Seven Principals of Patient-Clinician Communication
Patient-clinician communication is important in the sense that it can essentially save or lose a life. Many factors affect the quality and also the clarity of communications between a patient and clinician. Certain points serve as the foundation of the patient-clinician relationship; which are also the basis of trust between clinicians and patients. Better communication between healthcare providers and patients results in better health outcomes that fall within two categories ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"8Q4IEVre","properties":{"formattedCitation":"(Kelley, Kraft-Todd, Schapira, Kossowsky, & Riess, 2014)","plainCitation":"(Kelley, Kraft-Todd, Schapira, Kossowsky, & Riess, 2014)","noteIndex":0},"citationItems":[{"id":15,"uris":["http://zotero.org/users/local/aFLg5zv9/items/MDZ7KP2H"],"uri":["http://zotero.org/users/local/aFLg5zv9/items/MDZ7KP2H"],"itemData":{"id":15,"type":"article-journal","title":"The Influence of the Patient-Clinician Relationship on Healthcare Outcomes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","container-title":"PLoS ONE","volume":"9","issue":"4","source":"PubMed Central","abstract":"Objective\nTo determine whether the patient-clinician relationship has a beneficial effect on either objective or validated subjective healthcare outcomes.\n\nDesign\nSystematic review and meta-analysis.\n\nData Sources\nElectronic databases EMBASE and MEDLINE and the reference sections of previous reviews.\n\nEligibility Criteria for Selecting Studies\nIncluded studies were randomized controlled trials (RCTs) in adult patients in which the patient-clinician relationship was systematically manipulated and healthcare outcomes were either objective (e.g., blood pressure) or validated subjective measures (e.g., pain scores). Studies were excluded if the encounter was a routine physical, or a mental health or substance abuse visit; if the outcome was an intermediate outcome such as patient satisfaction or adherence to treatment; if the patient-clinician relationship was manipulated solely by intervening with patients; or if the duration of the clinical encounter was unequal across conditions.\n\nResults\nThirteen RCTs met eligibility criteria. Observed effect sizes for the individual studies ranged from d = −.23 to .66. Using a random-effects model, the estimate of the overall effect size was small (d = .11), but statistically significant (p = .02).\n\nConclusions\nThis systematic review and meta-analysis of RCTs suggests that the patient-clinician relationship has a small, but statistically significant effect on healthcare outcomes. Given that relatively few RCTs met our eligibility criteria, and that the majority of these trials were not specifically designed to test the effect of the patient-clinician relationship on healthcare outcomes, we conclude with a call for more research on this important topic.","URL":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3981763/","DOI":"10.1371/journal.pone.0094207","ISSN":"1932-6203","note":"PMID: 24718585\nPMCID: PMC3981763","shortTitle":"The Influence of the Patient-Clinician Relationship on Healthcare Outcomes","journalAbbreviation":"PLoS One","author":[{"family":"Kelley","given":"John M."},{"family":"Kraft-Todd","given":"Gordon"},{"family":"Schapira","given":"Lidia"},{"family":"Kossowsky","given":"Joe"},{"family":"Riess","given":"Helen"}],"issued":{"date-parts":[["2014",4,9]]},"accessed":{"date-parts":[["2019",2,6]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Kelley, Kraft-Todd, Schapira, Kossowsky, & Riess, 2014). The patient-clinician relationship has both emotional and informational/cognitive components. Emotional care includes mutual trust, care, and respect while cognitive care includes information gathering, patient information and expectation management. Both of these are quite important for a successful bonding between a healthcare provider and patient ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"SNCKvAQr","properties":{"formattedCitation":"(Molassiotis, Morris, & Trueman, 2007)","plainCitation":"(Molassiotis, Morris, & Trueman, 2007)","noteIndex":0},"citationItems":[{"id":18,"uris":["http://zotero.org/users/local/aFLg5zv9/items/DMTW3PRZ"],"uri":["http://zotero.org/users/local/aFLg5zv9/items/DMTW3PRZ"],"itemData":{"id":18,"type":"article-journal","title":"The importance of the patient-clinician relationship in adherence to antiretroviral medication","container-title":"International Journal of Nursing Practice","page":"370-376","volume":"13","issue":"6","source":"PubMed","abstract":"The aim of the study was to assess dimensions of the patient-clinician relationship in relation to adherence with antiretroviral medication in a sample of HIV patients. This was a correlational evaluation, using a cross-sectional design. Thirty-eight HIV patients in two UK HIV units provided complete data. Analysis suggested that the elements of the patient-clinician relationship contributing to adherence with medication were the patient perception of being valued and respected by the clinician, the patients' ability to initiate discussions about the treatment, empowerment and level of trust placed in the nurse. The latter, and the time since starting antiretroviral treatment, were the only two variables that could predict adherence in a regression model, explaining 41% of the variance in adherence. Building trusted relationships with the patients and investing in educational and communication techniques to improve the therapeutic relationship could strongly contribute to HIV patients to maintaining high adherence rates.","DOI":"10.1111/j.1440-172X.2007.00652.x","ISSN":"1322-7114","note":"PMID: 18021166","journalAbbreviation":"Int J Nurs Pract","language":"eng","author":[{"family":"Molassiotis","given":"Alex"},{"family":"Morris","given":"Kate"},{"family":"Trueman","given":"Ian"}],"issued":{"date-parts":[["2007",12]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Molassiotis, Morris, & Trueman, 2007).
