Keeping on top of the evidence Crawling out from underneath the - PowerPoint PPT Presentation

Keeping on top of the evidence Crawling out from underneath the evidence

Gathering my concerns • Is listening a good thing? • Is empathy a good thing? • Is patient centredness a good thing? • Does each bit of SAGE & THYME have an evidence base? • Is the workshop educationally effective? • Who else is teaching foundation level skills? • Is there another similar workshop out there? • Do communication skills effect patient outcomes? • Are the references we use out of date? • What’s new in the literature? • What if somebody comes to me and tells me about a ground breaking study that was published 3 years ago?

Empathy • No wonder you’re worried Mike, you’ve got a lot on your mind.

Who do you have to support you?

How do they help?

What do you think would help Mike? • I’d like to: – find what’s out there rather than wait for someone to tell me? – feel familiar with the evidence – have a process that keeps us all up to date

What would you like help with Mike? • I need help to: – be systematic – steadily catalogue important literature – have something ready for each S & T UK conference

Outcome • Search strategy • Nearly 4,000 hits • 277 ‘keeps’ • Endnoteweb • Evenings • Progress • A mountain still to climb

IS PATIENT CENTREDNESS A GOOD THING? • Moore, M. 2007 .Talking with patients from Howlong to the Himalayas - do all our patients want us to be patient centred?, Aust Fam Physician, 36(3), pp.175-6. • Pinto, R.Z., et al. 2012. Patient-centred communication is associated with positive therapeutic alliance: a systematic review. Journal of Physiotherapy, 58(2), pp.77-87. • Robinson, J.D., et al. 2013. Consultations between patients with breast cancer and surgeons: a pathway from patient-centered communication to reduced hopelessness. Journal of Clinical Oncology, 31(3), pp.351-8. • Saha, S., Beach, M. C., 2011. The impact of patient-centered communication on patients' decision making and evaluations of physicians: a randomized study using video vignettes. Patient Education and Counseling, 84(3), pp.386-92. • Swenson, S. L. et al. 2004. Patient-centered communication: do patients really prefer it?, J Gen Intern Med, 19(11), pp.1069-79. • Swenson, S. L. et al., 2006. 'She gave it her best shot right away': patient experiences of biomedical and patient-centered communication. Patient Education and Counseling, 61(2), pp.200-11.

WHO ELSE IS TEACHING FOUNDATION LEVEL SKILLS? • Knops, K., Lamba S.J., 2010. Clinical application of ASCEND: a pathway to higher ground for communication. Palliative Medicine, 13(7), pp.825-30. • Palmer, J.L., 2012. Caregivers' desired patterns of communication with nursing home staff- just TALKKK! J Gerontol Nurs,38(4), pp.47-54. • Stickley, T., 2011. From SOLER to SURETY for effective non-verbal communication. Nurse Educ Pract, 11(6), pp.395-8. • Tedder, J., Register, N., 2007. The "HUG": an innovative approach to pediatric nursing care. Am J Matern Child Nurs, 32(4), pp.210-4. • Turner, J. et al. 2009. Enhancing the capacity of oncology nurses to provide supportive care for parents with advanced cancer: evaluation of an educational intervention. Eur J Cancer, 45(10), pp.1798-806. • Wittenberg-Lyles, E., et al. 2013. The practical nurse: a case for COMFORT communication training. Am J Hosp Palliat Care, 30(2), pp.162-6. • Fossli Jensen, B., et al. 2011. Effectiveness of a short course in clinical communication skills for hospital doctors: results of a crossover randomized controlled trial. Patient Education and Counselling, 84(2), pp.163-9.

What’s out there? • ASCEND • TALKKK • SOLER to SURETY • The HUG • COMFORT • 4 HABITS • Simple Skills Secrets

4 Habits • Effectiveness of a short course in clinical communication skills for hospital doctors: results of a crossover randomized controlled trial Fossli Jensen • To test the hypothesis that a 20-h communication skills course based on the Four Habits model can improve doctor-patient communication among hospital employed doctors across specialties.

ASCEND Anticipation Summary Concerns Explore goals/Explain recommendations Next steps Documentation Clinical application of ASCEND: a pathway to higher ground for communication. Knops K, Lamba S.J Palliat Med. 2010 Jul; 13(7):825-30.

