Communication CBM Flashcards
1
Q
What are the principles of patient-physician communication in palliative care?
A
- reduces distress
- improves adherence to care
- Improves satisfaction
- communication with physician is one of the most important factors at end of life.
2
Q
List barriers to effective communication
A
- Discomfort asking questions
- Pre-existing misinformation
- lack of trust in health care system
- language barrier
- cultural barriers
- Physician fears about diagnosis
- Physician difficulty dealing with emotions
3
Q
FIFE
A
- Feelings
- Ideas
- Function
- Expectations
4
Q
Breaking Bad News
A
- Since 1970s, 97% patients indicated would want to know if they had cancer.
- Disclosure of diagnosis and prognosis is norm in western countries / Anglo-Saxon origin
- Most patients wish for full information, shared decision making
- Highly educated, younger and female patients most likely
- Other cultures variable
- Physician underestimate patients’ desire for information
- Make NO ASSUMPTIONS, individuals vary.
- ASK how much information they would like
5
Q
SPIKES
A
- SETTING
- environment, review chart, privacy, dedicated time, all family members, introductions, sit down
- PERCEPTION
- What does patient understand about their situation?
- KNOWLEDGE
- let the patient know bad news before further details
- non technical language
- slow pace, check for understanding
- clear words, not excessively blunt
- discuss news and plans for future
- EMOTIONS
- Silence, empathy
- STRATEGY/SUMMARY
- not too long of a meeting
- make a plan for future (treatment, test, follow up)
- summarize the information
6
Q
How would you respond to requests from family or friends for information about a patient?
A
- first responsibility to patient
- confidentiality
- cannot disclose without explicit consent
- Explore why
- don’t want to cause stress/be a burden
- financial concerns
- fears about stigmatizing
7
Q
Prognosis sharing
A
- inaccurate information sharing
- misunderstood
- unable to process information
- understand why prognosis is important (attending specific event for example)
- “Not curable”
- range of time (short days, weeks, short months, etc)
- important to convey you will not abandon them
8
Q
Prognosis and hope
A
- importance of not removing all hope during communication of bad news
- hope: “expectations of something that is realistically possible”
- some patients prefer ambiguity about the future
- Can respect patient’s desire to not have details about prognosis
- Hope may evolve as disease progresses (cure to more time to quality of life to peaceful death)
- I wish, I worry, I wonder
9
Q
When would you need to hold a family meeting?
A
- ensure all family members are on the same page
- change in status in patient
- change in treatment plan
- discord among family
- plan for discharge
10
Q
Family conference
A
- therapeutic intervention in pall care
- indications : change in status, change in treatment plan, discord among family members, discharge planning
- Pre-meeting with team
- private setting, circle, let hospital roommates know, all family members and professionals required
- Format:
- Introductions
- Goals/agenda
- Ask for input
- Clarify family/patient current understanding
- Summarizes current situation/medical information from the point of view of treating team
- Move towards a treatment plan/goals for care
- Summarize
- Designate a family spokesperson
11
Q
Denial
A
NURSE ACRONYM
- NAME the emotion
- UNDERSTAND : normalize the emotion
- RESPECT : state your appreciation of efforts
- SUPPORT: focus on patient and needs and offer help
- EXPLORE: open up discussion to the emotion or distress
Denial can be an inaccurate label for a patient or family member without adequately addressing person’s point of view and suffering.
12
Q
Substitute Decision Making
A
- Canada : partner/spouse > adult children > parents > siblings
- families with higher levels of pre-existing conflict likely to have stronger preferences for life prolonging care.
- Advanced care planning reduces conflict and stress
- SPIKES approach with family members
- What do they feel family member would want?
- Explore what the patient has expressed about their QOL
- Outline severity of condition, recent history
- Discuss risks vs benefits of each proposed course and impacts
- Burden without benefit
- Provide guidance
- If no consensus :
- postpone decision making
- time limited trial of therapy
- Third party (ethics, ICU, etc)
13
Q
List barriers to discussion of imminent death with family
A
- unrealistic hope
- lack of definitive diagnosis or event causing death
- poor communication skills
- concerns about what interventions, medications, treatments might be requested.