There are seven basic principles of patient-clinician's communications. All the seven components are important in designing effective healthcare facility for the patients. These principals are
Mutual respect
Harmonized goals
A supportive environment
Appropriate decision partners
The right information
Full disclosure and transparency
Continuous learning
These seven principles are helpful in identifying the mutual expectations of both patients and their clinicians. Each of the seven principles can help the physicians to interact with their physicians effectively. In case of mutual respect, both clinician and the patient are engaged with each other as decision making partner. Communication, in this case, should seek to improve healthcare decision making by exchanging information and also by supporting the improvement of a partnership relationship based on trust and respect ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"SH5iYLBI","properties":{"formattedCitation":"(Paget et al., 2011)","plainCitation":"(Paget et al., 2011)","noteIndex":0},"citationItems":[{"id":23,"uris":["http://zotero.org/users/local/aFLg5zv9/items/YJBRBT28"],"uri":["http://zotero.org/users/local/aFLg5zv9/items/YJBRBT28"],"itemData":{"id":23,"type":"article-journal","title":"Patient-Clinician Communication: Basic Principles and Expectations","container-title":"NAM Perspectives","volume":"1","issue":"6","source":"Crossref","URL":"https://nam.edu/perspectives-2011-patient-clinician-communication-basic-principles-and-expectations/","DOI":"10.31478/201106a","ISSN":"25786865","shortTitle":"Patient-Clinician Communication","language":"en","author":[{"family":"Paget","given":"Lyn"},{"family":"Han","given":"Paul"},{"family":"Nedza","given":"Susan"},{"family":"Kurtz","given":"Patricia"},{"family":"Racine","given":"Eric"},{"family":"Russell","given":"Sue"},{"family":"Santa","given":"John"},{"family":"Schumann","given":"Mary Jean"},{"family":"Von Kohorn","given":"Isabelle"}],"issued":{"date-parts":[["2011",6,15]]},"accessed":{"date-parts":[["2019",2,6]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Paget et al., 2011). Harmonized goal means the understanding and agreement of the proposed care plan. In this case, the factors should include health and other economic preferences. It should also include language and other ethnic differences. Supporting environment means a secure and nurturing environment where the patient will feel safe. Decision partners means to fully understand the patient option so that the patient will feel positive about the treatment procedure. The clinician should share the right information about the patient's health including his disease and any symptoms. Transparency means that the patient should be open to the clinician on all the relevant circumstances and medical history. By understanding the patient condition, reliable care can be given to him. Continuous learning means the establishment of an effective approach for constant feedback on the progress.
The three methods that are used to improve the interdisciplinary communication are multidisciplinary rounds using goal sheet, team huddles and also a standardized communication format that is called SBAR or Situation, Background, Assessment, and Recommendation. Among all the three methods SBAR is useful in eliminating the communication gaps, which is used to estimate the patient’s current situation. If there are any major complaint in the medical condition of the patient, they are estimated. The patient’s medical background is evaluated, the patient’s current diagnosis is assessed and lastly, recommendation is made about how the patient will be treated.
Among all the three methods the SBAR method is the most useful, and it can be used rapidly in healthcare for improving the communication gap. Because in this method all the information that is important for the development of successful treatment is taken out and by looking at it the patient can be treated accordingly ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"CaVEpOle","properties":{"formattedCitation":"(Gollust & Dwyer, 2013)","plainCitation":"(Gollust & Dwyer, 2013)","noteIndex":0},"citationItems":[{"id":24,"uris":["http://zotero.org/users/local/aFLg5zv9/items/U534CNNA"],"uri":["http://zotero.org/users/local/aFLg5zv9/items/U534CNNA"],"itemData":{"id":24,"type":"article-journal","title":"Ethics of Clinician Communication in a Changing Communication Landscape: Guidance From Professional Societies","container-title":"JNCI Monographs","page":"147-152","volume":"2013","issue":"47","source":"academic.oup.com","abstract":"AbstractBackground. Cancer experts engage in public communication whenever they promote their research or practice, respond to media inquiries, or use social m","DOI":"10.1093/jncimonographs/lgt028","ISSN":"1052-6773","shortTitle":"Ethics of Clinician Communication in a Changing Communication Landscape","journalAbbreviation":"J Natl Cancer Inst Monogr","language":"en","author":[{"family":"Gollust","given":"Sarah E."},{"family":"Dwyer","given":"Anne M."