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2.5.3 Introduction to communication strategies Cheat Sheet (DRAFT) by

communication

This is a draft cheat sheet. It is a work in progress and is not finished yet.

Verbal commun­ication

It is not just what we say, but how we say it.
Interp­ret­ation can have signif­icant conseq­uences in clinical practice.
This is made more complex in our clinical centres because many of the patients we treat are elderly, from other cultural backgr­ounds and may not be able to converse profic­iently in English.
Different types of questions used to elicit inform­ation from a patient
Open ended questi­ons-We use these when we want to hear the whole story.
Closed ended questions – prompt short focused answers, usually only one word. Helpful for keeping track of inform­ation on patient records.
Multiple choice questions – Useful in allowing patients to collab­orate and make them feel more empowered. Also helpful with patients who are withdrawn, anxious or depressed.
Commun­ication techni­que­s/tools & their advant­ages: Reflection listening skills After asking a patient a question, it is important that you reflect on what they have said, and ensure that you have understood their answer.
Paraph­rasing: Using other words in a brief, concise, succinct statement to reflect on what the speaker has said. Allows the RT to immedi­ately verify their unders­tanding of the patient’s comments and the patient to hear what their words sound like/c­larify.
Mirroring is a simpler form of reflec­tion. Short and simple – repeating almost the same as what the speaker has said.
Summar­ising: The listener pulls together the main ideas and feelings of the speaker to demons­trate unders­tan­ding.

Non-verbal Commun­ication

Physical contact is also a form of non-verbal commun­ica­tion. Touch has several important functions including:
Easing a patients’ sense of isolation, Decreasing patient anxiety, Demons­trating care empathy sensit­ivity and sincerity, Offers reassu­rance warmth and comfort, Enhances rapport between the patient and health care profes­sional, Supple­ments verbal commun­ication
Categories of non-verbal commun­ica­tion:
Kinesics (body movement, such as gestures, facial expres­sions and gaze patterns), Proxemics (involves the physical distance between people when they commun­icate, position, posture, personal space and territ­ori­ality), Para-l­ing­uistics (voice, pitch, stresses and pauses during verbal commun­ica­tion).

Profes­sional Commun­ication

Effective commun­ication and the use of approp­riate interp­ersonal skills can affect the outcome of situat­ions. As such, it is important with patients who are often in a vulnerable position that health care profes­sionals are honest, tactful and respectful of the patient’s situation.

Gathering Inform­ation

Developing the skills required to interview patients is crucial in radiation therapy because the interview (inter­action you have with the patient) may be the only chance you get to elicit important inform­ation about their perspe­ctive on their diagnosis and treatment and any factors which may impact on this.
Creating an enviro­nment where the patient and their signif­icant others feel comfor­table discussing their treatment and asking questions is paramount to the success of the first day chat and the genuine concern that the radiation therapist shows at this point can be very important in gaining the trust of the patient and in building a rapport for the subsequent days of treatment.
Gaze is a form of commun­ication as well as a method for gathering inform­ation. The 3 primary functions of gaze are:
1. Monitoring: Assessing the other person, and gathering clues about their condition or whether they are listening and responding to instru­ctions (you should be able to gauge their level of interest, unders­tan­ding, boredom or confusion)
2. Regulating: Used to regulate a conver­sation, using gaze to indicate to the other that it is their turn to speak.
3. Expressing – feelings and emotions.

Adapting commun­ication strategies

Use of interp­reters: Interp­reters are trained profes­sionals and are preferable to using family members to translate. Family members may not be familiar with medical termin­ology and therefore unable to translate accura­tely, and the health care profes­sional has no way of knowing that the message has been delivered correctly.
Dealing with angry patients: Recognise their anger, Stay calm, Stay focused on the patients’ needs, Use approp­riate non-verbal commun­ica­tion, Do not try and defend yourself if accused of something, Encourage patient to be specific when describing reasons for anger, Calmly and firmly present your point of view, Address the problem with a senior member of staff, If you feel threatened leave the enviro­nment immedi­ately

Patient Education

Patient education in radiation therapy is crucial if the best outcomes are to be achieved in terms of treatment success and minimi­sation of side effects for the patient (psych­o-s­ocial and physical).
There are 3 main learning styles:
Visual Learners Learn via seeing
Auditory Learners Learn through listening
Kinaes­thetic learners Learn through moving, doing and touching.
Coping behavious:
Compen­sation: Patients can over-e­mph­asises a certain trait/­beh­aviour in one area to make up for a deficiency or failure in another. e.g. Middle aged obese patient who despite the Doctors advice does not exercise regularly or eat a healthy diet, nevert­heless makes an elaborate show of telling the doctor that he has never missed a dose of his choles­terol medicine.
Denial: When a patient rejects or denies the existence of feelings, needs, thoughts, desires or even facts. For example: A cancer patient whose diagnosis has been confirmed by blood tests, CT, PET still thinks the DRs might have got it wrong. This patient may think that their results have been confused with those of another patient.
Regres­sion: When a patient uncons­ciously returns to an immature or infantile behavi­our­/th­ought. This may be when confronted with painful or difficult circum­sta­nces.
Repres­sion: When patient puts out of their mind painfu­l/d­iff­icult thoughts, feelings or events. For example: If they are confronted with a decision whether to undergo a difficult brain biopsy and then goes days without making decision or even consid­ering the options is repressing their thoughts of the condition.

Health Literacy

The degree to which indivi­duals have the capacity to obtain, process and understand basic health inform­ation and services needed to make approp­riate health decisions.
Often patients feel overloaded with inform­ation, come across confli­cting advice and are unable to apply the inform­ation on the internet to their own personal diagnosis.
Some strategies for a patient with low health literacy:
Evaluate the patients unders­tanding before, during and after the inform­ation has been provided by asking the patient to explain what you have just said, Limit the number of messages been provided, Deliver important points first, Avoid use of jargon, Break down inform­ation into unders­tan­dable chunks, Supplement instru­ction with pictures, Audio record consul­tation, Ensure inform­ation is written to an approp­riate level

Empathy

Empathy - Entering into the feeling or spirit of a person or thing; apprec­iative perception or unders­tan­ding.
Sympathy - The fact or the power of entering into the feelings of another, especially in sorrow or trouble; fellow feeling, compas­sion, or commis­era­tion.
Compassion - A feeling of sorrow or pity for the sufferings or misfor­tunes of another.
Caring - Exchanges of confid­ences, partic­ularly in relation to some distre­ssing experi­ence, which are intended to promote emotional healing.
Emotion - Any of the feelings of joy, sorrow, fear, hate, love, etc.
Rapport - Connec­tion, especially harmonious or sympat­hetic relation.
Affinity - A natural liking for, or attraction to, a person or thing.
Pity - Sympat­hetic or kindly sorrow excited by the suffering or misfortune of another, often leading one to give relief or aid or to show mercy.
Responding Empath­ically: Commun­icating with a patient in a helpful and emotio­nally validating way involves empathic1 respon­ding. Paraph­rasing is a very simple technique that can assist you to make patients feel listened to and unders­tood.