ENHANCING PATIENT CARE THROUGH EFFECTIVE COMMUNICATION

Transcription

1 Video Participant Guide ADVANCING CANCER CARE TODAY (ACCT) ENHANCING PATIENT CARE THROUGH EFFECTIVE COMMUNICATION This program meets Oncology Nursing Society (ONS) guidelines for quality educational content. The ONS Seal of Approval does not constitute medical advice, and does not imply product endorsement by ONS. Healthcare providers should exercise their own independent medical judgment. The program is sponsored by and the speaker is presenting on behalf of Lilly USA, LLC. It is being presented consistent with FDA guidelines and is not approved for continuing education credit.

2 2 Program Objectives Program Objectives Define the elements of patient-centered communication Describe the 6 core functions of provider-patient communication Discuss handling of difficult discussions Demonstrate specific skills for effective patient-centered communication Write your objectives for the program below 3 The Patient Experience What are your takeaways from the Communications Video Part 1?

3 3 What What Is Patient-Centered Is Communication? Communication? Key domains of patient-centered communication 1,2 Elicit, understand, and validate the patient s perspective Understand the patient within his or her own psychological and social context Reach a shared understanding of the patient s problem and its solution Help empower the patient by offering meaningful involvement in health-related choices Foster a relationship built on trust, respect, and commitment 1. McCormack LA, et al. Soc Sci Med. 2011;72(7): Epstein R, Street RL Jr. Patient-Centered Communication in Cancer Care: Promoting Healing and Reducing Suffering; Elements Elements of Communication of Communication Underlying elements to all patient-centered communications Nonverbal behaviors Provider self-awareness Verbal communication The role of the patient Understanding patient health literacy Epstein R, Street RL Jr. Patient-Centered Communication in Cancer Care: Promoting Healing and Reducing Suffering;

4 4 Nonverbal Nonverbal Behaviors Behaviors Nonverbal behaviors are directly a function of one s motivational state and orientation toward the patient 1 Providers must have observational skills and appropriate self-awareness 1 Nonverbal behavior aid: SOLER 2 S O L E R Sit squarely Open posture Lean toward the other Eye contact Relax What personal nonverbal behaviors have you noticed in others? 1. Epstein R, Street RL Jr. Patient-Centered Communication in Cancer Care: Promoting Healing and Reducing Suffering; Stickley T. Nurse Educ Pract. 2011;11(6): Write your response to the question below

5 5 Provider Provider Self-Awareness Self-Awareness Clinician burnout, a lack of mindfulness, and job dissatisfaction are associated with 1-3 Lower quality of care Medical errors Reduced empathy How might your emotional state affect your attentiveness? How might your emotional state lead to unexamined biases, errors, or confusion about the patient s emotional needs? What can you do to improve your emotional well-being? 1. Fahrenkopf AM, et al. BMJ. 2008;336(7642): Shanafelt T, et al. J Clin Oncol. 2012;30(11): Epstein R, Street RL Jr. Patient-Centered Communication in Cancer Care: Promoting Healing and Reducing Suffering; Write your responses to the questions below

6 6 Verbal Communication Verbal Communication Best practices for patient-centered verbal communication Organize the Visit Avoid interruptions or distractions Establish the purpose of the visit Encourage Patient Participation Solicit patient s beliefs, values, emotions, and preferences Discuss expectations and options Ask about family and social context Provide Sufficient Information Provide clear, jargon-free explanations Check for patient understanding Offer reassurance, encouragement, and support Which of these best practices are easiest for you? Which are the hardest? Why? Epstein R, Street RL Jr. Patient-Centered Communication in Cancer Care: Promoting Healing and Reducing Suffering; Write your responses to the questions below

7 7 Role of Role the Patient of the Patient Patients may vary in their abilities to be active communicators Introducing topics for discussion Interrupting if necessary Asking questions Telling their health stories Active Communication Behaviors Being assertive about opinions and preferences Expressing concerns and feelings How do you handle patients who don t say anything? How do you handle patients who don t hear you or misinterpret you? Epstein R, Street RL Jr. Patient-Centered Communication in Cancer Care: Promoting Healing and Reducing Suffering; Write your responses to the questions below

8 8 Patient Patient Health Literacy Health Literacy Nearly half of all American adults 90 million people have difficulty understanding and acting upon health information 1 Limited health literacy is associated with 1,2 Lower treatment adherence More frequent hospitalizations Higher mortality People with poor health literacy are less likely to participate in disease prevention and health promotion programs 3 Is there anything unique you do to address this in your office? 1. Nielsen-Bohlman L, et al. Health Literacy: a Prescription to End Confusion Matsuyama RK, et al. Patient Educ Couns. 2011;85(3):e229-e Koay K, et al. Asia Pac J Clin Oncol. 2012;8(1): Write your response to the question below

9 9 The 6 Core Functions of Patient-Centered The Communication 6 Core Functions of Patient-Centered Communication Responding to emotions Managing uncertainty Exchanging information Enabling patient self-management Health Outcomes Making decisions Fostering healing relationships Epstein R, Street RL Jr. Patient-Centered Communication in Cancer Care: Promoting Healing and Reducing Suffering; Core Core Functions: Functions: Skills Skills and Qualities and Qualities Fundamental skills Listening carefully Responding thoughtfully Qualities Empathy Genuineness Positive regard for the patient McQuellon RP, Cowan MA. The Art of Conversation Through Serious Illness: Lessons for Caregivers;

