Wednesday, February 7, 2018

Let's Talk - Patient / Physician Communication Feb 7, 2018


We know that communication plays an important role in the relationship patients have with their health care providers. During this month's #gyncsm chat, Let's Talk - Patient / Physician Communication, we discussed how communication has changed over the past few years, how you describe "good communication" and we finished the chat discussing the new ASCO Patient-Clinician Communication Guideline. We were pleased to have ASCO (@ASCO) and Timothy Gilligan (@TimGilliganMD) Cleveland Clinic, join us for this very important chat. We had 38 participants and 2.5 M impressions during the one hour chat. You may find the more analytics here and the complete transcript here.

Some sample responses to our questions appear below. Please see the transcript for more tweets.

T1: What shifts over time have you seen in communication between patients and physicians? What seems better? What seems worse?
  • Shared decision making is for the better for all! 
  • From a Docs POV, patients are more knowledgeable and engaged in their disease and how they’d like to treat it. Sometimes Dr Google can give patients misperceptions
  • I worry about impact of EMR. Is there eye contact with physicians or are they they staring at the computer screen?
  • there has been a shift away from paternalism (i.e. not telling a patient that they had cancer because it would be "upsetting") =good for openness. Flip side, demands from behind the scenes (billing, charting) can cause distraction & less attention during appointments
T2: What does "good communication" between patient and physician look like for you?
  • Good communication requires listening and the Take 5 rule. Take at least 5 minutes to listen, 5 to comprehend/consider, & 5 to respond.
  • T2: (I'm not a physician) but in my interactions with patients & families, "good communication" looks like a "normal" conversation that you might have w/ a friend: mutual info seeking+info giving+ reflecting on goals and purpose behind decisions and choices.
  • Listen, look & feel with compassion & understanding. Take your eyes off the computer screen
  • T2:@alihaider99  presents at @ASCO  study Results: Large majority of patients, 72%, preferred face-to-face interactions. Physicians who communicated face-to-face were perceived to be more compassionate, professional, and better communicators.
  • I find the listening, curiosity, empathy and a willingness to work collaboratively are key. Plus sincere interest in the person 
T3: What do you wish more doctors would do when it comes to communication? / What do you wish more patients would do when it comes to communication?
  • I know for myself that I can spend more time preparing questions and other things to get the most out of the appointment.
  • Again, from the psych perspective, I hear patients talk about wanting respect. I hear physicians talking about pressure to be infallible. 
  • Doctors: Please look me in the eye, and do not be afraid to admit you do not know the answer to my question.
  • Be honest transparent respectful and just have a conversation. It’s that easy.
  • One of our leaders challenged us to say "I don't know" more often. Wise advice
T4: What prompted @ASCO to produce the communication guideline as part of itsSupportive Care and Treatment Related Issues guidelines? What are the key points?
  • T4: Improved communication has been associated with improvements in several health outcomes, and patient-physician communication was identified as a high-priority topic by our Supportive Care Guidelines Advisory Panel
  • T4: The guideline includes recommendations for clinician training in communication skills; facilitating family involvement in care; and discussing goals of care and prognosis, treatment selection, and end-of-life care
  • T4: The guidelines also remind me how much cancer docs have to cover and how complex each area is on its own. Was good to see communication training mentioned as well.
  • Communication, while intuitive in care, is often difficult to do effectively. Most orgs should promote guidance for effectively communicating. @ASCO took the bull by the horns & its a good thing
T5: Why was it important to include family involvement as part of the Patient-Clinician Communication guideline?
  • T5: From my perspective as an oncologist, family and other loved ones are key to getting through cancer treatments.
  • T5: Most people don't make decisions in a vacuum but in the context of their relationships.
  • So important. So so important. Patients make decisions with support of caregivers, who can often provide some clarity in the chaos of diagnosis
  • Cancer care is a family affair.
  • Most patients discuss treatment with family and often rely on family to get to treatment and help manage side effects
T6: Hope and empathy are incorporated into the Patient-Clinician Communication guideline. What is it important for patients and physicians to consider when it comes to these concepts?
  • T6: For me, empathy is the beginning, middle and end of good patient connection. If empathy is present, even the hardest conversations can happen.
  • T6: Kindness and empathy can help diffuse negative emotions associated with cancer diagnosis/treatment, and may even help to improve patients’ outcomes
  • T6 If we're talking about #precisionmedicine, and let's face it, we should be; empathy and hope are vital to the communication plan, to the wholeness approach to tx
  • T6: I think that hope is trickier. In some cases, the hope is for the best quality of life, not for cure or survival. Communicating the nature of hope matters.
T7: How can both patients and physicians prepare for visits and lay the groundwork for good communication? What have you found helpful to get answers and keep everyone informed and connected between visits?
Please scroll down to find resources shared during this chat.

