Health - Clinician-patient-family communication Flashcards
Decision-Making Interventions and Strategies
List the three discussed in the lecture.
- Coaching patients to ask questions (ASK)
- Question-prompt lists (QPLs)
- Decision-aids (DAs)
Decision-Making Interventions and Strategies
Describe the study (Shepherd et al., 2011) with ASK…was it effective?
- used a real GP setting
- got half of patients to ask 3 questions of the doctors, the other half did not
- doctors did not know who was real or fake patient
This was designed to prompt doctors to give the most minimal information for patients to make an informed decision.
- what are my options?
- possible benefits/harms of these options?
- how likely are the benefits/harms?
It worked! The doctors gave more information and were more likely to share decision-making
Decision-Making Interventions and Strategies
In a follow-up study by Shepherd et al (2011), patients watched video clips of ASK in progress. This investigated whether patients could be ______ to be more ________ in consults. It found that almost _____ asked all three questions, and 87% asked at least _____. Hence, it is possible to teach patients.
taught
engaged
half
one
Decision-Making Interventions and Strategies
Question-prompt lists provide a list of ________ questions patients/family may want to ask. These may refer to:
- _____ the illness is
- how _______ it is
- treatment _______, and the costs/benefits of these
- _______ for me and family.
Here, patients _____ the questions they want to ask and can write their ____ questions.
______ patients and clinicians find this helpful, and it _______ the likelihood of asking difficult questions.
However, they are more effective with clinician ______ (doctor may be in a rush, or block questions), AND these tools in _______ are NOT a substitute for effective _______.
common
what
serious
options
support
tick
own
both
increases
endorsement
isolation
communication
Decision-Making Interventions and Strategies
What three things do decision aids do?
Decision aids
- INFORM
- provide evidence-based information on ALL options
- communicate probability clearly - CLARIFY VALUES
- help patients to personalise information to facilitate deliberation
- ask which benefits/harms matter most to the patient - SUPPORT PROCESS
- guided steps
- worksheets
- provides list of questions to ask, etc
Decision-Making Interventions and Strategies
How do decision-aids differ from information booklets?
DAs are conceived for a particular situation where SDM is important - when you have to weigh up options and clarify values.
Decision-Making Interventions and Strategies
DAs are effective. They:
- improve ______ of screening/treatment options
- facilitate more ______ and _______ expectations of possible benefits and harms
- facilitate _______ that are consistent with patient values
- increase accuracy of patient _____ perceptions
- increase _______ participation in decision-making
- improve doctor-patient __________
- reduce overuse of _______ procedures
knowledge realistic accurate choices risk active communication elective
Decision-Making Interventions and Strategies
There has been a surge in production of DAs. What has been shown to be higher quality? How is this being monitored?
More detailed ones are more effective than simpler ones.
Optimal format depends on the situation, population and cost restrictions.
The International Patient Decision Aid Standards is a criteria to assess the quality of DAs.
There is now a DA inventory which rates the quality of DAs based on this criteria
Patients expect more from their doctors than 30 years ago - not just technical expertise but also empathy/care.
What has been found about why patients initiate litigation?
Levison et al 1997 - clear communication differences between sued vs no sued clinicians
Those who were not sued
- longer consults
- explicit agenda
- facilitating behaviours
- humour and active listening
A follow-up study was actually able to predict who would be sued from their communication score in their exam
Importance of eliciting and addressing emotional cues and psychological concerns during consults
- This involves emotional cues (a message with some sort of _______ content)
- communication ______ (blocking vs facilitating)
- active ______
- empathy
Providing such support leads to:
- faster _______
- greater _______ with treatment
- fewer _________
emotional
behaviours
listening
recovery
cooperation
complications
Risk communication
- words (chance is “much lower”),
- relative risk (“halve your chances”,
- absolute risk (“after surgery 8 out of 10….” and “after surgery and radiotherapy 4 out of 10…”)
- pie charts
- 100 person diagram
- horizontal bars
- graphs
Which one leads to greatest patient understanding?
Is the preferred format the one that is usually best understood?
100 person diagram
NO
–> it also depends on the purpose - you don’t want to show end of life people a 100 person diagram
Risk communication
What are some considerations when thinking about absolute vs relative risk?
Relative risk
- no “base rate” - nothing about the actual risk - the benefits depend on how common or rare the disease is
eg: “halve” chances - from 2% to 1%? or from 50% to 25%? - not likely to lead the patient to make informed decision
- could even be considered coercive
- active treatment options chosen more with relative risk
Absolute risk
- risk of developing disease over a time period
Key points for Risk Communication:
- use consistent ______ when discussing pros/gains and cons/losses
- provide _____ rates for outcomes
- provide information on the ________ of the risk
- tailor risk presentation according to _______
- Check ________
framing base consequences context understanding
Communication Skills Training
Contrary to popular belief, effective communication skills can be ______, improved and ________. But only _____ health professionals receive such training.
taught
maintained
few
Communication Skills Training
Describe the Cochrane systematic review (Moore et al, 2013) of 14 RCTs comparing communication skills interventions and no communication skills interventions
- They found significant group differences - the CST groups were more likely to…
- –> use open questions
- –> show empathy
There were NO group differences in:
- –> patient satisfaction and perception of clinician communication skills
- –> clinician burn-out
Overall, courses were effective in improving information-gathering and support skills.
But it is unclear which training programs work…future research needs to explore this
