MODULE5:

Resources ENHANCINGCOMMUNICATION

Lesson1:CommunicatingwithPatients

LearningObjectives
x Identifycommonbarriersandsolutionstoeffectivecommunication
x Identifyandusestrategiestoimprovecommunication
x Describetipstohelppatientsimprovecommunication
x Identifyandimplementconflictresolutionstrategies
x Describestrategiesforhandlingdifficultconversations
KeyTakeaways
x Inahealthcaresetting,goodcommunicationisessential,andpoorcommunicationcan
havenegativeimpactsonpatientoutcomes.
x Therearemanycommonbarrierstocommunicationaswellaseffectivesolutionsto
thosebarriers.
x Activeorreflectivelistening,openendedquestions,affirmationsandsummarizingare
strategiesthatcanimproveyourcommunicationwithpatients.
x Everyonehastodealwithconflictatonepointoranother,sogoodconflictresolution
skillsareimportant.
x Patientnavigatorsmayhavedifficultconversationswithpatientsandshoulduse
strategiestodosorespectfullyandclearly.
 

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LESSON N1:COMMU UNICATINGW WITH
PATIENNTS

PatienttCenteredCCommunication
Framew work
Commo onCommunicationBarriersand
Solutions
StrateggiesforImprovingComm munication
Commu unicationTip
psforPatien
nts
ConflicttResolutionStrategies
BreakinngBadNewss
ResourcesforPatieentNavigatoors
ResourcesforPatieents

PatientC
CenteredCo
ommunicatio
onFramewo
ork

TheNatioonalCancerInstitutesPPatientCente eredCommuunicationFrrameworkco onsistsof6ccore

functionssthatoverlaapandinteraact,leadingttocommuniicationthatcanimproveeoutcomes.
Note:maanyoftheskkillsnecessarrytoimplemmenttheNCIIpatientcen
nteredcommmunication
framewo orkarecoverredinModu ule4.

Fosteringheaalingrelationships,whichincludesbuilddingtrustand
drapportwitththe
patient

Exchangingin
nformationaboutcanceraanditstreatm
ment

Respondingttoemotionsbbyrecognizinggapatients emotionalstaateandaskin
ng
appropriateq
questionstou
understandeemotions

Managingun ncertainty,wh
hichisparticu
ularlyrelevantforcancerp
patientswhooftenhave
complexillne
ess

Makingdecissions

Enablingselfmanagemen
nt




Source:EEpsteinetal.PatientCenteredCommunicationinCancerCaare.2007.

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Common
nCommuniccationBarrie
ersandSolutions

Goodcom mmunicationisnotalwaayseasy.Barrriersmaym
makecommuunicationhardbetweenyou
andtheppatient.Belo
owyouwillffindsomeco
ommoncom mmunicationbarriersasw
wellaspossible
solutionsstothosebaarriers.

CommonBarriers Solu
utions

Physicalenvironm ment Quiett,private,noondistractin

ng
Notliisteningtoth
hepatient location
Beinggdistracted Effecttivelisteningg
Judgingthepatient Stop,,look,listen
Informmationoverload Beemmpathetic
Focussingonaperrsonalagend da Askq
questions
Mispe erceptionoffpatientsmeaning Accuratepercepttion
Stereotypingandgeneralizingg Analyyzeyourown nperception
ns
Rushiing Workktoimproveethem
Distortedfocus Focussonothers
Makin ngassumptions Impro ovedverbalcommunicaation
Gettinngmixedsiggnals Focussontheissuue,notthepperson
Poorverbalcomm municationb by Begeenuineratheerthanmaniipulative
naviggator Empaathizeratherrthanremaiin
Lackinngclarity detacched
Usinggstereotypesand Befleexibletowarrdsothers
generralizations Valueeyourselfanndyourown
Jumppingtoconclusions experiences
Dysfuunctionalressponses Preseentyourselfasanequalrather
Lackinngconfidencce thanasuperior
Useaaffirmingressponses


UniversityoffWaterloo.EEffectiveCommunicatioon:BarriersaandStrategiees.2000.
Source:U

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StrategiesforImprovingCommunication

Thefollowingarestrategiesyoucanusetoimproveyourcommunication.