Patients and caregivers are invited to continue our discussion on the Smart Patients platform at https://www.smartpatients.com/partners/gyncsm

Join us next month on our regular day (second Wednesday of the month) Wednesday, March 14, 2018 at 9pm ET as we discuss Immunotherapy with guest Dr Christian Hinrichs.
Have a good month, 

Dee
#gyncsm Co-founder
 RESOURCES
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Friday, February 2, 2018

February 7, 2018 Chat : Let's Talk- Patient / Physician Communication


An important part of the patient-physician relationship is communication. This month we are holding our chat a week early on Wednesday, February 7, 2018 (9pm ET | 8pm CT | 6pm PT) and our February topic is Let's Talk - Patient / Physician Communication. 

Evidence shows that better communication of health care information leads to better outcomes for patients in a number of different ways. We also know that communication related to cancer has its own set of challenges. Patients have said that hearing the words, "You have cancer", impacts them in a way in which they don't hear what their physician says next. Patients are processing those words and experiencing many different emotions. Oncologists while sharing a cancer diagnosis with a patient and their family are also challenged to provide not only scientific information but support. At diagnosis, while discussing treatments, in addressing survivorship issues and end of life care, communication is a key part of the patient and clinician relationship.

Recently, ASCO (The American Society of Clinical Oncology) took on the task of developing the Patient Communication:ASCO Consensus Guideline. An expert panel was assembled to answer the question, What communication skills and tasks can clinicians use to optimize the patient-clinician relationship, patient and clinician well-being and family well-being?. We are pleased to be joined this month by Timothy Gilligan, MD (@TimGilliganMD) Co-chair of the ASCO panel and Kari Bohlke (@karibohlke), ASCO staff member to discuss the Guideline and cancer-care communications.

Below are the questions we will ask during our chat:

T1: What shifts over time have you seen in communication between patients and physicians? What seems better? What seems worse?

T2: What does "good communication" between patient and physician look like for you?

T3: What do you wish more doctors would do when it comes to communication? / What do you wish more patients would do when it comes to communication?

T4: What prompted @ASCO to produce the communication guideline as part of its Supportive Care and Treatment Related Issues guidelines? What are the key points?

T5: Why was it important to include family involvement as part of the Patient-Clinician Communication guideline?

T6: Hope and empathy are incorporated into the Patient-Clinician Communication guideline. What is it important for patients and physicians to consider when it comes to these concepts?

 T7: How can both patients and physicians prepare for visits and lay the groundwork for good communication? What have you found helpful to get answers and keep everyone informed and connected between visits? 

Our recommended readings for this chat are the ASCO Guideline which can be found at:
http://ascopubs.org/doi/full/10.1200/JCO.2017.75.2311
and the American Cancer Society page The Doctor Patient Relationship:
https://www.cancer.org/treatment/understanding-your-diagnosis/talking-about-cancer/the-doctor-patient-relationship.html

We look forward to having you join us on February 7th for this very important discussion.

Dee and Christina
#gyncsm Co-founders


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