Enhanced Communication Skills

2021 ◽  
pp. 44-59
Author(s):  
Myra Glajchen ◽  
Christine Wilkins
Keyword(s):  
Research Training ◽  
Narrative Medicine ◽  
Collaborative Communication ◽  
Patient Centered ◽  
Family Meeting ◽  
Quality Healthcare ◽  
Good Communication ◽  
Self Reflection ◽  
Advance Care ◽  
End Of Life Decision

Good communication is considered fundamental to high-quality palliative care. Communication includes serious illness conversations with patients and family caregivers, collaborative communication across teams and disciplines, and communication with community providers. This chapter explores definitions, evidence-based research, training, and best clinical practices in three areas of enhanced communication. Narrative medicine promotes empathy, patient-centered listening, and life review through reflective journaling, writing, and self-reflection. Goals-of-care discussions, which may include advance care planning, ensure that providers align care with what matters most to the patient. The family meeting is used to facilitate communication, discuss the illness experience, present treatment choices, and facilitate end-of-life decision-making. Quality healthcare mandates training for healthcare clinicians in communication using a systematic approach.

The implications of the Mental Capacity Act (MCA) 2005 for advance care planning and decision making

2018 ◽  
Author(s):  
Simon Chapman ◽  
Ben Lobo
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Advance Care Planning ◽  
Care Planning ◽  
Best Interest ◽  
Policy And Practice ◽  
Advance Care ◽  
Current Context ◽  
Mental Capacity Act ◽  
End Of Life Decision

This chapter provides an overview of the MCA’s impact on end-of-life care. It situates the MCA in the current context of policy and practice. It describes how the MCA can be used to improve care, enable people to express and protect choices, and empower and enable the professional and/or the proxy decision maker. It also presents an introduction and explanation of the role of the IMCA and how it might apply to advance care planning (ACP) and end of life decision making, and an explanation of the legal and ethical process involved in reaching best interest decisions, especially for potentially vulnerable people in care homes and other settings.

“Don’t talk to them about goals of care”: Understanding disparities in advance care planning

2021 ◽  
Author(s):  
Deepshikha Charan Ashana ◽  
Noah D’Arcangelo ◽  
Priscilla K Gazarian ◽  
Avni Gupta ◽  
Stephen Perez ◽  
...  
Keyword(s):  
Native American ◽  
Ethnic Groups ◽  
Health Systems ◽  
Advance Care Planning ◽  
Religious Beliefs ◽  
Barriers And Facilitators ◽  
National Study ◽  
Care Planning ◽  
Patient Centered ◽  
Advance Care

Abstract Background Structurally marginalized groups experience disproportionately low rates of advance care planning (ACP). To improve equitable patient-centered end-of-life care, we examine barriers and facilitators to ACP among clinicians as they are central participants in these discussions. Methods In this national study, we conducted semi-structured interviews with purposively selected clinicians from six diverse health systems between August 2018 and June 2019. Thematic analysis yielded themes characterizing clinicians’ perceptions of barriers and facilitators to ACP among patients, and patient-centered ways of overcoming them. Results Among 74 participants, 49 (66.2%) were physicians, 16.2% were nurses, and 13.5% were social workers. Most worked in primary care (35.1%), geriatrics (21.1%), and palliative care (19.3%) settings. Clinicians most frequently expressed difficulty discussing ACP with certain racial and ethnic groups (African American, Hispanic, Asian, and Native American) (31.1%), non-native English speakers (24.3%), and those with certain religious beliefs (Catholic, Orthodox Jewish, and Muslim) (13.5%). Clinicians were more likely to attribute barriers to ACP completion to patients (62.2%), than to clinicians (35.1%) or health systems (37.8%). Three themes characterized clinicians’ difficulty approaching ACP (Preconceived views of patients’ preferences; narrow definitions of successful ACP; lacking institutional resources), while the final theme illustrated facilitators to ACP (Acknowledging bias and rejecting stereotypes; mission-driven focus on ACP; acceptance of all preferences). Conclusions Most clinicians avoided ACP with certain racial and ethnic groups, those with limited English fluency, and persons with certain religious beliefs. Our findings provide evidence to support development of clinician-level and institutional-level interventions and to reduce disparities in ACP.

