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You must uphold people’s rights to be fully involved in their care.

There are four essential features of maintaining dignity in communication.

1. Attitude. Being aware of the other person’s experience, our attitudes towards them and how this affects the care provided.

2. Behaviour. Being respectful and kind, asking permission, giving your full attention and using understandable language.

3. Compassion. Being aware of and in touch with our own feelings and ‘acknowledging the person beyond their illness’ (Chochinov 2007, p.186).

4. Dialogue. Being able to demonstrate an appropriate knowledge of the patient’s history, experience and family context. You might usefully make educated guesses about the likely experiences of the patient, for example ‘It must have been difficult to have received the news at that point in your life’.

The Code also makes explicit the responsibility to be aware of the legislation regarding mental capacity, a factor that can have a significant impact on communication. The Mental Capacity Act (2005) sets out guidance. Firstly, always presume people have mental capacity unless they:

are unable to understand information given to them to make choices

can understand but are unable to retain the information

are unable to weigh up and relate the information accurately to their situation

are unable to communicate their wishes or choices (by any means).

(BMA 2007)

If any of these factors are in question, the Mental Capacity Act (2005) recommends that determining an individual’s decision-making capacity is best achieved through multidisciplinary assessment. A separate assessment of capacity must take place for every decision involving the individual. Brady Wagner (2003) specifies four key areas that need to be fulfilled in order to have the capacity to make a decision.

1. Understanding the diagnosis and other information given regarding treatment and non-treatment options.

2. Manipulating those options and consequences in relation to one’s personal values and goals.

3. Reasoning through a decision.

4. Communicating the preference/decision.

The mental capacity of an individual needs to be considered in any communication but particularly if it involves the patient making a decision about treatment or care options and in respect of consent. At any time before making any referral for further support, it is important that the patient fully understands and consents.

The Equality Act (2010) reinforces the duty to ensure that everybody, irrespective of their disability, sex, gender, race, ethnic origin, age, relationship status, religion or faith, has equal access to information and is communicated with equitably. This means, for example, that provision is necessary to meet the information needs of blind and partially sighted people (Section 21 of the Disability Discrimination Act, October 1999).

People from black and minority ethnic (BME) groups constitute 6% of the population in the United Kingdom (Dein 2006). Originating primarily from the Caribbean, Africa, South Asia and China, the majority of people falling into this group continue to maintain strong cultural links with their countries of origin even after being resident in the United Kingdom for several generations.

Communication needs are individual and information requirements are also culturally sensitive. People may hold different beliefs about why they have developed an illness, for instance thinking that they are being punished for something that they may or may not have done (Dein 2006).

Medical language is full of technical vocabulary and jargon which is often difficult to comprehend even for native English speakers. Macdonald (2004) suggests that people from BME groups may often come from communities where the opportunity for education is limited, thus making it increasingly difficult for them to comprehend the information that has been provided, particularly when their first language might not be English. Macdonald states that ‘sentences should be short, clear and precise