Putting it all together Samantha Tai CalgaryCambridge Guides

Putting it all together Samantha Tai

Calgary-Cambridge Guides The Four Habits 1. Invest in the beginning • • • Create rapport quickly Elicit patient concerns Plan the visit with the patient 2. Elicit the Patient Perspective • • Ask for patient’s ideas Explore impact on patient’s life 3. Demonstrate Empathy 4. Invest in the end Kurtz, S. , Silverman, J. , Bensons, J. Draper, J. (2005). Marrying content and process in clinical method teaching: Enhancing the Calgary-Cambridge Guides. Academic Medicine, 78(8), 802 -809. • • Be open to patient’s emotions Discern empathetic opportunities Express empathy Deliver diagnostic information Provide education Involve patient in making decisions Complete the visit Frankel, R. M. , & Stein, T. (1999). Getting the most out of the clinical encounter: the four habits model. Perm J, 3(3), 79 -88. 2

Applicability of the four habits into different scenarios 1. Invest in the beginning • • • Create rapport quickly Elicit patient concerns Plan the visit with the patient 2. Elicit the Patient Perspective • • Ask for patient’s ideas Explore impact on patient’s life 3. Demonstrate Empathy 4. Invest in the end • • Be open to patient’s emotions Discern empathetic opportunities Express empathy These communication tasks are transferrable to different audiological and rehabilitation scenarios. The habits does not need to be done in sequence. Be flexible! P: I’m having trouble with my hearing aids Deliver diagnostic information Provide education Involve patient in making decisions Complete the visit Frankel, R. M. , & Stein, T. (1999). Getting the most out of the clinical encounter: the four habits model. Perm J, 3(3), 79 -88. P = patient 3

How do we use the four habits with tinnitus patients? 1. Invest in the beginning • • • Create rapport quickly Elicit patient concerns Plan the visit with the patient 2. Elicit the Patient Perspective • • Ask for patient’s ideas Explore impact on patient’s life 3. Demonstrate Empathy 4. Invest in the end • • Be open to patient’s emotions Discern empathetic opportunities Express empathy Working in pairs, how would you use the Four Habits in a tinnitus appointment? P: I’ve been getting this bad ringing in my ears and it keeps getting louder Deliver diagnostic information Provide education Involve patient in making decisions Complete the visit Frankel, R. M. , & Stein, T. (1999). Getting the most out of the clinical encounter: the four habits model. Perm J, 3(3), 79 -88. P = patient 4

How do we use the four habits with rehabilitation patients? 1. Invest in the beginning • • • Create rapport quickly Elicit patient concerns Plan the visit with the patient 2. Elicit the Patient Perspective • • Ask for patient’s ideas Explore impact on patient’s life 3. Demonstrate Empathy 4. Invest in the end • • Be open to patient’s emotions Discern empathetic opportunities Express empathy Working in pairs, how would you use the Four Habits in a rehabilitation appointment e. g. pediatric (re)habilitation session with the child and their carer(s) P: My child does not want to wear the hearing device Deliver diagnostic information Provide education Involve patient in making decisions Complete the visit Frankel, R. M. , & Stein, T. (1999). Getting the most out of the clinical encounter: the four habits model. Perm J, 3(3), 79 -88. P = parent 5

Breaking bad news Bad news is defined as “any information likely to alter drastically a patient’s view of his or her future” - Buckman (1984) Barriers to delivering bad news • • • Fear of patient’s response Fear of being blamed Fear of being vulnerable Ethical and professional obligation to tell our patients about their results 6

Breaking bad news S-P-I-K-E-S Setting • find a private space • involve significant other Perception • find out what the patient knows e. g. ‘What is your understanding of an ABR assessment? ’ Invitation • consider patients’ information preference e. g. “Would you like me to go into the full detail of the diagnosis or the key points? ” 7

Breaking bad news S-P-I-K-E-S Knowledge Empathy Strategy & Summary • Use empathetic • • Provide a warning shot before giving the diagnosis e. g. ‘I’ve got some bad news…’ Chunk information Avoid jargon Check understanding • • response to address the patient’s emotions (shock, isolation, grief) e. g. ‘I know this isn’t what you wanted to hear, I wish the results showed otherwise. ’ Non-verbal communication is sometimes more effective • Discuss the next steps and share decisionmaking of treatment options 8

Examples of empathetic responses Baile, W. F. , Buckman, R. , Lenzi, R. , Glober, G. , Beale, E. A. , & Kudelka, A. P. (2000). SPIKES—a sixstep protocol for delivering bad news: application to the patient with cancer. The oncologist, 5(4), 302 -311. 9

Activity 1: Video example • What aspects of the Four Habits did the clinician use? • What worked well in this session? • If this was your session, what would you have done differently? 10

Activity 1: Video example 11

Feedback promts Areas to Improve Good Amazing! Adapted from: Krupat, E. , Frankel, R. , Stein, T. , & Irish, J. (2006). The Four Habits Coding Scheme: validation of an instrument to assess clinicians’ communication behavior. Patient education and counseling, 62(1), 38 -45. 12

Activity 2: Reflective exercise • Watch your own role-play video from unit 1 and reflect on your own communication. • Use the feedback prompts from the previous units to review areas you did well and areas that may need improvement 13

Activity 3: Role play Working in groups of three: • Share the scenario from your video-recording and why you considered it to be a challenging scenario. • Role-play the same scenario by applying what you have learnt • Video-record the role-play using your own smart phone 14

“Communication is a skill that you can learn. It's like riding a bicycle or typing. If you're willing to work at it, you can rapidly improve the quality of every part of your life” - Brian Tracy 15