Communication skills

Question 1

What is good communication styles?

Answer 1

Patient-center, shared decision making

Question 2

What makes good communication from the Patient’s perspective?

Answer 2

• Complete information. - Clarification of the future/ “What to expect?” - Opportunity to express emotions/concerns - To feel respected and cared for

Question 3

Patient-centered Communication: guideline

Answer 3

• Establish a partnership - Establish common ground - Understand psychosocial factors - Understand patient’s experience of illness - Be proactive: EOL issues

Question 4

Barriers?

Answer 4

Poor concentration, emotional overwhelms, medical illiteracy, cultural issues.

Question 5

12 steps to family meeting

Answer 5

1. Pre-meeting planning 2. The setting 3. Set the agenda 4. Build trust 5. Assess understanding 6. Review understanding 7. SILENCE 8. Address emotion 9. Manage conflicts 10.Present the options 11.Establish the plan 12.Summarize

Question 6

Step 1: Pre-meeting planning

Answer 6

information, co-ordinate with all involved MDs, goals, who to present and to who.

Question 7

Step 3: Set the agenda

Answer 7

3. Set the agenda MD’s goal “I would like to review your understanding of the current medical situation. I will then fill in any details and clarify any misunderstandings. Finally, based on our conversation, we will establish a plan that meets your goals.” Pt’s goals: “Are there any other topics that you would like to address today?”

Question 8

Step 4: Build trust

Answer 8

• Sit down; eye contact - Use names: introductions, relationships - EXPRESS empathy (can decrease anxiety): “I wish things could have been difference.” “ It might be difficult” - let THEM talk - Acknowledge concerns/ NOT defensive - Do NOT force decision/ explore and allow room to back off - Use THEIR terms/ words

Question 9

Step 5: Assess Understanding

Answer 9

• “Can you tell me what you have understood from what the doctors have told you?” - “Have you noticed any changes in your body since you started treatments?”

Question 10

Step 6: Review your understanding

Answer 10

• Ask before inform: “Would you like to hear?” “would it be helpful if I review…” - No more than 3 information at a time - No Jargon, speak slowly - Big picture: AVOID details: lab results, vital, etc.. - Use THEIR terms/ words

Question 11

JARGON and its translation

Answer 11

• “Prognosis is poor” -> “Patient is dying or likely to die.” - “Pt is not responding” -> “the treatments are not working.” - “We recommend a switch to comfort care” -> “Pt is dying despite our best efforts, but we will CONTINUE to maintain her comfort.”

Question 12

Dealing with uncertainty

Answer 12

1. Acknowledge 2. Offer recommendations, guidance, direct opinions “At this point CPR and ICU admission would not allow the patient to survive. In my opinion ….” “life-support/ dialysis would prolong the dying process, but would not prevent. In my opinion we not start …. and allow him to die naturally. Of course we will continue to do everything in our power to keep him comfortable.”

Question 13

STEP 8 Handle emotion

Answer 13

• name/ask the emotions “What are you feeling?”, “This must be difficult for you”, “ talking about this issues seems difficult for you.” -Legitimize the feelings “It;s very common for someone in your position to have a hard time making these decisions.” - Do NOT abandon - Explore

Question 14

STEP 9. Manage conflicts

Answer 14

• Emotion is usually the source of conflict - Clear information -Consider the use of a time-limited trial; BE SPECIFIC about how LONG and GOAL -Grieving and acceptance of death is a process - family dysfunction is NOT your job

Question 15

STEP 10: options

Answer 15

“life-prolongation” vs “Quality of life focus” - “ Improvement of quality of life may come at expense of life prolongation (and vise versa) Hints: Prognostication information, recommendations

Question 16

How to deliver prognosis

Answer 16

-Confirm that they want to know, how much and how to deliver “Would it be helpful to share the prognosis information in the patients having the same conditions?” -Giving a warning shot “I afraid I do not have a good news” - Present in a RANGE - Setting the possible goal “I know you are hoping that you disease will be cured. Are there other things that you at hoping for?” “Though we can not cure your disease, there are many things that we can still do to help- let’s focus on those.”

Question 17

Miracle Miracle

Answer 17

-Do NOT correct patient’s hope -Refer if appropriate: chaplain, consult -Assess whether the belief is functional or dysfunctional *Explore their beliefs; “What would a miracle look like to you.” *Acknowledge importance of religion *Align yourself with the patient by using “I hope” and “I wish” statements *Assess other hopes

Question 18

STEP 11.Establish the plan

Answer 18

• Confirm goals - Describe the plan: use active verbs and be SPECIFIC

Question 19

STEP 12.Summarize and DOCUMENT

Answer 19

Summarize and DOCUMENT to all TEAM members and Treatment team.

Question 20

ADDRESS hydration concerns

Answer 20

“Supplemental fluid s do not treat the sensation of thirst. In fact, the sensation of thirst can be well treated with oral swabs, ice chips and moisturizers.”

Question 21

4 interventions commonly used in systemic family therapy

Answer 21

1. Direct linear questions: useful in gathering information and clarifying information, especially at the beginning of therapy.
2. Circular questions: identify another’s state / behaviour /beliefs/ opinions, a way of introducing new information into the system.
3. Statements: clarify and acknowledge a communication; comment on the position or emotional state of a member;introduce therapist/team ideas, directly or in the form of a reflecting team
4. Reflecting teams; introduce the therapy team’s ideas

Question 22

4 Therapeutic domains

Answer 22

grief, communication, cohesiveness, and conflict resolution.