- fear of shortening life
- cultural, spiritual barriers
NOT DISCUSSING IMMINENT DEATH:
- loss of trust
- dissatisfaction with quality of death
- uncontrolled symptoms
- family members not being present
- unmet cultural and spiritual needs
- inappropriate interventions
14
Q
After Death
A
- Time for spiritual/religious rites
- Practical matters (death certification, morgue, funeral home)
- primary health care provider make contact with family
- grief and bereavement support
15
Q
Avoiding Physician burnout
A
- emotional exhaustion
- depersonalization
- cynicism
Strategies:
- transcendental perspective
- hobbies
- clinical variety
- setting boundaries
- personal relationships
- team debriefing
16
Q
Defining patient centred
A
- eliciting patient perspective
- understanding patient social context
- shared understanding of problem and treatment in context of patient values and goals
- empowerment of patient to be involved in decision making
17
Q
List domains of effective communication between patients and physicians
A
- adequate information
- receptive
- balance between honestly and empathy
- response to patient concerns
- attention to emotion
patients want open ended empathetic approach with quality interactions rather than quantity.
18
Q
Communication TIPS
A
- ASk about communication preferences (discussion vs recommendation)
- open ended questions
- respond to affect and emotion
- ask before telling
19
Q
Evidence based communication
A
- Prepare
- communicate face to face
- open ended questions
- solicit patient agenda
- ask permission - do not assume how much patient wants to hear.
- ask tell ask
- empathize NURSE acronym
- praise
- wish statements
- “hope for the best”
- “are you are peace” - screen for spiritual distress
- use interpreters
20
Q
WHy should you use interpreters vs family translation?
A
- risk of faulty translation or reinterpretation
- puts family members in difficult spot being spokesperson
- risks:
- important medical information may not be understood or may not have terminology for it
- issues of confidentiality
- may be abbreviated, filtered or omitted information
21
Q
Stages of Grief
A
Denial
Anger
Bargaining
Depression
Acceptance
Kubler Ross
22
Q
Principles of good interprofessional communication
A
- Attitude of curiosity
- Communication on many levels at once (emotion, non verbal)
- Conflict management
23
Q
SBAR
A
Structured communication when reporting a concern/handover
SITUATION
BACKGROUND
ASSESSMENT
RECOMMENDATION
24
Q
Interdisciplinary feedback
A
- SBAR
- Dedicated forums for feedback (debriefs, m and m)
- organization with flattened hierarchy
- open no fault culture when address med errors
- culture of psychological safety
25
Q
Factors that improve referring physicians compliance with consultant recommendations
A
- response within 24 hours
- 5 or fewer recommendations
- Identification of critical recommendations
- focus on central issues
- definitive language
- specifity on drug dose, route, frquency, duration
- frequent follow up
- written documentation
- direct verbal contact
- therapeutic recommendations
26
Q
Barriers to palliative care consultation
A
- fear of palliative care agenda to stop aggressive treatment
- physican emotion
- difficulties in addressing specific questions - whole person
- fear of addressing dying
27
Q
Communication as a consultant
A
- Curiosity - non judgmental
- Humility
- Transparency
- Clarity
- Judiciousness
28
Q
Palliative care in the Media: public engagement
A
- public forums
- special interest groups
- news media
- speaker’s bureau of local experts
29
Q
Engagement with politicians
A
- home care, EOL, aging strategy can be a minefield
- Risk of biting the hand that feeds you
30
Q
Speaking with news media about palliative care : tips
A
- stick to own key messages
- do not allow reporter to manage your interview or guide questions
- no such things as off the record
- social media and internet are permanent and news media but fewer rules of engagement
31
Q
PLanning for media engagement, public or government speaking
A
- Who are you talking to?
- what is now in their minds?
- research audience
- what is objective of communication?
- How do we convey that message?
- How do we know we are right?
- give evidence
32
Q
List benefits of effective communication
A
- reduces patient distress
- improves adherence to treatment
- improves satisfaction with care
- improve informed decision making
- increase delivery of high value care
33
Q
Describe types of questions that are useful in family meetings
A
- Circular - around the table
-
Reflexive - invite family to reflect on possibilities
- what benefits might come from having your dad at home? In what ways might it be hard?
-
Strategic - to guide family toward an outcome
- “what level of agitation would need to occur for you to decide on admission to hospice?”
-
Integrative summary:
- family’s views reflected back wtih neutrality and promotion of problem solving
