II. Management: Patient-Centered Communication
- Bedside Presence
- Understand patient's agenda
- Introduce patient, provider, family and others in the room
- Welcome new patients
- Start with non-medical break-the-ice topics (if time)
- Ask open ended question (e.g. "How can I help you today")
- Allow patient to speak uninterrupted initially
- Ask, is there something else?
- Actively listen while the patient is speaking without distracting activities
- Understand patient's perspective, psychosocial context
- Avoid judging patient's emotions as appropriate or inappropriate
- Avoid offering premature reassurance or normalizing patient's concerns (e.g. "common reaction")
- Understand patient's expectations from encounter (e.g. work note, reassurance)
- Express empathy and concern
- See Breaking Bad News
- See Discussing Terminal Illness (Discussing Death, End-Of-Life Care)
- Shared treatment goals
- Discuss treatment options (including no treatment or watchful waiting)
- Avoid overwhelming the patient with too much information
- References
III. Management: CLAP Mnemonic
- Curiosity
- Approach conversations with an nonjudgmental attitude, open mind and genuine curiosity
- Listen
- Actively listen and hear the patients concerns
- Aspirations
- What does the patient and their family want from the encounter
- Personal
- Avoid taking conflict personally
IV. Management: Maintain good communication with patients and their families
- Establish a relationship with patient and families
- Listen well
- Avoid missing important details due to interruption
- Direct the patient to the current history and avoid interrupting for at least the first minute
- Gain credibility through reciprocal communication
- Listening to a patient's story allows them to unload details and free-up memory to absorb what medical providers say
- Apologize for medical errors (with administrative Consultation)
- Medical providers should consult with their employers and Risk Management teams prior to disclosure
- Some hospitals have full disclosure policies
- A majority of states have apology laws
- Protect providers and organizations to some extent when they disclose medical errors
- Address patient or family dissatisfaction, anger or other negative emotions associated with the visit
- See Conflict Resolution (for effective methods including better listening)
- See Emergency Department Patient Satisfaction
V. Management: Benevolence correlates with best and most satisfied FP's
- Preserve and Enhance people's welfare
- Patient Descriptions of "Good" physicians
- Helpful
- Honest
- Forgiving
- Loyal
- Responsible
VI. Management: Shared Decision Making
- All decisions regarding patient care should involve input from the patient or their proxy
- Shared Decision Making lies on a continuum of paternalistic and informed decision making
- Incorporates information exchange, deliberation and choice
- Characteristics
- Respect for patient values
- Integration of care
- Communication and Education
- Involvement of family or friends
- Four criteria of Shared Decision Making
- Involves at least two participants (typically provider and patient/proxy)
- Both participants share information
- Both participants work together to form consensus
- Agreement on treatment plan is reached
- Numerical Data Best Practices
- Use a mix of numbers of pictures (e.g. pictograms, infographics, icons)
- Use numbers to define what you mean by "rare", "unusual", "uncommon" or "common"
- Use absolute risk instead of Relative Risk
- "Double the risk" is misleading when the risk increases from 0.5 per million to 1 per million
- In this case the Relative Risk is 2, but the absolute risk increase is 0.5 per million
- Use natural frequency instead of percentage
- Use "1 in 10 people" instead of "10% of people"
- Use consistent units (including the same denominator) when describing risks and benefits
- Avoid comparing, for example "1 in 14 versus 1 in 5"
- Instead, use a consistent denominator, "7 in 100 versus 20 in 100"
- Define risk over a fixed period of time (e.g. months, years)
- For example, "in five years, 5 in 100 people would have experienced this side effect"
- Frame benefits and risks in positive and negative terms
- "Treatment is a success in 8 out of 10 people, but 2 out of 10 fail to see any benefit"
- Three Talk Model
- Team Talk
- Patient and provider collaboration in a supportive environment
- Patient is autonomous, and asked to share their preferences and goals of care
- Patient and provider agree on an agenda with prioritized topics within encounter time constraints
- Option Talk
- Evaluation and Treatment options are compared with their associated risks and benefits
- Risks and benefits are described with numerical data when available using best practices (see above)
- Options (including "no treatment") are considered in the context of patient's preferences and goals
- Provider should ensure patient understanding at intervals along the discussion
- Break discussion into small chunks of information and then check that this is understood
- Consider asking patient to explain concepts discussed ("teach back")
- Decision Talk
- Joint decision making with a timeline for the ongoing plan and next review
- Provider summarizes decisions made with next steps, and documents in the medical record
- Patient may change their mind at any time
- Team Talk
- Resources
- Shared Decision Making (UK National Institute for Health and Care Excellence)
- References
- Boyle and Ponce (2018) Crit Dec Emerg Med 32(10): 11
- (2022) Am Fam Physician 106(2): 205-7 [PubMed]
VII. References
- Swadron and Shoenberger in Herbert (2019) EM:Rap 19(7): 1-2
- Henry (2013) Avoid Being Sued, EM Bootcamp, CEME
Images: Related links to external sites (from Bing)
Related Studies
| Definition (MSH) | Collaborative process to reach a decision. |
| Concepts | Mental Process (T041) |
| MSH | D003657 |
| English | Making, Shared Decision, Decision Makings, Shared, Shared Decision Makings, Decision Making, Shared, Shared Decision Making, Makings, Shared Decision |
| Czech | společné rozhodování, rozhodování sdílené |