Health and death literacy and cultural diversity: insights from hospital-employed interpreters

2017 ◽  
Vol 10 (1) ◽  
pp. e8-e8 ◽  
Author(s):  
Barbara Hayes ◽  
Anne Marie Fabri ◽  
Maria Coperchini ◽  
Rafatullah Parkar ◽  
Zoe Austin-Crowe
Keyword(s):  
End Of Life ◽  
Qualitative Description ◽  
Cultural Issues ◽  
Structured Interviews ◽  
Individual Values ◽  
Language Groups ◽  
A Value ◽  
Values And Beliefs ◽  
Advance Care ◽  
End Of Life Decision

Objectives001225The aim of this qualitative study is to better understand, through the experiences and insights of hospital interpreters, how people from culturally and linguistic diverse (CALD) communities might respond to advance care planning (ACP) and end-of-life discussions.MethodsHospital interpreters from five Melbourne metropolitan health services were recruited for in-depth semi-structured interviews that explored the question, ‘What can be learnt from hospital interpreters about cultural issues related to ACP and end-of-life decision-making?’ Thirty-nine interpreters, representing 22 language groups, were interviewed. Analysis of the transcribed interviews used qualitative description.ResultsThematic analysis identified three major themes: (1) moral difference; (2) health and death literacy; and (3) diversity within culture.ConclusionA value-based approach to ACP is recommended as a way to capture the person’s individual values and beliefs. Health and death literacy have been identified as areas that may be over-estimated; areas that can be addressed and improved, if recognised. Health and death literacy is a particular area that needs to be assessed and addressed as a pre-requisite to ACP discussions.

Dare voce ai pazienti nella ricerca sulle malattie rare e sui famaci orfani / Giving patients a voice in the rare diseases and orphan drugs research

2018 ◽  
Vol 67 (1) ◽  
pp. 25-40
Author(s):  
Elena Mancini ◽  
Roberta Martina Zagarella
Keyword(s):  
Clinical Trials ◽  
Rare Diseases ◽  
Patient Reported Outcomes ◽  
Narrative Medicine ◽  
Orphan Drugs ◽  
New Drugs ◽  
Patient Centered ◽  
Patient Reported ◽  
Critical Issues ◽  
The Impact

L’articolo ha l’obiettivo di mettere in luce potenzialità e criticità dell’inclusione della prospettiva dei pazienti nella ricerca sulle malattie rare e sui farmaci orfani. A tal fine, nella prima parte, si propone un’analisi epistemologica dell’utilizzo dei racconti dell’esperienza individuale della malattia nella ricerca scientifica e nei trial clinici, facendo emergere, anche attraverso gli strumenti della medicina narrativa, le sfide teoriche e operative poste dall’inclusione della soggettività del paziente e del vissuto di malattia nonché l’importanza della valorizzazione della prospettiva del paziente, sia in generale sia nella ricerca sulle malattie rare e sui farmaci orfani. Nella seconda parte, il testo analizza in particolare il ruolo degli esiti riportati dai pazienti o Patient Reported Outcomes (PROs), misure per la valutazione complessiva della salute basate sulla prospettiva dei pazienti stessi, incentrandosi sulla sperimentazione clinica nel campo delle malattie rare. In questo contesto, infatti, i racconti di malattia, raccolti e valorizzati da fonti istituzionali e associazioni di pazienti, hanno contribuito a far emergere importanti questioni critiche e difficoltà nell’impiego di outcome centrati sul paziente nello sviluppo di nuovi farmaci e trattamenti, generando una serie di documenti e raccomandazioni relative al loro utilizzo per il benessere della comunità dei malati rari. ---------- This paper aims to highlight the potentiality and criticality of including patients’ perspective in rare diseases and orphan drugs research. In the first part, we propose an epistemological analysis of individual narrations of disease experience as they are used in scientific research and clinical trials. With the help of narrative medicine approach, this analysis points out theoretical and operational challenges of a perspective that includes patient’s subjectivity and illness experience. Furthermore, it reveals the significance of patients’ standpoints in general and in rare diseases as well as in the orphan drugs research. The second part of our article focuses on the role of the Patient reported Outcomes (PROs) – which are measures for the health’s overall assessment based on patient’s perspective – by investigating the impact on clinical trials for rare diseases. In this context, illness stories, which are collected and promoted by institutional sources and patients’ associations, contribute to underline important critical issues at stake in the employment of patient-centered outcomes both in new drugs and in the treatments development. Moreover, these stories are crucial to elaborate documents and recommendations concerning the use of PROs for the rare patients’ community welfare.

Attitudes of Patients With Incurable Cancer Toward Medical Treatment in the Last Phase of Life

2005 ◽  
Vol 23 (9) ◽  
pp. 2012-2019 ◽  
Author(s):  
Elsbeth Voogt ◽  
Agnes van der Heide ◽  
Judith A.C. Rietjens ◽  
Anna F. van Leeuwen ◽  
Adriaan P. Visser ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Advance Care Planning ◽  
Care Planning ◽  
Incurable Cancer ◽  
History Of ◽  
Advance Care ◽  
Positive Feelings ◽  
End Of Life Decision ◽  
History Of Cancer