Active/ReflectiveListening
Appropriateeyecontactearlyintheinteraction
Attendingtoverbalandnonverbalcues
Clarifyingtheinformationprovidedbythepatient
Clarifyingthepatientsunderstandingoftheinformationprovidedbythedoctor
Makingstatementsthatcaptureandreturntopatientssomethingaboutwhattheyhavejustsaid
and/ormakesaguessaboutanunspokenmeaning
OpenendedQuestions
Cannotbeansweredwithyesorno
Allowforafuller,richerdiscussion
Arenonjudgmental
Letthepatientsyouworkwiththinkoutloud
Allowthemtodomostofthetalking,usingtheirownwords
Letthemknowtheconversationisaboutthem
Affirmations
Statementsorgesturesthatcomeintheformofcompliments,appreciationorunderstandingthat
validatethepatientsexperiences,buildrapport,reinforceexplorationandbuildpatientconfidence
Summarizing
Restatesthekeypartsoftheconversation,includingthoughts,concerns,plansorreflections 

Othertipsinclude:

Askopenended Allowpatientto Waitforpatientto

Reflectback
questions answer saymore

Summarizeto
Askmore
makesureyou
questions
understood

Sources:PNTC;CommonwealthofAustraliaNationalHealthandMedicalResearchCouncil.
CommunicatingwithPatients:AdviceforMedicalPractitioners.2004;Milleretal.2002.

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Commun
nicationTipssforPatientts

Belowarresomecommmunicationtipsforpatiients.ThesetipscomeffromtheNattionalCoalition
forCance
erSurvivorsh olbox,whicchisanaudiioprogramfforpatients and
hipsCancerrSurvivalToo
teachesp
peoplecomm municationsskillsandoth
herimporta ntskills.

Be
eassertive

UsseImessagges

Acctivelisteningg

Matchwhatyo
M ousayinword
dswithwhatyousaywitthout
words

Exxpressyourfe
eelings




Source:N
NationalCoaalitionforCaancerSurvivo
orship.CanccerSurvivalTToolbox.n..d.

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ConflictR
ResolutionSStrategies

Everyone ehastodealwithconflicctatonepointoranoth er.Hereareesometipsfforresolvingg

conflicts..

Workatttalkingabou
uttheissues
maybedifficulttotalkabou
Itm utconflict,bu
utavoidanceuusuallyends upleadingto
oothersmaking
assu
umptionsandanincreaseiinanger.Avo oidancedoesnotstoptheconflict.Peopplemayneeddtoback
awayforamome entbutthepaartiesshoulddiscussthecconflict.

Recognizethevalueoftheconflicct
Conflictisnaturaal,andcanevenbeasourcceofimproveedrelationsandagoodsolution.Itcanhelpset
expe
ectations,mo ovearelationshiptoanothherlevel,andidentifyaprooblem.

Recognizeconflictisaspiralandyyoucanchangethedirectiionofthespiiral
Thereisaconstructiveandde
estructivedire matchourtoneeofvoiceand
ection.Wem dourbodypo ostureto
theother,whichcanbeusedproductively..Forexamplee,youcanlow
weryourtoneeofvoicetob
bringdown
theemotionallevvel.

Emphassizecommongoals.
Aroundanygiven ntopictherearedifferentgoals forexxample,webbothwantyoutogetqualiitymedical
e.Figureoutwhichgoalsyyouhaveinccommon.Oncceyoushoww
care wherethegoalsarecompatible,you
nolo
ongerhavecoonflict.Youcaanuseleadin ntproblem:Howcan
nsthatwillframetheprobblemasajoin
we,Whatcannbedoneto ,Whattim meframeisaccceptableto

Checkp
perceptions
Thin
nkabouttheq
questions,W
Whatresourceesdoyouactuuallyhave?Issanythinggeettinginthew
way?"

Usecom
mpetentcommunicationte
echniques
Such
hasactivelyllistening,askiingquestionssandprovidinngfeedbackttocheckyourperceptions..

Agreeto
odisagree
Som
meconflictjusstcantbesolvedorisntimportantenooughtotrytooohardtoressolve.

Attackttheproblem,nottheperso
on
Theotherpersonnisahumanbeingwithho
opesanddreaamstoo,soyyouneedtom
makesureyou
urespect
thepersonandfo
ocusonthep
problemandhhowitcanbeeresolved.

Source:P
PNTC.

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BreakingBadNews

Ofteninthehealthcaresetting,thetermdifficultconversationreferstotellingapatientthat
treatmentisntworking.Asapatientnavigator,youshouldnotbetellingpatientsthattheir
treatmentisntworking.However,youmightencounterdifficultconversationsrelatedtohighly
emotionalpatients,difficultpatients,familymemberconfrontationsortheneedtotella
patientsomethingtheymightfinddisappointing,suchasdenialforfinancialaid.TheSPIKES
protocolisusedforbreakingbadnews.

