Communication Skills and Teamwork in EoLC Support workers, assistant practitioners and carers

Transcription

1 Communication Skills and Teamwork in EoLC Support workers, assistant practitioners and carers By Dr Georgina Parker Consultant in Palliative Medicine Presented by Kerry Harrison, Advanced Practitioner, Head of Hospice Day Service

2 Aims and Objectives To build on current communication skills and explore attitudes, behaviours and skills required for EoLC interactions To recognise own strengths and areas for development when communicating with families, carers and the MDT Demonstrate awareness of how own experiences of death and dying, can affect capacity to listen and respond appropriately

3 Name exercise Please share some information about your name: Origins How it is used personally and professionally Mis-spelling / mis-pronunciation and how that makes you feel

4 She was Eliza for a few weeks when she was a baby Eliza Lily. Soon it changed to Lil. Later she was Miss Steward in the baker s shop and then my love, my darling, Mother. Widowed at thirty, she went back to work as Mrs Hand. Her daughter grew up, married and gave birth. Now she was Nanna. Everybody calls me Nanna she would say to visitors. And so they did friends, tradesmen, the doctor In the geriatric ward they used the patients christian names. Lil, we said, or Nanna, but it wasn t on her file and for those last bewildered weeks she was Eliza once again Wendy Cope

5 E Learning for Health E-learning for Health Website:

6 Communication What do we mean by communication? A 2 way process Can occur via speaking, listening and observing An exchange of thoughts, views, feelings or emotions

7 Impact of communication on patients Body Language Tone of voice Content

8 Communication Consequences of good communication: Increased trust Effective information giving Identification of patient priorities Exploration of feelings and concerns

9 Communication Consequences of poor communication: Psychological distress and morbidity Poor adherence to treatment Reduced quality of life Dissatisfaction with care Complaints and litigation Potential burnout in healthcare professionals Some studies suggest that patients only remember 10% of what they are told

10 What do patients expect? Consider attitudes and behaviours as well as specific skills and types of information. Concentrate on EoLC 10 minutes Feedback to group

11 What do patients expect? What do patients expect from communication with healthcare professionals? Patients give priority to - being treated with humanity, dignity and respect - good communication - clear information - best possible symptom control - psychological support when needed NHS Cancer Plan 2000 Willingness to listen and explain is considered by patients to be one of the essential attributes of health professionals.

12 What do patients expect? Patients tell us that the emotional aspect of dealing with a life threatening illness is as difficult and distressing as the physical aspects Macmillan 2006 Listening Identify their concerns Empathy Understanding of their needs Knowledgeable Sort out their problems Point them in the right direction Non-judgemental Not interrupted Time and space Not rushed No jargon Willingness to listen and explain Establish patients understanding Confidentiality Answer their questions Eye contact Do their expectations depend on the role of the professional?

13 Review of own skills Review questionnaire in pairs What specifically do you find challenging? Remember to include challenges in team working 10 minutes Make brief notes

14 Communication challenges Feedback from discussions Challenges may involve: Specific situations Types of patients Subject of conversations Patient-based and team-based challenges

15 Skills that help develop conversations Skills that help to: Discover the patient s issues or concerns Make joint decisions with patients Give information to patients in a way they can understand and remember Eye contact No distractions Psychological focus Acknowledging Clarification Exploration Paraphrasing Educated guesses Open body language Open questions Pauses / silence Active listening Minimal prompts Reflection Empathy Summary Picking up on cues

16 Cues A verbal or non verbal hint which suggests an underlying unpleasant emotion Psychological symptoms Words / phrases which describe physical symptoms that could indicate unpleasant emotional states Words / phrases suggesting vague or undefined emotions Verbal hints to hidden concerns Mention of a life event/repeated or emphasised mention of a neutral event Mention of a life threatening illness

17 HCP behaviours that may block conversations Physical questions Inappropriate information Closed questions Multiple questions Leading questions Defending/justifying Premature reassurance Premature advice Normalising Minimising Jollying along Passing the buck Chit chat

18 Barriers What are the things that stop us from communicating effectively? Consider Fears Beliefs/attitudes Skills Working environment

19 Barriers Fears Unleashing strong emotions Upsetting patients/relatives Patient refusing treatment Difficult questions Damaging the patient Beliefs Emotional problems are inevitable Not my role Talking raises expectations Patient will fall apart Will take too long Lack of skills Assessing knowledge and perceptions Integrating medical and psychosocial modes of enquiry Handling difficult reactions Working environment No support or supervision No referral pathway Staff conflict Lack of time Lack of privacy

20 Use of frameworks for conversations Useful tools to structure conversations Several versions have been proposed What frameworks do you use currently? Try to pick one and stick to it / adapt it for your own purposes

21 Use of frameworks for conversations Cambridge Calgary framework (Silverman, Kurtz and Draper 2005) Disease Illness model (from Levenstein et al 1989 and Stewart et al 2003) A framework for effective communication skills for nurses (Hamilton and Martin 2007) SPICES (adapted by Serena Cooper)

22 SPICES S Setting the scene (privacy, involvement of others, time boundaries, establish rapport) P Person perception (what is going on ask before you tell) I Invite (space for the patient / carer to discuss their concerns) C Coping (what mechanisms do they have in place already) E Empathy (responses to emotions / statements) S Summary (agreeing a way forward)

23 Macmillan DVD Patient experiences of communication with professionals Patient preferences for how they would like to be communicated with

24 Inhibitory behaviours Look for the behaviours that are inhibiting or blocking the conversation Non verbal Verbal Pick up cues

25 Facilitatory behaviours Contrast with previous clip

26 Participant role play Pair of role players and one observer Role players play themselves or the patient/family member/carer Observer look for: Things which helped the conversation move along Things which might have blocked the conversation Cue or hints from the patient/carer Swap roles for subsequent role plays

27 Review of challenges and barriers Re-visit lists created earlier

28 Feedback and evaluation Identify 3 learning points that you will take back to practice How do you hope this will change your practice Evaluation forms