Leslie Chang Evertson, GNP Lead Dementia Care Manager

UCLA Alzheimer’s and Dementia Care Program

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DISCLOSURES

None of the faculty, planners, speakers, providers nor CME committee has any relevant financial relationships

with commercial interest There is no commercial support for this CME activity

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Objective Review tasks in conducting a family meeting Improve communication skills in difficult

patient/family conversations Identify and practice some nuanced communication

skills

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“All medical care flows through the relationship between physician and patient,

and the spoken word is the most important tool in medicine.”

Eric Cassell

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Improving Communication Skills Communication skills can be improved

- There are strategies that improve patient satisfaction and psychological outcomes

- Training and experience does improve physician skills

Expanding your spectrum of comfort - Areas of greater/less comfort - Comfort may increase clinical competence

Example of a Difficult Discussion

Screening Questions for Almost All Discussions

What do you know?

“How do you think [the patient] is doing?” “Tell me what you understand or have been told about

[the/your] illness?” “What did the [consultant/others] say or tell you?” “How do you feel about that?” “Do you have questions about what you have been

told?”

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Screening Questions for Discussions

Getting Consent What do you want to know? Would you like to have someone else here when we

talk about this? Who do you want with you?

Nuanced Skills: Clarifying Ambiguity

Ambiguity is common Clarification is appreciated Clarification is important

- For getting to “the agenda” - Understanding expectations

“What do you mean?”

“Tell me more” “What were you hoping for?” “How do you feel about that?”

Nuanced Skills: Balance Talking AND Listening

Talking is not the same as communicating Achieves a common understanding Communication is a balance Reciprocal Variable Cultural Situational

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Nuanced Skills: Balance Talking AND Listening

Patient-centered interviewing - Understand patient as a person, their illness experience - Open-ended questions, generous listening

Outcomes of Listening:

- Improved Satisfaction - Visit length effects

Uninterrupted, patients go only a little bit longer 1/3 of problems are mentioned just to be heard, not fixed Visits often last a few minutes longer Missed cues lead to longer visits

Kaplan, Ann Intern Med, 1996 Levinson, JAMA, 2000 Levinson, JAMA, 1997

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Nuanced Skills: Respond to Emotion

Responses - Listen (“Don’t just do something. Sit there.”) - Bear Witness - Empathize

Outcomes of Responsiveness: Empathy - Improved patient satisfaction - Improved QOL - Decreased depression Spiro, Annals Int Med, 1992 Hojat, Am J Psych, 2002 Ong, Patient Educ Couns, 2000

Healing is accomplished not by experts, but by human beings.

- Rachel Naomi Remen, MD

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A Better Discussion

Readings Rabow, MW, Hauser JM, Adams Jocclia. JAMA (2004) 291(4): 483-491

Thank you Leslie Chang Evertson, GNP Lead Dementia Care Manager UCLA Alzheimer’s and Dementia Care Program 200 UCLA Medical Plaza Suite 365A Los Angeles, CA 90095 Phone: (310)319-3222 levertson@mednet.ucla.edu http://dementia.uclahealth.org

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