Clin Comms Flashcards
what are patient centered interviews?
- interviewer identifies, acknowledges, responds to pt in a way that encourages pt participation
- ensures their agenda is part of the consultation process
what do PCI’s contrast with?
paternalism
what are the advantages of PCIs for clinicians?
- basic medical tasks are accomplished
- informative
- facilitative
- responsive
- participatory
what are the advantages of PCIs for pts?
- explore pt reasons, concerns and need for info
- integrated understanding of pt world
- common ground with pt and dr
- enhances prevention and health promotion
- enhancing relationships
what is the calgary-cambridge model?
describes the different stages of a consultation
What are the stages of the Calgary-Cambridge model?
- initiation (initial rapport, reason for consultation)
- info gathering (exploration of pt problem)
- physical exam
- explanation and planning (provide correct amount of info, check understanding, shared decision making)
- closing session
THROUGHOUT: - building relationship
- provide structure
what are some non-verbal cues the pt may show?
- wincing in pain
- reduced eye contact if embarassed
- body posture
- reduced attention is irritated
what are the types of non-verbal communication that the pt may use?
- physical touch
- body language
- proximity
- eye contact
- expression of emotion
what is the iceberg model of cultural infulences?
identifies how some cultural influences may be readily apparent whilst other major influences are hidden and may not be recognised by HCP
what is the iceberg model used to explain?
it is used to explain how differences in nationalities and languages can be experienced as cultural barriers to effective communication
what are cultural beliefs that can affect our view towards healthcare?
- interpretation of symptoms
- beliefs about causation
- beliefs about efficacy of alternative treatments
- attitudes towards illness and disease
- gender/ age expectations about relationships
- role of doctor related to power
- perceived responsibilities about adherence to medical recommendations
- family life events
- psychological issue
- role of clinician in mental health
what are some sensitive cultural issues?
- sexuality/ birth control
- physical exam
- alcohol use/ abuse
- domestic violence
- breaking bad news
- problems encountered by refugees
what are barriers to the dr in cultural communication?
- extent of dr-pt relationship
- extent of family involvement
- ethical issues in care
- doctor’s stereotyping and prejudice
- concurrent consulting with alternative medicine practitioner
what are the aims of effective communication with pt?
- provide correct amount/ type of info
- aid accurate recall and understanding
- achieve shared understanding
- shared decision making and planning
what is the name of the model used for effective communication with pt?
Calgary Cambridge Model
what are some skills to achieve effective communication?
- check what pt already knows
- determine amount of info pt wants
- what are they concerned about
- use logical sequence
- use explicit signposting
- relate to ICE
- use repetition and summarise
- explain medical terms
- use visual methods to trigger pt questions
- check pt understaning
- provide opportunities for pt contribution
- pick up on verbal/non-verbal cues
- listen attentively
- explain causation, diagnosis, test etc
- check if pt has Q’s
- ask about anxieties
- discuss negative outcomes
- use specific advice
what are the 2 methods of describing risk?
- verbal
2. numerical
what us informed consent?
permission granted in full knowledge of the possible consequences, typically that is given by a pt to a dr, for treatment with knowledge of the possible risks and benefits
what is something that would dec pt understanding?
- when a dr does not engage with ICE
- also less likely to align with dr recommendations in this situation
what does engaging with a pt ICE ensure that?
- pt can fully evaluate info
- informed decision making is enabled
- pt more likely to comply
- pt will have better grounds for understanding
- dr and pt establish common ground for mutual decision making
how do you find out pt needs and shared understanding?
- check what they know
- ask concerns
- ask how much detail they want
how do you deliver info in shared understanding?
- explicit oppurtunities for clarification
- relate explanations to ICE
- use signposting
How do you break bad news?
- Ensure pt/relatives are in private room
- ensure they know who you are
- keep intro short
- sit if pt is seated
- establish what they already know
- acknowledge pt view, prepare ground
- be direct, allow pt to respond
- allow relatives to ask Q’s
- move to discussing next stages
- give positive, practical support
- offer follow up appointment, helpful agencies, telephone no
what is the SBAR format?
handover structure
- Situation
- Background
- Assessment
- Recommendations
what is the purpose of a handover?
- efficient transmission of info about pts between HCPs
- provides continuity of care
- promote pt safety
- demonstrate team approach to care
- educational for MDT
- can identify range of problems
what are the obstacles to an effective handover?
- insufficient time/prep
- insufficient attention to handover
- not reading written handover
- incomplete handover
- imprecise role function
- omission of critical medical and nursing factors
- multiple conversations simultaneously
- team receiving handover not engaged
- inadequate info tech
what are the benefits of an effective handover to doctors?
- educational
- professional protection
- reduced stress
- job satisfaction
what are the benefits of an effective handover to patients?
- improved safety
- less discontinuity of care
- dec repetition
- inc service satisfaction
how do you maximise learning during handovers?
- listening to clincial info
- doing handovers
- use structured template to process info
- interactions with experienced staff
what are the characteristics about sea level in the iceberg model of cultural influences on communication?
- age
- gender
- ethnicity
- nationality
what are the characteristics below?
- socioeconomic status
- occupation
- health
- previous health experiences
- religion
- education
- sexual orientation
- cultural beliefs