10 10 Principles Principles of Cultural of Cultural Considerations Considerations Everyone has a profound need to be heard and understood All people really care about is being cared about Family is an extension of the patient Words can harm and words can heal Physical touch is a powerful force that can be destructive or healing Nonverbal cues are significant Spirituality is important to nearly everyone Allow the patient and family as much control as possible Epner DE, Baile WF. Ann Oncol. 2012;23(Suppl 3): Multidisciplinary Multidisciplinary Care Care Team Team Communication Communication Requirements for quality cancer care 1,2 Coordination Information exchange Regular communication among all those involved Clear and respectful communication Characteristics of high-functioning teams 3 Positive communication Low levels of conflict High levels of collaboration, coordination, cooperation, and participation 1. Fennell ML, et al. J Natl Cancer Inst Monogr. 2010;40: Epstein R, Street RL Jr. Patient-Centered Communication in Cancer Care: Promoting Healing and Reducing Suffering; Lemieux-Charles L, McGuire WL. Med Care Res Rev. 2006;63(3):

11 11 Communicating With With Caregivers Caregivers Family and caregiver communication issues may include Differences in caregiver knowledge Hierarchical roles within the family Cultural considerations Avoiding communication To reduce distress and prohibit uncomfortable discussions To exclude certain family members from decision making Recognizing communication patterns within a family can help teams better support family and caregivers Wittenberg-Lyles E, et al. Semin Oncol Nurs. 2012;28(4): Notes

12 12 Difficult Difficult Discussions Discussions Are an intrinsic part of oncologic practice 1,2 Can be a major source of stress 1,2 >94% of oncologists say they received no formal training for breaking difficult news to patients 1 How difficult news is discussed can affect the patient s 1 Comprehension of information Level of hopefulness Satisfaction with care Psychological adjustment Goals of care Hospice care How do you respond to angry patients? Diagnosis/ prognosis Emotionally charged dialogues End of active treatment Disease recurrence Disease progression How do you respond to hopeless patients? 1. Baile WF, et al. Oncologist. 2000;5(4): Campbell TC, et al. Cancer J. 2010;16(5): Write your responses to the questions below

13 13 Useful Useful Language Language for Difficult for Difficult Discussions Discussions Invite Other Decision Makers Assess Understanding Identify Goals Reframe ( Wish Statements) Identify Needs Who do you usually rely on to help you make important decisions? When we discuss your results, who would you like to be present? Tell me about your understanding of the most recent tests. Can you share with me what you think is happening with your cancer and the treatments? What is most important to you right now? What are your biggest concerns right now? In the future? What are your hopes for the coming weeks/months? I wish I could promise you that I wish I had better news, but I wish for that too. What has been hard for you and your family? What is your life like when you are at home? Shin J, Casarett D. J Support Oncol. 2011;9(3): What is some other helpful language that you use with your patients?

14 14 Difficult Difficult News: News: The SPIKES The SPIKES Strategy Strategy S ETTING Provide privacy and give the patient your full attention P ERCEPTION I NVITATION Assess how the patient perceives the medical situation Ask the patient how much information he or she wants K NOWLEDGE Provide information tailored to the individual E MOTIONS S TRATEGY AND SUMMARY Respond with empathy When the patient is ready, present treatment options and make decisions together Baile WF, et al. Oncologist. 2000;5(4): Handling Difficult Situations What are your takeaways from the Communications Video Part 2?

15 15 Key Key Takeaways Takeaways Improved outcomes may be accomplished by Fostering healing relationships Exchanging information Responding to emotions Managing uncertainty Making decisions Enabling patient self-management Listen carefully and respond thoughtfully Be mindful Help patients feel heard Ask open-ended questions Use empathic phrases Tell me how you re feeling about Sounds like I can see that you are 23 Resources

16 16 Video Video Resources Resources ONCOTALK Improving Oncologists Communication Skills MD Anderson Cancer Center I*CARE Clinical Communications Skills Video Library i-care/complete-library-of-communication-videos/index.html Fundamental Principles Managing Difficult Communication Achieving Communication Excellence Lecture Series ONCOTALK is a registered trademark of Vital Options International, Inc. 25 Print Print Resources Resources Back A, Arnold R, Tulsky J. Mastering Communication With Seriously Ill Patients: Balancing Honesty With Empathy and Hope; Kissane DW, Bultz BD, Butow P, Finlay I. Handbook of Communication in Oncology and Palliative Care; McQuellon RP, Cowan MA. The Art of Conversation Through Serious Illness: Lessons for Caregivers;

17 17 Thank You Thank you for your participation Additional ACCT programs available on lillyoncology.com Promoting Healthy Behaviors: Moving Toward Wellness Survivorship Care: Implementing the Essentials For more information, or if you are interested in a live speaker presentation on this topic, please contact your local Lilly Oncology sales specialist or call LillyRx 1 ON /2015 Lilly USA, LLC All rights reserved.