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• Are the references we use out of date?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 SQUARELY OPEN POSTURE LEAN TOWARDS THE OTHER EYE CONTACT RELAX SIT AT AN ANGLE UNCROSS LEGS AND ARMS RELAX EYE CONTACT TOUCH 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 TodayVolume 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
• rganisation: 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

SETTING – think first about the setting – can you respond to this hint from the patient now

• r should you return

when you and they can protect ten minutes? – Can you create some privacy? Would they like to talk? WHY?

Patients notice that nurses are busy and withhold worries unless given an explicit opportunity to describe their concerns (McCabe 2004, R3b). It is important to create the setting or environment within which patients or carers can disclose their concerns (Hase and Douglas 1986, R5).

ASK – ask the patient what is concerning or worrying them (don’t worry yourself about problems that you cannot solve – just listen)

WHY?

Patients frequently hint about their underlying

• concerns. These hints need to

be noticed and responded to (Oguchi et al. 2010, R3b). Asking specifically about emotions encourages patients to describe psychological and emotional issues (Ryan et al. 2005, R3a). Specific questions about psychological concerns are important (Maguire et al. 1996, R3b, Booth 1999, R3b).

GATHER – gather all of the concerns – not just the first few (ask if there is something else) - repeat back to the patient what you have heard (this proves that you are listening) – make a list

• f all of the concerns

(actually write them down) WHY?

Listening is an active process, requiring concentration, silences and verbal affirmation that you hear what is being said (Silverman et al. 2005, R5, Wosket 2006, R5). It is important to hear all of the patient's concerns, to summarise and check that you have understood correctly (Maguire et al 1996, R3b).

EMPATHY – say something which suggests that you are aware of the burden

• f their worry, such

as: “I can see that you have a lot to be worried about at the moment” WHY?

Empathy is about creating a human connection with your patient (Egan 2002, R5). Empathy shows that you have some sense of how the patient is feeling (Maguire and Pitceathley 2002, R3b, Booth 1999, R3b)

TALK – ask who they have to talk to - what support they have – make a list of all the people that help. “Who do you have that you can talk to about your concerns?”

WHY?

Patients commonly rely on family and friends for support (Ell 1996, R5). Good social support is associated with enhanced coping skills for the patient (Chou et al 2010, R3b). Supportive ties may enhance well-being by meeting basic human needs for companionship, intimacy and a sense of belonging (Berkman and Glass 2000, R5). It is helpful know what social support surrounds the patient. (Stewart 1995, R5)

HELP – ask how these people help “How do these people help?” WHY?

People’s social networks may help them reinterpret events or problems in a more positive and constructive light (Thoits1995, R5). The support from family and friends commonly involves reassurance, comfort and problem solving (Schroevers et al 2010, R5).

YOU – ask the patient: “What do you think would help?” Or “What would help?” WHY?

It is helpful to use a style of problem solving which seeks the patient's own solutions first (Booth 1999, R3b, Tate 2003, R5).

ME – ask the patient: “Is there something you would like me to do?” WHY?

It is helpful to use a negotiated style of communication which allows the patient control over what, if any, professional help they receive with their concerns

• r dilemmas (Fallowfield and

Jenkins 1999, R3b).

END – summary and strategy. “I now know what you are worried about and the support you have. I know what you think would help and what you want me to do. I’ll get on with that and come back to you when I can. Is ok to leave it there for now?”

WHY?

It is important to know how to summarise and close an interaction (Bradley 1990, R5)

So what?

• These are useful things to teach
• The way we teach them is educationally sound
• What they actually learn…

– Is their responsibilty

• Whether they actually use the skills in practice…

– Is their responsibility

Checking and trusting

• Listening is better than not listening
• Fully listening before responding is better than

responding before fully listening

• Using empathy is better than not using

empathy

• Giving people the chance to describe what

would help is better than not giving people…

Learning to drive vs learning to listen

Driving

• 20 lessons+
• Test
• Some follow the

rules…some don’t Listening

• 1 lesson
• No test
• Some follow the

rules…some don’t

Learning to listen

• Is the 3 hour workshop a big enough dose of

learning?

• Perhaps 1 lesson per year with a 6 monthly
• nline top up?