Communication Skills and Teamwork in EoLC

Support workers, assistant practitioners and carers

By Dr Georgina Parker

Consultant in Palliative Medicine

Presented by Kerry Harrison, Advanced Practitioner, Head of Hospice Day Service

Aims and Objectives

• To build on current communication skills and explore attitudes, behaviours and skills required for EoLC interactions

• To recognise own strengths and areas for development when communicating with families, carers and the MDT

• Demonstrate awareness of how own experiences of death and dying, can affect capacity to listen and respond appropriately

Name exercise

Please share some information about your name:

• Origins

• How it is used personally and professionally

• Mis-spelling / mis-pronunciation and how that makes you feel

She was Eliza for a few weeks when she was a baby – Eliza Lily. Soon it changed to Lil. Later she was Miss Steward in the baker’s shop and then “my love”, “my darling”, Mother. Widowed at thirty, she went back to work as Mrs Hand. Her daughter grew up, married and gave birth. Now she was Nanna. “Everybody calls me Nanna” she would say to visitors. And so they did – friends, tradesmen, the doctor In the geriatric ward they used the patients’ christian names. “Lil”, we said, “or Nanna”, but it wasn’t on her file and for those last bewildered weeks she was Eliza once again Wendy Cope

E Learning for Health

• E-learning for Health Website:

www.e-lfh.org.uk

Communication

• A 2 way process

• Can occur via speaking, listening and observing

• An exchange of thoughts, views, feelings or emotions

What do we mean by communication?

Impact of communication on patients

Body Language

Tone of voice

Content

Communication

Consequences of good communication:

• Increased trust • Effective information giving • Identification of patient priorities • Exploration of feelings and concerns

Communication Consequences of poor communication:

• Psychological distress and morbidity • Poor adherence to treatment • Reduced quality of life • Dissatisfaction with care • Complaints and litigation • Potential burnout in healthcare professionals

Some studies suggest that patients only remember 10% of what they are told

What do patients expect?

• Consider attitudes and behaviours as well as specific skills and types of information.

• Concentrate on EoLC

• 10 minutes

• Feedback to group

What do patients expect?

What do patients expect from communication with healthcare professionals?

Patients give priority to - being treated with humanity, dignity and respect - good communication - clear information - best possible symptom control - psychological support when needed

NHS Cancer Plan 2000

Willingness to listen and explain is considered by patients to be one of the essential attributes of health professionals.

What do patients expect?

Patients tell us that the emotional aspect of dealing with a life threatening illness is as difficult and distressing as the physical aspects Macmillan 2006

Listening Time and space Identify their concerns Not rushed Empathy No jargon Understanding of their needs Willingness to listen and explain Knowledgeable Establish patients understanding Sort out their problems Confidentiality Point them in the right direction Answer their questions Non-judgemental Eye contact Not interrupted Do their expectations depend on the role of the professional?

Review of own skills

• Review questionnaire in pairs

• What specifically do you find challenging?

• Remember to include challenges in team working

• 10 minutes

• Make brief notes

Communication challenges

• Feedback from discussions

• Challenges may involve:

– Specific situations

– Types of patients

– Subject of conversations

• Patient-based and team-based challenges

Skills that help develop conversations Skills that help to:

• Discover the patient’s issues or concerns

• Make joint decisions with patients

• Give information to patients in a way they can understand and remember

Eye contact Open body language No distractions Open questions Psychological focus Pauses / silence Acknowledging Active listening Clarification Minimal prompts Exploration Reflection Paraphrasing Empathy Educated guesses Summary

Picking up on cues

Cues

“A verbal or non verbal hint which suggests an underlying unpleasant emotion”

Psychological symptoms

Words / phrases which describe physical symptoms that could indicate unpleasant emotional states

Words / phrases suggesting vague or undefined emotions

Verbal hints to hidden concerns

Mention of a life event/repeated or emphasised mention of a neutral event

Mention of a life threatening illness

HCP behaviours that may block conversations

Physical questions Inappropriate information

Closed questions Multiple questions

Leading questions Defending/justifying

Premature reassurance Premature advice

Normalising Minimising

Jollying along Passing the buck

Chit chat

Barriers

What are the things that stop us from communicating effectively? • Consider Fears Beliefs/attitudes Skills Working environment

Barriers Fears • Unleashing strong emotions • Upsetting patients/relatives • Patient refusing treatment • Difficult questions • Damaging the patient

Beliefs • Emotional problems are inevitable • Not my role • Talking raises expectations • Patient will fall apart • Will take too long

Lack of skills • Assessing knowledge and perceptions • Integrating medical and psychosocial modes of enquiry • Handling difficult reactions

Working environment • No support or supervision • No referral pathway • Staff conflict • Lack of time • Lack of privacy

Use of frameworks for conversations

• Useful tools to structure conversations

• Several versions have been proposed

• What frameworks do you use currently?

• Try to pick one and stick to it / adapt it for your own purposes

Use of frameworks for conversations

• Cambridge Calgary framework (Silverman, Kurtz and Draper 2005)

• Disease Illness model (from Levenstein et al 1989 and Stewart et al 2003)

• A framework for effective communication skills for nurses (Hamilton and Martin 2007)

• SPICES (adapted by Serena Cooper)

SPICES

• S Setting the scene (privacy, involvement of others, time boundaries, establish rapport)

• P Person perception (what is going on – ask before you tell)

• I Invite (space for the patient / carer to discuss their concerns)

• C Coping (what mechanisms do they have in place already)

• E Empathy (responses to emotions / statements)

• S Summary (agreeing a way forward)

Macmillan DVD

• Patient experiences of communication with professionals

• Patient preferences for how they would like to be communicated with

Inhibitory behaviours

• Look for the behaviours that are inhibiting or blocking the conversation

– Non verbal

– Verbal

• Pick up cues

Facilitatory behaviours

• Contrast with previous clip

Participant role play

• Pair of role players and one observer

• Role players play themselves or the patient/family member/carer

• Observer look for:

– Things which helped the conversation move along

– Things which might have blocked the conversation

– Cue or hints from the patient/carer

• Swap roles for subsequent role plays

Review of challenges and barriers

• Re-visit lists created earlier

Feedback and evaluation

• Identify 3 learning points that you will take back to practice

• How do you hope this will change your practice

• Evaluation forms