TALKKK • The six patterns are represented by the acronym TALKKK (tell them; ask them; listen to them; know their family member by relating and communicating; be knowledgeable about dementia, its progression, dementia-specific care, and commonly used medications; and share that knowledge with them).

SOLER to SURETY SIT AT AN ANGLE SIT SQUARELY UNCROSS LEGS OPEN POSTURE AND ARMS LEAN TOWARDS RELAX THE OTHER EYE CONTACT EYE CONTACT TOUCH RELAX YOUR INTUITION

HUG • Start here, not there • See • Then share • Gaze • Then Engage

COMFORT • Communication • Orientation and opportunity • Mindful presence • Family • Openings • Relating • Team

Simple Skills Secrets • Visual model for any staff member, in any setting, where faced with unanswerable questions or lost for words. • Safely responding to cues • Listening • Encouraging • Summarising • Assisting the formation of the patient’s own plan • While resisting the urge to rush in with solutions • Enhancing communication with distressed patients, families and colleagues: The value of the Simple Skills Secrets model of communication for the nursing and healthcare workforce. Jack et al Nurse Education Today Volume 33, Issue 12, Pages 1550 – 1556, December 2013

INTERESTING PAPERS • Henderson, C., 2003. Power imbalance between nurses and patients: a potential inhibitor of partnership in care. Journal of Clinical Nursing, 12(4), pp.501-8. • Jagosh , J., 2011. Importance of physician listening from the patient’s perspective – enhancing diagnosis, healing, and the doctor patient relationship. Patient Education and Counseling, 85(3), pp.369-74. • Moore, P. M., 2013. Communication skills training for healthcare professionals working with people who have cancer. Cochrane database. • Uitterhoeve, R. J., 2010. The effect of communication skills training on patient outcomes in cancer care: a systematic review of the literature. Eur J Cancer Care, 19(4), pp.442-57. • Roter, D.L., 2008. Interactive and evaluative correlates of dialogue sequence: a simulation study applying the RIAS to turn taking structures. Patient Education and Counseling, 71(1), pp.26-33.

INTERESTING PAPERS • Sobel, R., 2008. Beyond empathy. Perspect Biol Med, 51(3), pp.471-8. • Stein, T., et al. 2005. Enhancing clinician communication skills in a large healthcare organisation: a longitudinal case study. Patient Education and Counseling, 58(1), pp.4-12. • Swayden, K.J., 2012. Effect of sitting versus standing on perception of provider time at the bedside: a pilot study. Patient Education and Counseling, 86(2), pp.166- 71. • Talen, M.R., et al. 2011. Patients’ communication with doctors: a randomised controlled study of a brief patient communication intervention. Fam Syst Health, 29(3), pp.171-83. • Tran, A.N., et al. 2004. Empowering communication: a community-based intervention for patients. Patient Education and Counseling, 52(1), pp.113-21.

• Systematic reviews of the effectiveness of communication skills training…..little effect • In the absence of evidence…why do we keep going? • The big fear? The training makes no difference

WHY? SETTING – Patients notice that nurses think first about the are busy and withhold setting – can you worries unless given an explicit opportunity to respond to this hint describe their concerns from the patient now (McCabe 2004, R3b). or should you return when you and they It is important to create the setting or environment can protect ten within which patients or minutes? – Can you carers can disclose their create some privacy? concerns (Hase and Would they like to Douglas 1986, R5). talk?

WHY? ASK – Patients frequently hint ask the patient what about their underlying concerns. These hints need to is concerning or be noticed and responded to (Oguchi et al. 2010, R3b). worrying them (don’t worry yourself about Asking specifically about emotions encourages problems that you patients to describe cannot solve – just psychological and emotional issues (Ryan et al. 2005, R3a). listen) Specific questions about psychological concerns are important (Maguire et al. 1996, R3b, Booth 1999, R3b).

GATHER – WHY? Listening is an active gather all of the process, requiring concerns – not just concentration, silences and the first few (ask if verbal affirmation that you there is something hear what is being said else) - repeat back to (Silverman et al. 2005, R5, the patient what you Wosket 2006, R5). have heard (this It is important to hear all of proves that you are the patient's concerns, to listening) – make a list summarise and check that of all of the concerns you have understood (actually write them correctly (Maguire et al down) 1996, R3b).