Models of Communication for engaging with patients

https://meditropics.com/models-of-communications-for-engaging-with-patients/

Sreenivas M.
Director Professor& Head, Department of Forensic Medicine & Toxicology, Maulana Azad Medical College & Associated Hospitals, New Delhi

 

            The Physician-Patient relationship is essentially a fiduciary relation and must be based on a feeling of connectedness and building of trust of the patient. This can only be achieved by establishing a good conduit of communication to foster the development of understanding, and empathy. In recent times, communication has received great emphasis as an essential skill set and as a core competency for the doctors. Further,it has become a curricular imperative to impart communication skills to medical students and trainee-doctors.

            This discussion will focus on some well-established models of communication in encounters with patients in clinical settings as mentioned here under:

  1. Kalamazoo consensus statement for medical encounters.
  2. The SPIKES model for breaking bad news.
  3. Universal upset patient protocol.

 

The Kalamazoo Consensus Statement:

  • Build a Relationship: The Fundamental Communication Task

            A strong, therapeutic, and effective relationship is the sine qua non of physician–patient communication.The Kalamazoo consensus model endorses a patient centered, or relationship centered, approach to care, which emphasizes both the patient’s disease and his or her illness experience. This approach regards the physician–patient relationship as a partnership, and respects patients’ active participation in decision making.

  • Open the Discussion
  • Allow the patient to complete his or her opening statement
  • Elicit the patient’s full set of concerns
  • Establish/maintain a personal connection
  • Gather Information
  • Use open-ended and closed-ended questions appropriately
  • Structure, clarify, and summarize information
  • Actively listen using nonverbal (e.g., eye contact) and verbal (e.g., words of encouragement)techniques
  • Understand the Patient’s Perspective
  • Explore contextual factors (e.g., family, culture, gender, age, socioeconomic status,spirituality)
  • Explore beliefs, concerns, and expectations about health and illness
  • Acknowledge and respond to the patient’s ideas, feelings, and values
  • Share Information
  • Use language the patient can under- stand
  • Check for understanding
  • Encourage questions
  • Reach Agreement on Problems and Plans
  • Encourage the patient to participate in decisions to the extent he or she desires
  • Check the patient’s willingness and ability to follow the plan
  • Identify and enlist resources and supports
  • Provide Closure
  • Ask whether the patient has other issues or concerns
  • Summarize and affirm agreement with the plan of action
  • Discuss follow-up (e.g., next visit, plan for unexpected outcomes)

            This outline of essential elements in effective physician–patient communication provides a coherent framework for teaching and assessing communication skills, determining relevant knowledge and attitudes, and evaluating educational programs.

 

SPIKES Model for breaking bad news

            The aim of any health-professional is to use his/ her skills to deliver bad news clearly, honestly and sensitively, in order that patients can both understand and feel supported. This is a framework that was developed by Baile and Buckman (2000). The components convey the major points to be considered when giving bad news to patients and/or their relatives. These may vary according to context, the severity of the news, the people involved, time given for planning, etc.

 

SPIKES – The Six-Step Protocol for Delivering Bad News

This acronym helps memorize the steps and consider their elements

STEP 1: SETTING UP the Interview

STEP 2: Assessing the Patient’s PERCEPTION

STEP 3: Obtaining the Patient’s INVITATION

STEP 4: Giving KNOWLEDGE and Information to the Patient

STEP 5: Addressing the Patient’s EMOTIONS with empathic responses

STEP 6: Strategy and Summary

 

Universal Upset Patient Protocol

            Here are the six steps to improving doctor patient communication with the Universal Upset Patient Protocol.

1) “You look really upset.”

2) “Tell me about it.”

3) “I’m so sorry this is happening to you.”

4) “What would you like me to do to help you?”

5) “Here’s what I’d like us to do next.”

6) “Thank you so much for sharing your feelings me with, it’s really important that we understand each other completely, thank you.”

 

References:

  1. Med. 2001; 76:390–393
  2. Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP (2000) SPIKES – A Six Step Protocol for Delivering Bad News: Application to the Patient with Cancer. Oncologist 5:302-311.
  3. Dike Drummond at TheHappyMD.com 
  4. Fallowfield L, Jenkins V. (2004) Communicating sad, bad and difficult news in medicine. Lancet. 363: 312-19
  5. http://www.bmjlearning.com/foundation/learnonline/badnews11.htm
  6. http://www.skillscascade.com/badnews.htm