Purpose When cancer has advanced to a stage in which cure becomes unlikely, patients may have to consider the aim of further treatment. We studied the relationship of patients' attitudes toward treatment with advance care planning and the development of these attitudes after diagnosis of incurable cancer. Patients and Methods Patients with incurable cancer were interviewed and asked to fill out a written questionnaire about their attitudes concerning life-prolonging treatment and end-of-life decision making. These questions were repeated after 6 and 12 months. Results One hundred twenty-two patients (mean age, 64 years; standard deviation, 10.5 years; 53% women) participated in the study. Patients' attitudes toward treatment could be categorized into the following three different profiles: striving for quality of life, striving for length of life, and no clear preference. Patients who were older, more tired, or had less positive feelings and patients who had more often taken initiatives to engage in advance care planning were more inclined to strive for quality of life than others. Patients with a history of cancer of less than 6 months were more inclined to prefer life prolongation than patients with a longer history of cancer. During follow-up, no changes in attitudes toward treatment were found, except for patients with a short history of cancer in whom the inclination to strive for length decreased. Conclusion Patients who appreciate advance care planning were more inclined to strive for quality of life than other patients. Shortly after the diagnosis of cancer, patients typically seem to prefer life-prolonging treatment, whereas quality of life becomes more important when death is nearing.

scholarly journals Physician-patient communication: A qualitative study of perceptions, barriers, and needs in 4 EU MS

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
A Dalma ◽  
K Zota ◽  
P Karnaki ◽  
A Veloudaki ◽  
A Linos
Keyword(s):  
Nursing Education ◽  
Health Communication ◽  
Communication Training ◽  
Patient Communication ◽  
Positive Health ◽  
Patient Centered ◽  
Good Communication ◽  
Number Of Patients ◽  
Physician Patient Communication ◽  
Physician Patient

Abstract Background Good physician-patient communication is an important aspect of patient-centered care and contributes to positive health outcomes. However there is a lack of standard EU communication training policies for physicians. This study explores the barriers to good communication for both physicians and patients across four EU countries as part of the EU-funded Project “H-COM”, Health Communication Training for Health Professionals. Methods Eight focus groups were conducted with a total of 31 patients and 38 physicians from Germany, Greece, Spain, and Cyprus. Three themes were covered; perceptions, barriers and needs for health communication. Results Commonalities and differences between countries and target groups were identified, with participants discussing attitudinal, emotional, educational, and systemic barriers to good communication. Identified barriers among patients include a deeply embedded hierarchical notion and arrogance among physicians, inadequate or difficult to understand language, busy schedules. Among doctors barriers identified were mostly systemic having to do with busy schedules, large number of patients, and lack of time. Participants especially patients indicated a significant gap in health communication knowledge, skills, and training for physicians, with several regional differences being present especially between Mediterranean and central European countries. Conclusions The results imply a strong need for communication training, tailored accordingly in specific countries. Further development of policies related to the inclusion of such training in medical studies across EU would be of great importance. Key messages There are differences concerning health communication needs and barriers between EU regions and the development of tailored training. Although identified as important there is a lack of health communication training in certain EU MS and an urgent need to incorporate training in basic medical and nursing education.

scholarly journals Application of the JA-CHRODIS Integrated Multimorbidity Care Model (IMCM) to a Case Study of Diabetes and Mental Health

2019 ◽  
Vol 16 (24) ◽  
pp. 5151 ◽  
Author(s):  
Maria Forjaz ◽  
Carmen Rodriguez-Blazquez ◽  
Inmaculada Guerrero-Fernández de Alba ◽  
Antonio Gimeno-Miguel ◽  
Kevin Bliek-Bueno ◽  
...  
Keyword(s):  
Mental Health ◽  
Rating Scales ◽  
Care Process ◽  
Care Model ◽  
Patient Centered ◽  
Quality Healthcare ◽  
Complex Patients ◽  
Potential Applicability ◽  
Two Phases

The Integrated Multimorbidity Care Model (IMCM), developed by the Joint Action on Chronic Diseases and Promoting Healthy Ageing across the Life Cycle (JA-CHRODIS), proposes a set of 16 multidimensional components (i.e., recommendations) to improve the care of persons with multimorbidity in Europe. This study aimed at analyzing the potential applicability of the IMCM. We followed a qualitative approach that comprised two phases: (1) The design of a case study based on empirical clinical data, which consisted of a hypothetical woman with multimorbidity, type 2 diabetes mellitus, mental health, and associated social problems, and (2) the creation of a consensus group to gather the opinions of a multidisciplinary group of experts and consider the potential applicability of the IMCM to our case study. Experts described how care should be delivered to this patient according to each model component, suggested the use of specific rating scales and tools to assess her needs in a comprehensive and regular way, and pointed our crucial health and social resources to improve her care process. Experts also highlighted patient-centered, integrated and tailored care as one of the keystones of quality healthcare. Our results suggest that the IMCM is applicable in complex patients with multimorbidity.

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