Communication

Clear communication, both between provider and patient and among healthcare professionals, is a vital component of good patient care. It builds trust and confidence, helps to dispel fears and concerns, establishes realistic and achievable expectations, avoids misunderstandings, facilitates adherence to therapy, helps to ensure timeous delivery of necessary healthcare interventions and optimises co-operation between providers of healthcare, patients and their families.

Good communication between physician and patient requires the establishment of rapport and time should be set aside for this. Listening is as important as talking and patients’ beliefs, fears and concerns need to be heard, understood and addressed. Where language differences present a barrier, a competent translator, preferably one who is a healthcare worker sharing the same first language, should be employed. It should be borne in mind that communication using a shared second language or even different dialects of the same language, and between individuals from different cultural backgrounds, may not be clear. In the same way, the sensitivity of pain rating scales may be influenced by cultural and language differences.²⁰

It is important to invite the patient to tell their own story in their own words. The clinician then summarises what is heard and asks the patient to correct any misunderstandings. This helps to improve the rapport between patient and physician and ensure correct assessment and clinical decisions. Wherever possible, explanations should be delivered in the patient’s home language and should be free of jargon. To confirm that the explanation has been clear, patients should be asked to repeat what they have understood and misunderstandings need to be corrected.

Although the degree to which patients, caregivers or their proxies want to be involved in decision-making with their practitioner is variable, patient participation is vital to get the most out of treatment. A ‘partnership’ or ‘concordant’ approach with open and clear discussion between patients and their doctor leads to decisions that respect the beliefs and wishes of the patient in determining whether, when and how treatment is administered. In this way, it is more likely that agreement on treatment strategies that are acceptable to the patient/ proxy will be reached, with the aim of improving patient adherence.

Five prerequisites have been proposed for a concordant consultation:²¹

1. A willingness to share power and a commitment to giving appropriate weight to the patient’s values and goals
2. Open discussion of the options with explicit enquiry as to patients’ views without making assumptions
3. Adequate sharing of information, including uncertainties, to arrive at a decision
4. Listening as much as talking
5. Time

Table 1 lists some practical considerations for open discussion with patients and their families.

Table 1: How to Have Open Discussions About Treatment Options 21

Explain the disease, treatment options and benefits, side effects and risks associated with treatment Determine the patient’s views and concerns and expectations from treatment. Proactively ask and listen to the patient. Acknowledge and summarise to ensure that their position has been correctly understood Involve the patient (and, where appropriate, relevant family members) in treatment decisions as far as they want to be involved Offer your opinion and check any assumptions that you are making Invite response from the patient Be open to disagreement and check that you understand the basis for that Clarify misunderstandings where they exist Try to achieve a shared decision and confirm that you have understood the patient’s decision correctly. Allow time for the patient to consider their options before making a decision and schedule a future appointment to discuss this if necessary Arrange follow-up and support as appropriate Anticipate non-adherence rather than adherence and ask about it at every follow-up visit in a nonjudgmental way Ask the patient for their thoughts on what might help them to be compliant with treatment and hospital appointments

Communication between healthcare professionals at all levels is also crucial. Because much of patient care may occur at home, the primary care practitioner and community nursing staff must be included.