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Third in a series of presentations focused on interprofessional research related to medical communication. Looks at barriers and catalysts to successful medical communication of emotional news. Particular attention is paid to the emotional state of the physician.
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Kyle P. Edmonds, MD Institute for Palliative MedicineSan Diego Hospice
Lost in Translation:Barriers and catalysts
There are individual and environmental influences that impact
the success of communication.
Summary
Acknowledging the Overlap
Elements to Negotiate
Provider Perspective
Patient Perspective
Understanding Prognosis
Zier et al., 2012.
Meanwhile…
Weeks et al., 2012.
• Who communicatesMessenger
• Mental shortcuts (avoiding loss)Incentives
• What others doNorms
• We “go with the flow”Defaults
• What is novel and relevant
Salience
The Patient’s World: MINDSPACE
Dolan et al., 2009.
• Sub-conscious cuesPriming
• Emotional associationsAffect
• Public promises / reciprocated acts
Commitments
• Act in ways that make us feel betterEgo
The Patient’s World: MINDSPACE
Dolan et al., 2009.
Patient
Data
Cues
Framing
Ambival-ence
HistoryBeliefs
Coping Style
Trust in Provider
Chosen Role
The Patient’s World
The Provider’s World
Provider
Experiences
Population Data
Patient Data
Ambivale-nce
BeliefsChosen
Role
Professional Norms
Education
Assump-tions
Obstacles: AmbivalenceAvoidance
Patient Defenses
Provider Discomfort
Ambiguity
Reality
Patient Obstacles: Trauma
Maciejewski & Prigerson, 2013.
Provider Obstacles: Distress
Event• Empathy• Perspectiv
e• Memory
Arousal• Overload• Ambivalen
ce
Emotion• Personal
distress
Behavior• Selfish
Pro-social• Avoidance• Freeze
Adapted from: Halifax, 2011.
Provider Catalysts: Targeted helping
de Waal, 2012.
Provider Catalysts: Emotional regulation
Event• Empathy• Perspectiv
e• Memory
Arousal• Emotional
regulation
Emotion• Sympathy
Behavior• Selfless
Pro-social• Other-
centered
Adapted from: Halifax, 2011.
• Mutual understanding
• Willingness to engage
• Reframing anxiety
Provider Catalysts: Compassion
Provider Catalysts: Compassion
Halifax, 2012.
• Rapport
• vs. Trust
Provider Catalysts: Relational
Elements to Negotiate
Control Needs
Meaning Making
Location of Hope
Power of Optimis
m
Outcome Spectrum
OutcomeFraming
Tailoring
Defining Hope
Affective Cues
AmbivalenceAssumptionsAvoidance
Confidence Interval
Lack of Trust
Actions Experiences
There are individual and environmental influences that impact
the success of communication.
Summary
Kyle P. Edmonds, MD [email protected]
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