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Flashcards in 23 Clinician-patient-family communication Deck (32)
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1
Q

What is the evidence for the impact of communication?

A
  • Patients value good communication

- Patients are more likely to litigate when communication is poor

2
Q

What is the impact of good communication on patients and how can it help?

A

Good communication can help patients:

  • Remember more and make more informed decisions
  • Adhere to medicate better
  • Cope better and recover quicker

Good communication reduces stress and burnout in health professionals

3
Q

What are patient expectations of health professionals?

A
  • Technical expertise e.g. medical knowledge is the baseline
  • Accurate information
  • Empathy/emotional support - predicts whether someone is a good doctor or not a good doctor
  • Access to services - could vary depending on where you live
  • Continuity and coordination of care - the continuous care after you leave the hospital and continued visits
4
Q

In clinicians who are not sued, what do they do differently?

A
  • Longer consultations (only by 3 minutes)
  • Explicit agenda for patient
  • Asked patients what they would like to discuss.
  • Facilitating behaviours (empathy)
  • Used humour and active listening

Use a warm tone of voice

5
Q

What did the meta-analysis by Ambady et al., (2002) find?

A

Changed the frequency of the audiotaped sound that made the content unrecognizable -> which lead to 1/2 being used

6
Q

What did the meta-analysis by Tamblyn et al., (2007) find?

A

Doctor-patient communication score from the clinical skills (licensing) exam predicted future patient complaints to medical regulatory authorities

7
Q

Explain eliciting and addressing emotional cues

A
  • Eliciting emotional cues -> message from the patient with some reference to emotional (verbal and/or non-verbal) content
  • Blocking and facilitating communication behaviours
  • Active listening
  • Empathy
8
Q

Which emotional cue is one of the most powerful communication tools?

A

Empathy

9
Q

What is the best way to present risk in health risk communication?

A

Each presentation format has its advantages and limitations

e.g. words, relative risk, absolute risk, pie charts, horizontal bars, 100 person diagram and survival graph

10
Q

What is the absolute risk in risk communication?

A

Your risk of developing the disease over a time period, taking into account risk factors (e.g. high blood pressure, family history of illness)

11
Q

What is a relative risk in risk communication?

A
  • Compares the risk in two different groups of people e.g. smokers vs non-smokers
  • Tell you nothing about the actual risk
  • The benefit really depends on how common or rare the disease is (i.e. baseline rate/actual/absolute risk)
12
Q

What is an example of treatment effectiveness statement?

A

“radiotherapy after surgery for XX cancer will halve your risk of cancer coming back”

13
Q

What are the pros of stating treatment effectiveness?

A
  • BUT the chance of cancer coming back in this situation is only 2/100, reduced to 1/100 by radiotherapy
  • And radiotherapy can have long-term consequences (e.g. chronic diarrhea, infertility)
14
Q

What are the cons of communicating about treatment side effects?

A

But the base rate of ovarian cancer is very low => the increase is from 1 in 3,000 to 2 in 3,000

15
Q

Give an example of communicating treatment side effects

A

“taking hormonal treatment/drug XX will double your risk of developing ovarian cancer”

16
Q

Explain active treatment options and the outcomes according to Moxley et al (2003)

A

Active treatment options (e.g. surgery, medication) are chosen more often when outcomes described in terms of relative (rather than absolute) risk reductions

17
Q

In risk communication, what does simplification of risk help with?

A

(What does an (absolute) risk of 3 in 500 mean?)

Most people convert a numerical risk into categorical risk => GIST (i.e. high risk or low risk - it will happen to me, or it won’t)

18
Q

In risk communication, how are analogies helpful?

A

The risk of -this- cancer coming is about the same as your risk of:

  • Low risk: getting hit by lightning or winning the lottery
  • High risk: getting a cold this year
19
Q

What is the best way to communicate risk?

A
  • Use consistent framing when discussing pros/gains and cons/losses
  • Provide base rates of outcomes and use absolute risk comparisons
  • Provide information about the consequence of the risk
  • Preferred formats are not always the best understood
  • 100 dot/person diagrams - greatest accuracy/understanding
  • check and re-check understanding of risk
20
Q

What are the three decision-making interventions and strategies for patients and their family?

A
  1. Coaching patients to ask questions (ASK)
  2. Question-prompt lists (QPL’s)
  3. Decision Aids (DA’s)
21
Q

What do communication skills not exhibit?

A

They do not;

  • reflect the personality or natural talent of clinician
  • improve with age or professional experience

Effective communication skills can be taught, maintained and improved

22
Q

Describe coaching patients to ask questions (ASK)

A

Study in a GP setting: standardised patients

Designed to prompt physicians to provide minimum information but patients need to make an informed decision => activating the patients (who need to be prepared for answers)

23
Q

What are the 3 questions to ask doctors in ASK?

A
  1. What are my options
  2. What are my benefits or harms of those options
  3. How likely are the benefits or harms to occur
24
Q

What were the results of the study in ASK?

A

It worked -> in consultations where patients asked questions:

  • Doctors gave more information, and patients were more likely to share in decision-making
  • Majority (87%) asked at least 1 out of 3 Qs
  • Almost half (43%) asked all 3 Qs
  • Half (49%) recalled all 3 Q’s
25
Q

Describe Question-prompt lists (QPL)

A

Provides a list of common questions patients derived from patient and health professional interviews
- Patient/family tick relevant questions and write their own questions

26
Q

What have studies found about QPL’s?

A
  • Both patient and doctors find this useful -> increases likelihood of asking difficult questions - can be used in later consultations
  • More effective with clinicians endorsement -> patient needs to feel that the doctor endorses it
27
Q

Describe Decision-Aids (DA’s)

A

Inform (provide evidence about the condition and all options)

Clarify values (explore patient experiences, ask which benefits/harms matter most, facilitate communication)

Support process (guide in steps in deliberation, provide worksheet)

28
Q

Is the format important in DA’s?

A

Format depends on the clinical situation, patient population, and cost restrictions -> more detailed DA’s seem more effective than simple DA’s

29
Q

What are decision-aids effective at improving compared to usual care?

A

Improves knowledge of screening options for patients, feel more informed, are clearer about their personal values, have more accurate risk perceptions, more actively participate in decision-making and can improve doctor-patient communication

30
Q

Describe the effectiveness of communication skills training (CST)

A

Taught to deliver bad news, responding to emotional cues, discuss sexuality with patients, discuss death and dying, discuss alternative medicine, the transition to palliative care

31
Q

What were the results of the review of communication skills training?

A

Significantly group differences
- CST group more likely to use open-ended questions and show empathy towards patients + less likely to give facts only

No group differences
- Patient satisfaction and perception of clinician’s communication skills and clinician burnout.

32
Q

Are CST courses effective?

A

CST courses appear effective in improving information-gathering skills and support skills but unclear which CST programs are likely to work