23 - Clinician-Patient Communication Flashcards
What are patient expectations of health professionals?
- Technical expertise
- Accurate information
- Empathy/emotional support
- Access to services
- Continuity and coordination of care
It is a failure on the part of doctors to communicate caring that lies at the heart of most patients’ dissatisfaction with their decisions
In clinicians who are not sued, what do they do differently?
- Longer consultations (only by 3 minutes)
- Explicit agenda for patient
- Asked patients what they would like to discuss.
- Facilitating behaviours (empathy)
- Used humour and active listening
Use warm tone of voice
What is the SPIKES protocol?
- Setting
- Patient perception of condition and its seriousness
- Invitation from the patient to give information
- Knowledge: giving medical facts (simple language and avoiding jargon)
- Explore emotions and Empathise
- Strategy and Summary
In Duric’s (2003) study on empathy, what were the results?
- Patients whose 1st emotional cue was responded to with empathy gave significantly more cues (than those whose cues were ignored)
- Patients who received more empathic responses to their cues had significantly reduced depressive symptoms 3 weeks later
What did the 40 seconds of compassion study reveal?
“Standard videotape” vs. “enhanced compassion videotape” discussing treatment options for metastatic breast cancer.
Acknowledging patient’s emotional state;
- Significantly lessened patients’ anxiety
- Clinician was perceived as warmer, more pleasant and sensitive
What are the benefits in attending to emotional cues/concerns and providing adequate info and emotional support in consultation lead to?
- Faster recovery amongst patients (Average 1 day reduction in hospitalisation)
- Greater cooperation with treatment
- Fewer post-hospital complications
What is the best way to present risk?
- Use consistent framing when discussing pros/gains and cons/losses
- Provide base rates of outcomes
- Use absolute risk comparisons
- Provide information about the consequences of the risk
- Preferred formats are not always the best understood
- 100 dot/person diagrams: the greatest accuracy/understanding
- Check and re-check understanding of risk
- Best graphical format will depend on its intended purpose
In risk communication, what does simplification and analogies help with?
Simplification
- Give Gist (high or low risk, will get it or wont)
Analogies
- low; getting hit by lightening
- high; getting a cold
What do communication skills not exhibit?
They do not;
- reflect personality or natural talent of clinician
- improve with age or professional experience
Effective communication skills can be taught, maintained and improved
What were the results of the review of communication skills training?
Significant group differences
CST group more likely to;
- Use open ended questions
- Show empathy towards patients
No group differences
- Patient satisfaction and perception of clinician’s communication skills and clinician burnout.
CST courses appear effective in improving information gathering and supportive skills
- BUT, I is unclear which CST programs likely to work.
