5.1 (6.1) communication with patient and family Flashcards
List four situations in PC where difficult discussions with patients/family may arise
delivering bad news discussing prognosis eliciting goals of care identifying tx options saying goodbye
What are four components of patient centred care/communication
eliciting and understanding patient perspective
understanding psychosocial context
achieving a shared understanding of the problem and its appropriate treatment in the context of pt preferences and values
empowerment by involving patients actively in the decision making
Other than being patient centred, name THREE important domains in communication w/ physicians
◆ Provide adequate info that is straightforward and understandable
◆ Clinicians to be receptive when patients are ready to talk
- a balance between empathy and honesty
◆ Want doctors to elicit & respond to patient concerns and attend to emotion
◆ Want as much info as possible about symptoms, treatments, side effects
- 15-20% do not want to discuss survival
◆ Maximize quality interactions rather than quantity
Provide three examples of how a physician might balance empathy and honesty
- leave open the possibility that unexpected miracles may occur (or at least do not dispute pt claims of such)
- discussing outcomes rather than cure that can offer patients hope and meaning
- emphasize what can be done, explore realistic goals and discuss day to day living
List four ways a physician can help elicit patient concerns when communicating
maintaining good eye contact
asking open ended questions
focusing on patient concerns as well as agenda
responding to the patient’s affect
asking about the patient’s life outside of their illness and the healthcare environment
attending to psychosocial concerns
ensuring non-verbal behaviour signifies attentiveness
List three things that inhibit the ability of a physician to elicit patient concerns when communicating
closed ended or leading questions
focusing on physical aspects of illness
offering advice and premature reassurance inhibit disclosure of patient concerns
List four features of communication that are linked to decreased patient satisfaction with care
lack of warmth or friendliness
emotional distance
failure to consider patient concerns or expectations of the encounter
unclear explanations about a diagnosis or cause
use of medical jargon
List four communication factors that improve family experiences of communication
including family in the decision making process
open honest communication
assistance with practical supports at home, psychosocial support, equipment
dislike for the notion of false hope and avoidance of prognostic discussions
listened to and feel heard
like to be contacted after the death
You are designing a communication workshop to enhance the communication skills of local physicians. What are the four steps in the workshop that you will employ to enhance communication teaching?
observe behaviour well done
practice while being observed themselves
receive feedback
opportunity to try again
What are the 4 principles that all models of communication have in common?
assess patient’s preference for communication as part of encounter
information given using non technical language in brief understandable chunks
discuss treatments in the framework of function and relationships
attention to the affective component of the conversation is as important as the cognitive aspects
You are meeting a patient and family to discuss the results of a CT scan which shows progressive malignancy despite treatment. After creating an appropriate setting what 6 steps will you take?
assess patient’s perception
invitation to share information
delivering the ‘knowledge’
offering empathy
summarizing
strategizing
What are five ways that empathy can be offered to a patient and their family in the midst of a family meeting?
Name ‘i imagine this might be upsetting’
Understand ‘i expect most people would feel that way in a setting like this’
Respect ‘im impressed at how well you have handled such a tough decision’
Support ‘ill be here to help you through this’
Explore ‘tell me more about how you are feeling and what this means for you’
List 6 techniques for improving communication with a patient and their family
whenever possible communication face to face
use open ended techniques
solicit the patient’s agenda
ask permission
ask-tell-ask
Empathize
praise - ie you have been a truly remarkable advocate for your husband
Use ‘wish’ statements’
‘hope for the best’
‘are you at peace?’
use interpretters
List four outcomes of “good communication:”
decreased anxiety in pts with cancer
improved prognostic concordance b/w physicians and their patients
better matching of treatments with pt’s preferences and goals
improved pt satisfaction
improved compliance with treatments