SETTINGuptheinterview
Privacy
Family/Friends
Sit
Connectwiththepatient
PERCEPTION
Whatisthepatientsunderstandingofthesituation?
INVITATION
Assesspatientpreferenceforinformation
GiveKNOWLEDGEandinformationtothepatient
Useplain,nontechnicallanguage
Avoidexcessivebluntness
Giveinformationinsmallchunks,andcheckforunderstandingperiodically
AssessEMOTIONSwithEMPATHICResponses
Observepatientsreaction
Allowforsilence
Useempathicstatements(Iknowthisisntwhatyouwantedtohear.Iwishthenews
werebetter.)
STRATEGYandSUMMARY
Checkforunderstanding
Makeanactionplan


Source:Baileetal.2000.

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ResourcesforPatientNavigators

x NationalCancerInstitutesPatientCenteredCommunicationinCancerCare
Thisbookprovidesinformationforhealthcareprofessionalsrelatedtocommunication
andcancercare.
x NationalCancerInstitutesCommunicationinCancerCarePDQ
Thiswebpagehasinformationabouttheimportanceofgoodcommunicationincancer
care.
x OncotalkTeach
Thisfreetrainingprogramcontainsmanyresourcestohelpcancercareprofessionals
bettercommunicatewithpatients.Thesitehaswrittenlessonsandvideos.

ResourcesforPatients

x NationalCoalitionforCancerSurvivorshipsCancerSurvivalToolbox
TheCancerSurvivalToolboxisafree,selflearningaudioprogramthatpeopledevelop
skillstobettermeetandunderstandthechallengesoftheirillness.Itincludessections
oncommunicating,findingInformation,makingdecisions,solvingproblems,negotiating
andstandingupforyourrights.
x NationalCoalitionforCancerSurvivorshipsTeamwork:TheCancerPatientsGuideTo
TalkingWithYourDoctor
Thisbookcoverstipsforunderstandinghowtotalkwithyourdoctor,background
informationandstaging,copingwithadiagnosis,treatmentoptions,costandinsurance
issues,treatmentplanning,transitioningofftreatment,whentreatmentoptionsare
limitedandlivingwithloss.
x CancerCaresCommunicatingWithYourHealthcareTeam
Thismodulewalkspatientsthroughhowtocommunicatewiththehealthcareteam.
 

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Module5,Lesson1:CommunicatingWithPatients

References:Presentation

BaileWF,BuckmanR,LenziR,etal.SPIKESAsixstepprotocolfordeliveringbadnews:
Applicationtothepatientwithcancer.Oncologist.2000;5(4):302311.

CommonwealthofAustraliaNationalHealthandMedicalResearchCouncil.Communicating
withPatients:AdviceforMedicalPractitioners.2004.Retrievedfrom:
https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/e58.pdf.

MillerWR,RollnickS.2002.MotivationalInterviewing:PreparingPeopleforChange.2nded.
NewYork(NY):TheGuilfordPress.ISBN10:1572305630.

NationalCancerInstitute.CommunicationinCancerCarePDQ.2013.Retrievedfrom:
http://www.cancer.gov/cancertopics/pdq/supportivecare/communication/patient.

EpsteinRM,StreetRL,Jr.2007.PatientCenteredCommunicationinCancerCare:Promoting
HealingandReducingSuffering.NationalCancerInstitute,NIHPublicationNo.076225.
Bethesda,MD.Retrievedfrom:
http://appliedresearch.cancer.gov/areas/pcc/communication/pcc_monograph.pdf.

NationalCoalitionforCancerSurvivorship.CancerSurvivalToolbox.n.d.Retrievedfrom:
http://www.canceradvocacy.org/resources/cancersurvivaltoolbox/.

PatientNavigatorTrainingCollaborative.n.d.Retrievedfrom:
http://patientnavigatortraining.org/.

UniversityofWaterloo.EffectiveCommunication:BarriersandStrategies.2000.Retrieved
from:https://uwaterloo.ca/centreforteachingexcellence/teachingresources/teaching
tips/communicatingstudents/telling/effectivecommunicationbarriersandstrategies.

References:BriefQuiz

CenterforPublicHealthPracticeandColoradoSchoolofPublicHealth.PatientNavigation.
2014.Retrievedfrom:https://www.publichealthpractice.org/trainingcategory/patient
navigation.

MillerWR,RollnickS.2002.MotivationalInterviewing:PreparingPeopleforChange.2nded.
NewYork(NY):TheGuilfordPress.ISBN10:1572305630.

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NationalCoalitionforCancerSurvivorship.CancerSurvivalToolbox.n.d.Retrievedfrom:
http://www.canceradvocacy.org/resources/cancersurvivaltoolbox/.

UniversityofWaterloo.EffectiveCommunication:BarriersandStrategies.2000.Retrieved
from:https://uwaterloo.ca/centreforteachingexcellence/teachingresources/teaching
tips/communicatingstudents/telling/effectivecommunicationbarriersandstrategies.

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