Communication Framework

Question 1

Communication framework
(M: IT ID CE FB AE C)

Answer 1

A. Introduction
- Introduce yourself: Good morning, my name is Dr __
- Confirm identity: Am I speaking to ___

B. Task
- The reason we are here today is to __
Hold off saying sensitive information at this stage (SPIKES)

C. Ideas (choose 1 opening)
- What have you been told so far about your condition
- Have you been informed anything about this condition before we start?
- Have you any ideas about this condition

D. Diagnosis and Explanation +/- warning shots
- Provide warning shots
- Explain in details about the condition and etc in Layman terms

E. Concerns
- What are your concerns? What are you worried of in particular?

F. Expectations and reactions

G. Feelings
- I understand this news must be quite traumatising, how do you feel?
- Acknowledge feelings and provide empathy

H. Background
- Explore background and personal history
- Explore previous encounters or stories

I. Agenda
- Explore on hidden agendas

J. Ethics conflict

K. Conclusion and way forward

Question 2

Ethical principles in communications

Answer 2

A. Beneficience
- Duty to do good and of patient’s best interest

B. Non-maleficence
- Avoid doing harm
- Weighing risks and benefits

C. Justice
- Universal fairness and equity
- Avoid discrimination, abuse or exploitation

D. Autonomy and dignity
- Respects patients capacity to think and decide, and act on basis of such thought and decision freely and independently
- Even if their decisions are not the best course of action

E. Confidentiality
- Upholding patient’s rights for confidentiality

Question 3

Discussing “incurable” but treatable conditions

Answer 3

1. The condition can be potentially serious but treatable and controlled with medications
2. It may return without treatment
3. Nevertheless it is likely to be fully controllable
4. May still lead a normal and healthy life with good control, on top of leading a healthy lifestyle

Avoid using the term “incurable” even if it is so

Question 4

Explaining an investigation or procedure

Answer 4

1. Description of the investigation
2. Purpose/indication
   - Diagnostic
   - Therapeutic
   - Monitor response to treatment
3. Risks involved
4. Alternatives and their downsides

Question 5

Explaining benefits and risks of treatment

Answer 5

1. Explain as accurately as possible
2. Explore any prior experience/stories
3. Reassure patient that many others are taking the same treatment, and approved by larger body of current medical opinion
4. Balancing side effects with benefits. Reassure monitoring for side effects
5. Advise to stop if symptoms occur

Avoid overwhelming patients with studies outcomes

Question 6

Balancing prescribing for older people

Answer 6

1. Review indications
2. Review side effects and limit prescribing
3. Do not withhold treatment that works
4. Stop inappropriate medications
5. Be imaginative with routes of administration
6. Consider concordance - medication list with reasons for each

Question 7

Issues to be aware of in managing older people

Answer 7

1. Reduced body reserve
2. Atypical presentation
3. Multiple problems
4. Polypharmacy
5. Social adversities

Question 8

Risk perception, response efficacy and self efficacy

Answer 8

Risk perception can determine risk reducing behaviour
- People who are able to perceive increased risk will adopt risk reducing behaviour
- However it may be difficult to motivate, or downplayed by people, thus failure to adopt it

Risk perception:
- Likelihood: probability of event occuring
- Severity: how severe when it occurs

Risk communication - shares information about risk, how to reduce it and ensure patients have confidence to change their behaviour

Response efficacy
1. Outline benefits to current disease
2. Widespread benefits of preventing other diseases

Self efficacy
1. Explore on expected outcomes
- Desire to return/maintain normal life
- What do you think may impact family life if you are ill again?
- What are the chances of the disease happening again?
2. Consequences in future of failing to modify behaviour
3. Baby steps if modification is too hard
- Slow reduction in smoking with eventual aim to stop completely
- Incremental exercise regime
- Healthy diet with cheat days to maintain quality of life
4. Support networks and assistance