Patient-centred communication: involving the patients on their own terms

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Candace Merritt
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1 Patient-centred communication: involving the patients on their own terms A workshop Jonathan Silverman and Pål Gulbrandsen Hindsgavl Castle, Denmark June 2016

2 Patient-centeredness doesn't come about by chance

4 Introductions: us and you Your professional background Background in communication: Teaching, research, practitioner, patient

5 Why you are here In pairs with someone you don t know Discuss why you have come to this workshop? 3 minutes each Some ideas about your needs

6 Aims for the workshop What do health professionals have to do to make it patient-centred? Involve you and your experience in how to involve the patient on their own terms Explore the underlying attitudes and skills Consider what communication behaviours are required of professionals to make this work Give each of you one new thing to try in your day-to-day work

7 Exercise in different pairs: Discuss a difficult communication between a health professional and yourself as a patient in the last few years or one of your relatives or friends What was missing? Work together for 6 minutes, 3 minutes each Brainstorm the difficulties

8 Small groups of four: What does the health professional have to actually do to make the interview patient-centred Work together for 15 minutes Work on paper and produce a creative diagrammatic representation Share diagrams with your neighbouring group

9 Lessons from the evidence What makes a patient-centred atmosphere? Looking at one small area of communication research and practice

10 What makes a patient-centred atmosphere? welcoming the patient clarifying the patient s agenda and expectations attentive listening facilitation especially via paraphrasing of content and feelings and repetition encouraging the expression of feelings and thoughts picking up cues, checking out our interpretations or assumptions internal summary acceptance non-judgmental response use of silence encouraging the patient to contribute as an equal offering choices

11 Looking at one small area of communication research and practice

12 Patient cues

13 initiating the interview gathering information explanation and planning Cues building the relationship

14 Cues and concerns A verbal or non-verbal hint which suggests an underlying emotion which would need clarifying by the health professional Del Piccolo et al 2006 Hints to patient's concerns and thoughts about the cause of the illness

15 Facilitative skills Goldberg et al 1993; Wilkinson 1991; Maguire et al 1996: Zimmerman et al, 2003 Open questions Open directive questions Screening questions Listening Pauses/use of silence Minimal prompts/encouragement Summarising The emergence of cues and concerns

16 Not picking up and exploring cues Levinson (2000) patients gave cues throughout the interview from the opening to the closing minute doctors only responded to patient cues in 38% of cases in surgery and 21% in primary care Zimmerman et al (2007) a systematic review, documenting 58 original quantitative and qualitative research articles demonstrating patient expressions of cues and/or concerns, all based on the analysis of audio or videotaped medical consultations. overall conclusion - physicians missed most cues and adopted behaviours that discouraged disclosure. Rogers and Todd (2000) oncologists preferentially listen for and respond to certain disease cues over others pain amenable to specialist cancer treatment is recognised, other pains are not acknowledged or dismissed

17 Cues - will it take more time? Consultations which were cue based were shorter that those in which cues were missed o GP consultations 12.5% o Surgical consultation were 10.7% shorter Levinson et al 2000 In oncology consultations, addressing cues reduced consultation times by 10-12%. Butow et al 2002

18 Facilitative skills Open questions Open directive questions Screening questions Listening Pauses/use of silence Minimal prompts Summarising The emergence of cues and concerns What skills can you use to pick up cues? Acknowledging/reflection /paraphrasing Checking Clarifying Exploring Educated guesses Empathy

19 Watch a video Watch a video of a consultation (6 minutes) As you watch, think about what do you think is going on in terms of patient-centredness? Afterwards use worksheet to consider what you have seen is this primarily a problem of attitude or skill is it teachable?

20 Pair with someone else ask each other about your thoughts and feelings about the video. Discover what you have experienced in common and what you have experienced differently 5 mins pairs report : something that they found in common and something which their partner noticed or experienced differently skills or attitudes

21 Skills and attitudes Final common pathway = skills

23 One thing learnt for your own practice

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