Communication

Definition

Develop rapport, trust and ethical therapeutic relationships with patients and families

• Establish positive therapeutic relationships with patients and their families
• Respect patients confidentiality, privacy and autonomy
• Respect patient diversity and difference (including gender, age, religion, culture, ...

Accurately elicit and synthesise relevant information from patients, families, colleagues and other professionals

• Gather information about a health condition and also about a patient's beliefs, concerns, expectations and illness experience
• Identify when a patient is likely to interpret information as bad news and adjust their communication accordingly

Accurately convey relevant information and explanations to patients and families, colleagues and other professionals

• Communicate information to patients (and their family) about procedures, potentialities, and risks associated with surgery in ways that encourage their participation in informed decision making
• Communicate with the patient (and their family) the treatment options, potentials, complications, and risks associated with the use of drugs
• Appropriately adjust the way they communicate with patients to accommodate cultural and linguistic differences

Develop a common understanding (with patients, families, colleagues and other professionals) on issues, problems and plans

• Discuss relevant information with patients (and their family) in ways that encourage their participation in informed decision making
• Encourage patients to discuss and question
• Effectively identify and explore problems to be addressed from a patient encounter

Module

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Module rationale and competencies
Completion
Resources
Topics covered in this module

Module rationale and competencies

The quality of practitioner-patient communication is fundamental to effective health care. Good communication is an essential competence for all surgeons - whether with patients and their families, or with colleagues and team members.  Surgeons and trainees are required to develop the necessary knowledge, motivation and skills to interact effectively and appropriately with people from all sectors of the community.

Completion

This module guides trainees to:

• establish a therapeutic relationship with patients (and their families) characterised by understanding, trust, respect, empathy and confidentiality
• communicate information to patients (and their family) about procedures, potentialities, and risks associated with surgery in ways that encourage their participation in informed decision making
• communicate with the patient (and their family) the treatment options, potentials, complications, and risks associated with the use of drugs
• use effective listening skills and elicit and provide information through appropriate non-verbal communication and open, clarifying questioning
• communicate with and co-ordinate surgical teams to achieve an optimal surgical environment
• communicate effectively with all persons involved in the care of the surgical patient
• initiate the resolution of misunderstandings or disputes
• appropriately adjust the way they communicate with patients to accommodate cultural and linguistic differences
• maintain clear, accurate and appropriate records
• communicate information (in oral and written form) about their own and other's research

Resources

There are no prescribed texts; trainees are expected to keep abreast with current literature. Some suggested sources include:

Australian Council for Safety and Quality in Health Care, 2005, 'Communicating Effectively', National Patient Safety Education Framework,
http ://www.safetyandquality.gov.au/internet/safety/publishing.nsf/Content/C06811AD746228E9CA2571C600835DBB/$File/framework0705.pdf

Baile, W. Buckman, R. Lenzi, R. Glober, G. Beale, E. & Kudelka, A. (2000) A six-step protocol for delivering bad news: Application to the patient with cancer, The Oncologost, 5:4, 302-311 http://theoncologist.alphamedpress.org/cgi/reprint/5/4/302?ijkey=31c929d85ebace64f5a8609bf70c7941df60ed4e

Cultural Competence Training: Literature Review Abstracts http://www.diversityrx.org/htmL/RCPROJ_B_01.htm#section

Kidder K. (2003) The relationship beween communication competence and malpractice claims in plastic surgeons,   http://sweb.uky.edu/~klkidd0/Final_Project.pdf

Lee, S. Back, A. Block, S. & Stewart, S. (2002) Enhancing physician-patient communication. Hematology, http://www.asheducationbook.org/cgi/reprint/2002/1/464

Maguire, P. & Pitceathly, C. (2002) Key communication skills and how to acquire them, BMJ, 325: 697-700 http://bmj.bmjjournals.com/cgi/reprint/325/7366/697

National Health and Medical Research Council, (2004) Communicating with Patients: Advice for medical practitioners; and General Guidelines for medical practitioners on providing information to patients, http://www.nhmrc.gov.au/publications/synopses/e58syn.htm

Topics covered in this module

Basic communication skills

• Provide information in a clear (to the recipient), truthful, considerate, and responsive manner
• Communicate information to patients (and their family) about procedures, potentialities, and risks associated with surgery, as well as any possible alternatives, in ways that encourage their participation in informed decision making
• Discuss with the patient (and their family) the treatment options associated with pre and post-operative treatments in order to maximise the chance that the patient will follow agreed decisions about treatment and/or lifestyle
• Maintain patient confidentiality and trust
• Ensure appropriate levels of privacy

Communication as interaction

• Aware of others in their interaction and treat patients as people
• Elicit a patient's problem, their perceptions and concerns about the problem, and the potential impact of the problem on their lifestyle
• Actively listen
• Check to ensure understanding (their own as much as the patient's) through summarising and clarifying questions
• Continuously self-monitor
• Avoid interrupting the patient (or family) in ways that reduce their capacity to provide information
• Encourage patients (and their family to ask questions

Respond appropriately to the communication context

• Are consciously and consistently competent in their intercultural communications
• Maintain an open-minded and non-judgemental approach to patients (their families) and colleagues
• Adjust their communication in response to feedback (verbal and non-verbal) from others throughout the interaction
• Appropriately adjust their communication style to the kind of information that is being conveyed

Cultural awareness

• Aware of their own cultural expectations and potential biases
• Recognize and respond to health-related beliefs and cultural values, disease incidence and prevalence, and treatment efficacy (their own as well as others'). Examples of culturally competent care include:
• strive to overcome cultural, language, and communications barriers;
• provide an environment in which patients from diverse cultural backgrounds feel comfortable discussing their cultural health beliefs and practices in the context of negotiating treatment options;
• use community workers as a check on the effectiveness of communication and care;
• encourage patients to express their spiritual beliefs and cultural practices; and
• being knowledgeable about and respectful of various traditional healing systems and beliefs and, where appropriate, integrating these approaches into treatment plans.
• Adjust their communication to accommodate the effects of differences in the cultures of staff and patients on clinical and other workforce encounters, including effects of the culture of western medicine and clinical training
• Effectively communicate among staff and patients of different cultures and different languages, including working with interpreters
• Resolve racial, ethnic, or cultural misunderstandings or disputes between staff and patients
• Access interpreters and translated written materials

Non-verbal communication

• Ensure that their non-verbal communication is appropriate for the message that is to be conveyed
• Coordinate non-verbal and verbal communication
• Maintain an interactive posture throughout an encounter with patients and other professionals.
• Be knowledgeable about different non-verbal communication rules in the cultures of their patients and co-workers
• Supplement verbal explanations with written materials written in lay language

 Delivering bad news

• Identify when a patient has interpreted information as 'bad news'
• Acknowledge and address emotions (the patient's and their own)
• Provide information according to each patient's priorities and needs
• Enable patients to talk about their fears and concerns
• Identify problematic responses and be able to deescalate them
• Manage time constraints and potential interruptions

Communicating with colleagues and team members

• Maintain clear and accurate records of case-notes and patient files
• Identify and communicate the most salient information effectively
• Establish and maintain an effective working environment characterised by respect
• Demonstrate and utilize conflict resolution techniques

Communicating about research

• Effectively communicate information about research interests and findings in conferences, seminars and/or journals
• Analyse research relevant to specific cases and communicate this to patients and/or colleagues