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Professional Clinical Practice > HX1.3 - Clinical Communication > Flashcards

HX1.3 - Clinical Communication Flashcards

1
Q

What is communication?

A

Exchange of Information/ Messages by Verbal & Non-verbal Means

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2
Q

What does communication allow between doctor and patient?

A

Allows Collaboration Between Patient & Doctor

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3
Q

How do you ensure that communication has taken place?

A

Ask what the patients understanding of the information is.

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4
Q

What percentage of communication is non-verbal?

A

(65%)

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5
Q

What is the difference between language and paralanguage?

A

Language: Actual Words Used
Paralanguage: Tone, Volume, Rate

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6
Q

What techniques allow for effective doctor patient communication?

A
  • Open Questions
  • Listening
  • Silence
  • Encouragement
  • Acknowledgement
  • Empathy
  • Reflection
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7
Q

What are some of the issues in palliative care?

A
  • Communication With Patient & Family
  • Children
  • Denial
  • Collusion
  • Communication Difficulties e.g. Deafness, Tracheostomy
  • Different Cultures & Languages
  • Emotion & Difficult Questions
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8
Q

What is collusion?

A

Co-operating in creating an illusion

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9
Q

What constitutes bad news?

A

Any Information Which Adversely or Seriously Affects an Individuals View of their Future.
(In the Eye of the Beholder)

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10
Q

What two principles are competing in the breaking bad news?

A

Patients Have Right To Full Information: Diagnosis, Treatment, Prognosis

BUT

Balance Between Giving Information & Confronting Unwanted Detail

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11
Q

How should bad news be viewed by the doctor?

A 
Not a “Once-off” Event
Ongoing Process
Patient Focused- Pace & Depth
Listen to What is Said/ Not Said
Non-verbal Cues
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12
Q

What are the issues for the patient in receiving bad news?

A 
Need to Deny
Self-protection
Protecting Family Members
Protecting Health Care Professionals
Swing Between Reality & Denial
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13
Q

What are the issues for the family in receiving bad new?

A

He Will Give Up
He Always Said He Wouldn’t Want to Know
He Must Have Hope
It Will Kill Him

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14
Q

What are the 10 steps in breaking bad news?

A

PETER KAYE 1996

  1. Preparation
  2. What Does the Patient Know?
  3. Is More Information Wanted?
  4. Give a Warning Shot
  5. Allow Denial
  6. Explain (If Requested)
  7. Listen to Concerns
  8. Encourage Ventilation of Feelings
  9. Summary & Plan (Repetition And Reiteration)
  10. Offer Availability
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15
Q

What preparations should be made prior to breaking bad news?

A

Why?
- Models Communication Style

Who?
–Patients Choice
–Professionals Should Not Outnumber Family

Where?
–Comfortable, Quiet Room; No interruptions; No Telephones/Bleeps

When?
–All Info Available; Suit Patient & Professional; Time

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16
Q

How should the bad news be delivered?

A

Avoid Jargon- Use Patients Language, at Least Initially
Clear Accurate Explanation (Chunks & Check)
Avoid Misleading Soft Descriptions
Few Words as Possible
Stop & Wait- Stay With Silence
Avoid Premature Reassurance

17
Q

What is the checklist before leaving a patient having broke bad news?

A

Repeat Information
Check Message is Understood
Empathic Response
Definite Plan to Meet Again

18
Q

What is the role of prognostication for the patient?

A

Informed Decision About Treatment Options
Facilitate Preparation & Timely Resolution of End of Life Issues
Advanced Care Directives
Putting Meaning on Life Lived

19
Q

What is the medical role of prognostication?

A

Avoid Burdensome Procedures/ Investigations
Change Focus: Symptom Control/ Quality of Life
Early Referral to Palliative Care if Appropriate
Place of Care Decisions

20
Q

How accurate are most prognostication?

A

Only 20% prognoses correct (within 33% of survival time)

Doctors overestimate prognosis by factor of 5.3
63 % of prognoses overestimate
17% underestimate

21
Q

What factors should be initially considered in cancer patients?

A

INITIALLY
Disease Factors
Patient Factors
Decisions Made

LATTERLY
Performance Status (KPS, ECOG)
Clinician’s Prediction of Survival
Albumin, Lymphocytes, CRP
Delirium, Dyspnoea, Cachexia etc.
22
Q

What are some useful General Predictive Factors?

A
  1. Performance status most accurate
  2. ‘Taking to the bed’ without correctable cause
  3. Progressive decline
    Month to month = months
    Week to week = weeks
    Day to day = days
  4. Surprise Question
    “Would you be surprised if this patient died in the next 6-12 months?”
23
Q

How can prognostication be improved?

A

Most Accurate = Both Clinical Prediction of Survival And Objective Measures
Experience +/- Distance Improve Accuracy
Always Add Caveat About Sudden Event
NEVER Give Date !

Professional Clinical Practice (8 decks)

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