communication skills in practice a parting well made?
TRANSCRIPT
Communication skills in practice
A parting well made?
A parting well made?
And whether we shall meet again I know not. Therefore our everlasting farewell take: For ever, and for ever, farewell, Cassius! If we do meet again ,why, we shall smile; If not, why, then, this parting was well made.
William Shakespeare Julius Caesar Act V Scene I
Does Communication Matter?
Does Communication Matter?
Patients give priority to:
• being treated with humanity, dignity and respect
• having good communication with health professionals
• being given clear information about their condition• receiving the best possible symptom control• receiving psychological support when they need it
The NHS Cancer Plan, September 2000
Patients ask for Clinicians
To be:-
honest giving straightforward and clear information
sensitive to their emotionsinvolve them in decisions Darzi 2008
National reports
Department of Health Cancer Plan (2000) NICE Supportive and Palliative Care Cancer Service
Guidance (2004) Health Service Ombudsman Report (2006) Cancer Reform Strategy (2007) High Quality Care for All – NHS Next Stage Review,
Lord Darzi (2008) End of Life Care Strategy (2008) Equality and Excellence: Liberating the NHS (2010) Improving Outcomes Guidance (2011) National Cancer Survey (2012) NICE Patient Standard (2012)
Patient’s AssociationSeptember 2012
40% GPs poor communication skills
80% patients want to be more involved in decisions
6/10 GPs have no compassion
Rebecca Smith. Medical Editor
November 9th 2012
GMC report the state of medical education and practice 2011
Key findings. Complaints up 23% in last year Complaints re poor communication up 69%Over representation More than 20 yrs since qualifying Male, surgeons, psychiatrists and GP
Consequences of poor communication
Psychological distress and morbidity (Massie et al., 1994)
Reduced quality of life (Kerr et al., 2003)
Poor adherence to treatment (Kim et al., 2004)
Dissatisfaction with care (Zachariae et al., 2003; Kim et al., 2004)
Complaints and litigation (Lenckus, 2005)
Potential burnout in healthcare professionals (Ramirez et al., 1995, 1996;
Berman et al., 2007)
What will help us communicate effectively?
Minimise BarriersReduce Blocking BehavioursPick up CuesGather patient information Acknowledge patients agenda/concernsGive tailored information effectivelyNegotiate decision making
Barriers to effective communication
Fears
Beliefs/attitudes
Skills / abilities
Environment
Blocking behaviours
Blocking behaviours:
Inhibit patient disclosure of feelings and concerns
Maguire et al 1996; Wilkinson et al 2008
Del Piccolo et al 2006
Cues
Something that the patient says or does that is a hint to you that there is something more to be explored.
Butow et al 2002
A verbal or non verbal hint which suggests an underlying unpleasant emotion and would need clarification from the health provider.
Del Piccolo et al 2006
Importance of cues
Facilitative questions linked to cues increase the probability of further cues and are key to a patient-centred consultation
Zimmerman et al 2003
Open questions linked to a cue are 4.5 times more
likely to lead to further significant disclosure than unlinked open Questions
Facilitating the first patient cue appears to be important20% drop in cues during consultation if first cue is not facilitated
Fletcher PhD thesis 2006
Cues - will it take more time ?
Consultations which were cue based were shorter that those in which cues were missed GP consultations 12.5% 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
Facilitative behavioursGoldberg et al 1993; Wilkinson 1991; Maguire et al 1996: Zimmerman et al 2003; Del Piccolo et al 2011;
Gathering information Open questions Open directive questions Screening questions Clarification Exploration Pauses Pauses/silence Minimal prompts
Picking up cues
Active listening skills• Reflection
(acknowledgment)• Paraphrasing
(acknowledgement and checking)
• Summary• Empathy• Educated guesses
Supporting Evidence
Silence or minimal prompts most likely to precede disclosure Eide H et al 2004
Giving information reduces likelihood of further disclosure Zimmerman et al 2003
Polarity of words important: Screening questions: “something else” elicited significantly more concerns than “anything else”
Heritage J et al 2006
DVDDVD
DVD
A parting well made?
And whether we shall meet again I know not. Therefore our everlasting farewell take: For ever, and for ever, farewell, Cassius! If we do meet again ,why, we shall smile; If not, why, then, this parting was well made.
William Shakespeare Julius Caesar Act V Scene I