidate the pain and force the patient to repress their emotions to please those around them.

Ambiguous or minimizing language is also not advisable, such as saying,  “Don’t worry,” or “Don’t cry.”  Minimizing what the patient is feeling will prevent them from expressing their fears and processing what they are experiencing.

What we should never use in palliative care is the devastating phrase  “there is nothing more that can be done”  because, although medically a curative treatment is no longer an option, in palliative care  there is always “much that can be done”  such as relieving suffering, providing comfort, caring, accompanying, etc.

Using a diagnosis as a label is disrespectful to the patient, as we shouldn’t reduce their identity to their illness by saying things like,  “They’re terminally ill,” or “They’re receiving palliative care.  ” Even worse is asking questions like,  “How was the night, cirrhosis patient 224?”  We must remember that the patient is still a person with a name, a family, and a life story.

And finally, we must avoid white lies, such as concealing the prognosis or lying about the severity of the condition. Honesty is essential so that the patient can make informed decisions about their life.

Once we’ve reviewed what not to do, let’s consider some recommended language alternatives:

We can prioritize emotional validation with expressions such as:  “it’s normal to feel this way”, “I’m here to listen to you”, “tell me what you need”.

We can focus on comfort by saying,  “Our goal now is for you to feel no pain and be as comfortable as possible.”

It was Dr. Cicely Saunders who used a phrase in palliative care language that has guided many professionals in how to address our patients, expressing our helpful attitude. The phrase I’m referring to is:  “You matter because you are you, and you matter until the very last moment of your life.”

Article published on the website of the  San Juan de Dios Hospital in Santurtzi (Bizkaia)