HL2 - Dr Patient Family Communication Flashcards
1
Q
What are the different decision making interventions and strategies?
A
- Coaching patients to ask questions (ASK)
- Question prompt lists
- Decision Aids
2
Q
What is the process of coaching patients to ask questions?
A
- Study in GP setting - (Shepherd et al., PEC, 2011)
- Patients coached to asked 3 questions
- What are my options?
- What are the possible benefits and harms of those options?
- How likely are the benefits and harms of each option occur?
- Designed to prompt physicians to provide minimum information that patients need to make an informed decision => activating the patients (who need to be prepared for the answers)
- In consultations where ‘patient-actors’ asked the questions:
- doctors gave more information
- patients were more likely to share in decision-making
3
Q
What are question prompt lists?
A
- Provide a list of common questions patients/families may want to ask
- Questions may relate to: Diagnosis, prognosis, treatment options, benefits vs costs, support for me and my family
- Patient/family tick relevant questions & write their own questions
- QPLs taken into consultation as a prompt
- Importance of co-design involving key stakeholders
- Both patients & doctors find QPLs useful
- Increases likelihood of asking difficult questions
- More effective with clinicians endorsement
- Can be used in subsequent consultations
- Second Ears iphone app
- Patients given audio-recordings of their consultations
- Improves understanding and information recall
- Helps patients to be more actively involved in subsequent consultations & treatment decision-making
- Provides a means to share accurate info and initiate treatment discussions with family.
- A copy can be stored with patient’s electronic medical records.
- Problems
- Could change behaviour of doctors - practicing defensive medicine - withholding experimental treatments
- Patients given audio-recordings of their consultations
4
Q
What are decision aids?
A
- Inform
- Provide evidence-based information about: the condition, ALL options (benefits vs. harms)
- Communicate probabilities in a clear graphical form
- Clarify values
- Help to think about the options from a personal point of view
- Ask which benefits and harms ‘matters most’
- Facilitate communication/deliberation
- Support process
- Guide re steps in deliberation/communication
- Provide worksheets/QPLS
- International patient decision aid inventory (IPDAS)
5
Q
How are decision aids effective?
A
- Decision aids are effective (Stacey et al. 2018)
- Feel more knowledgeable about their (screening/treatment) options
- Feel more informed
- Are clearer about their personal values
- Have more accurate risk perceptions
- More actively participate in decision-making
- Can improve doctor-patient communication
6
Q
Why is there an increasing need for & demand for family carers (unpaid care for patient)?
A
- Improved survival - Chronic illness care
- Increased incidence of cancer
- Shift in healthcare delivery from inpatient to outpatient to home-based care
- Professional care replacement - $60.3 billion
- Family support comes at a cost
- Mental illness, stress, become ill themselves
7
Q
What are the roles of family carers?
A
- Assist patients with activities of daily living,
- Accompany them to medical appointments,
- Provide emotional and informational support
- help to make important treatment decisions,
- advocate for their loved ones (ensuring safety and quality)
- assist in illness management at home,
- whilst often taking on extra home,
- family, and financial responsibilities.
8
Q
What does research say about family involvement in decision making?
A
- Family usually involved in some capacity, very limited research
- Hobbs et al. (2015)
- 49% - Shared decision making with family
- 1% - Family controlled decision making
- 22% - Some family input
- 28% - Little family input
- Greater involvement in family in different cultures
9
Q
What is the balance between patient priority and family input in decision making?
A
- Patient as priority
- Patient has ultimate authority over a medical decision => patient wishes are paramount
- Challenge: family who compromise patient autonomy
- Rights of the family to be involved
- Although patient rights emphasised, family’s involvement in decision-making also seen as important
- Some situations may call for greater family involvement
- TRIO program of research
- The more people in the room = the harder it can be to judge the mood
10
Q
Why is family engagement in healthcare important?
A
Family carers seem themselves as secondary to the doctor-patient relationship
TRIO Framework
- New clinician-patient family conceptual framework
- Not a prescriptive guide on how family should be involved
- Describes & maps the possible wide-ranging family influences
- Captures and explains the complexity and variability of family involvement
- Spectrum - Relative involvement of each party changes as time progresses
11
Q
What are the TRIO strategies to facilitate effective family involvement?
A
Everyday Consultations
- Consider family carers in inpatient and outpatient procedures and set up
- Welcome and encourage family attendance
- Build rapport with and show respect to family members
- Engage in careful communication of information when family are involved
- Be observant of the patient-family relationship
- Meet family carers emotional and informational needs
**Challenging & complex situations**
12
Q
What is eTRIO interactive online training?
A
- Facilitates the implementation of TRIO guidelines and improve family carer engagement
- For both clinicians and the family carers themselves through short interactive films
13
Q
What are the issue with general communication?
A
- Generally communication skills don’t reflect
- Personality
- Natural talent
- Improve with age
- Improve with professional experience
- Even when communication training given, might not apply to communication actually used in hospitals by more senior staff
- Effective communication skills can be taught, maintained and improved
14
Q
Why is good communication important?
A
- Vital for establishing therapeutic/trusting relationship
- High quality clinical practice
- Strong evidence
- Patients value good doctor-patient-family communication
- Patients are more likely to litigate when communication is poor
- Good communication can help patients:
- remember more
- make more informed decisions
- adhere to medication better
- cope better
- recover quicker
- Good communication reduces stress and burnout in clinicians
- Good communication and interpersonal skills of a cliniciano vital for establishing a therapeutic/trusting relationshipo high-quality clinical practice.
- Patients expect more from their doctors
15
Q
Why do patients initiate litigation?
A
- Communication differences between SUED vs. NOT-SUED clinicians
- Levison et al (1997): 10 audiotaped routine consultations, each with 59 GPs and 65 surgeons (general/orthopaedic) => 1,265 consultations
- Clinicians who were NOT SUED:
- longer consultations (only by 3 mins.)
- explicit agenda for patient
- facilitating behaviours/active listening
- used humour
- Clinicians who were NOT SUED:
- Tamblyn et al (2007)
- Doctor-patient communication score from the clinical skills (licensing) exam predicted future patient complaints to medical regulatory authorities
- Levison et al (1997): 10 audiotaped routine consultations, each with 59 GPs and 65 surgeons (general/orthopaedic) => 1,265 consultations
16
Q
What is the best way to present risk?
A
- Communicate via words
- e.g. If you add radiotherapy to surgery, your chances of the cancer coming back in the same place are MUCH LOWER
- Use relative risk
- e.g. having additional radiotherapy will halve you chances of the cancer coming back
- Absolute risk
- e.g. pie charts