}],"issued":{"date-parts":[["2013",12,1]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Gollust & Dwyer, 2013). Normally patients face different medical issues; it is not necessary that the issue is only physical it can be an emotional and psychological issue. In that case the nurses and other healthcare providers should make sure that the information is not leaked and the trust should not be breached and if the information is related to any sensitive issue like sexual abusive then the patient should be taken in confidence and steps should be taken for the best interest of the patient. Ethics is an important and sensitive issue in healthcare because patients put their trust in the practitioners and it is on the practitioners that how they safeguard that information. For a successful communication trust is important and nurses should make sure that it is not broken in any case ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"1t0DnD5w","properties":{"formattedCitation":"(Wang, Wan, Lin, Zhou, & Shang, 2018)","plainCitation":"(Wang, Wan, Lin, Zhou, & Shang, 2018)","noteIndex":0},"citationItems":[{"id":27,"uris":["http://zotero.org/users/local/aFLg5zv9/items/E9AHG5VC"],"uri":["http://zotero.org/users/local/aFLg5zv9/items/E9AHG5VC"],"itemData":{"id":27,"type":"article-journal","title":"Interventions to improve communication between nurses and physicians in the intensive care unit: An integrative literature review","container-title":"International Journal of Nursing Sciences","collection-title":"Special Issue: Midwifery and Women's Health","page":"81-88","volume":"5","issue":"1","source":"ScienceDirect","abstract":"Effective communication among healthcare professionals in the intensive care unit (ICU) is a particular imperative, with accurate and efficient interdisciplinary communication being a critical prerequisite for high-quality care. Nurses and physicians are highly important parts of the healthcare system workforce. Thus, identifying strategies that would improve communication between these two groups can provide evidence for practical improvement in the ICU, which will ultimately improve patient outcomes. This integrative literature review aimed to identify interventions that improve communication between nurses and physicians in ICUs. Three databases (Medline, CINAHL, and Science Direct) were searched between September 2014 and June 2016 using 11 search terms, namely, nurse, doctor, physician, resident, clinician, ICU, intensive care unit, communication, teamwork, collaboration, and relationship. A manual search of the reference lists of found papers was also conducted. Eleven articles met the inclusion criteria. These studies reported on the use of communication tools/checklists, team training, multidisciplinary structured work shift evaluation, and electronic situation–background–assessment–recommendation documentation templates to improve communication. Although which intervention strategies are most effective remains unclear, this review suggests that these strategies improve communication to some extent. Future studies should be rigorously designed and outcome measures should be specific and validated to capture and reflect the effects of effective communication.","DOI":"10.1016/j.ijnss.2017.09.007","ISSN":"2352-0132","shortTitle":"Interventions to improve communication between nurses and physicians in the intensive care unit","journalAbbreviation":"International Journal of Nursing Sciences","author":[{"family":"Wang","given":"Ya-Ya"},{"family":"Wan","given":"Qiao-Qin"},{"family":"Lin","given":"Frances"},{"family":"Zhou","given":"Wei-Jiao"},{"family":"Shang","given":"Shao-Mei"}],"issued":{"date-parts":[["2018",1,10]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Wang, Wan, Lin, Zhou, & Shang, 2018).
Although nurses should be focused in providing only healthcare facility but there are cases where they encounter patients who belong to different culture and also face different situation so in that case, it is the duty of the nurses to console their patients by communicating with them, there are many methods of this inter-communication, and it is on them that which method they use. It should be kept in mind that the information or the secrets that are shared with them are sometimes quite sensitive. So in such a situation, any step that is taken should be cautious. Also, the patient should be taken in confidence before any step because if the patients lost their interest, then it is not possible to design an effective treatment for them. Therefore, ethics should be taken care of.
References
ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY Gollust, S. E., & Dwyer, A. M. (2013). Ethics of Clinician Communication in a Changing Communication Landscape: Guidance From Professional Societies. JNCI Monographs, 2013(47), 147–152. https://doi.org/10.1093/jncimonographs/lgt028
Kelley, J. M., Kraft-Todd, G., Schapira, L., Kossowsky, J., & Riess, H. (2014). The Influence of the Patient-Clinician Relationship on Healthcare Outcomes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PLoS ONE, 9(4). https://doi.org/10.1371/journal.pone.0094207
Molassiotis, A., Morris, K., & Trueman, I. (2007). The importance of the patient-clinician relationship in adherence to antiretroviral medication. International Journal of Nursing Practice, 13(6), 370–376. https://doi.org/10.1111/j.1440-172X.2007.00652.x
Paget, L., Han, P., Nedza, S., Kurtz, P., Racine, E., Russell, S., … Von Kohorn, I. (2011). Patient-Clinician Communication: Basic Principles and Expectations. NAM Perspectives, 1(6). https://doi.org/10.31478/201106a
Wang, Y.-Y., Wan, Q.-Q., Lin, F., Zhou, W.-J., & Shang, S.-M. (2018). Interventions to improve communication between nurses and physicians in the intensive care unit: An integrative literature review. International Journal of Nursing Sciences, 5(1), 81–88. https://doi.org/10.1016/j.ijnss.2017.09.007
