Introduction
Method
Design
Retreat Training
Recruitment
Interviews
Procedure
Analysis
Results
Participants
Topic Area 1: Key Learnings
Interview 1 | N | Interview 2 | N |
---|---|---|---|
Skills/strategies to use within conversations | |||
Value of silence/allowing pauses | 5 | Taking time--pausing | 4 |
Reflecting/responding to emotions, | 2 | Seeing things from the patient’s point of view/ask don’t tell/reflecting patient emotions | 3 |
Probing why a question was asked, rather than just answering it | 2 | Importance of listening | 2 |
Listening | 2 | Use of “I wish” statements | 2 |
Asking open questions | 1 | Chunking information | 2 |
Sitting with discomfort | 1 | Importance of open questions | 1 |
Importance of summaries | 1 | Being clear about what happens next/what the next steps are | 1 |
Attending to cues in the conversation | 1 | ||
Sitting with ambivalence in the conversation | 1 | ||
Signposting what is coming up in conversation | 1 | ||
Being clear: not being afraid to use the actual word, not camouflaging what you’re saying | 1 | ||
Awareness of non-verbal communication | 1 | ||
Enhanced self-awareness | |||
Awareness of own communication style | 2 | Awareness of own communication style | 1 |
How sentences are structured | Awareness of speaking too fast, the need to slow down speech | 2 | |
Awareness that agenda of patient and health professional may differ, need to align agendas | 1 | Ability to reflect and acknowledge my response and where I am when engaging with someone | 1 |
What health professionals say can impact patients | 1 | ||
Small changes can have a big impact | 1 | ||
Reflecting on own emotions/ responses | |||
Methodology | |||
Frameworks for communication | 4 | Methodology of communication skills | 2 |
Learning from observing others | 3 | ||
Tools in your toolkit to pull out to try | 2 | ||
Preparation | |||
To think through a conversation rather than just approach it ad hoc/preparation | 4 | ||
Setting up a space and room | 1 |
My key learnings were probably around how I might approach difficult conversations or how I might structure my sentences and the way I might ask a question or try and tease out more information from someone. (T1) (social worker)
The key learnings were the methodology of the communication skills, for example, different tools to use for communicating with patients. Something I find I do a lot more is chunking information to patients. I find that a very useful tool. (T2) (specialist doctor)
Topic Area 2: ‘Implementation of learnings, outcomes and barriers’
Exemplar quotes | |
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Patient impact | |
T1 | I had one patient where I had met for the first time and he came out of the consultation and sort of said, “I have never revealed this particular issue to anyone before.” So he had been seen by multiple medical oncologists, radiation oncologists, psychologists, which he didn’t feel he kind of connected with. In that instance, it was a slightly surprising outcome, that he felt he was able to open up and discuss an issue particularly troubling him. (Doctor) |
I left a lot of spaces in the conversation for them to process. I also broke up the conversation into two separate events so that I gave them more time so that they weren’t overwhelmed, which is something I learned from the course, just about not just dumping and leaving. And the feedback from—and also choosing to use direct terms with them about death and dying and the feedback from them both was I was the first doctor who had ever mentioned the word dying with them. And they were both very relieved that they had both been thinking it and not talking to each other or talking to anyone else about it, so to have it out on the table they felt was a bit of a relief. (Doctor) | |
I had a patient just recently, she’s pretty unwell and I was talking to her about her pain and things like that. And I just got a sense that there was more on her mind about what was going on and so instead of trying to ask more focused questions on the pain, I asked a more open question and gave her a bit of time to answer. And she was able to open up about her worries that she wasn’t going to make it to Christmas and that making it to Christmas is really important to her, but she’s worried that she’s not going to make it. And I felt like I wouldn’t have got that if I had just focused on her pain and management of her pain and not given her that chance to explore her feelings more. (Nurse/Allied Health) | |
It was the first time I had spoken with [male carer] so I made sure I listened to everything he was saying in detail and I wrote a lot of notes and left a lot of pauses and slowed down what I was saying to him, so I could pick up on cues and ask those questions “tell me a bit more about that” or “you mentioned this can you explain that to me a bit more.” ….. At the end of the conversation, I explained my role to him and said that I am available for emotional support, ongoing support while his wife is receiving treatment. He said, “Yeah, actually you’ve been really helpful already today.” (Nurse/Allied Health) | |
T2 | Today I saw a terminal patient. I guess my approach to it was to slow the consult down, not rushing or being this brand-new doctor dispensing advice. It was just to take some time to come in slowly, acknowledge everybody in the room, make sure they were comfortable with me and a med student being present. And then to explore what it meant to them to have their father, husband, dying and to watch them settle down and go, “Oh, this is a safe environment, we can talk.” (Doctor) |
I could see that we had to probably stop her treatment soon because she was getting too many toxicities from it and it was affecting her quality of life. Just utilizing those skills to be able to move her forward in her thinking, asking “What if she couldn’t go on with her treatment, because of the peripheral neuropathy?” It facilitated a conversation about there being other treatments, but we are coming to the end of the options, and is now a good time to think about, or talk about preparing for the event where you may be passing away soon or an advanced care planning, and we got into that conversation. (Nurse/Allied Health) | |
With the comm skills course I spent time at the start of the consultation just letting him talk to me about what he was concerned about and went into some personal issues and let him run with it for a bit. I still achieved my objective of getting through the consenting process [for medical procedure], but it was actually, from a personal point of view, a far more rewarding consult because I think he walked out of the door a little bit more chirpy than he when he arrived. (Doctor) | |
Communication with other professionals | |
T1 | A team member who I needed to talk to about their performance and so preparing for that I used a lot of the work [from the training] and thinking about what I was going to say and how I was going to say it. So I found that very useful, when you can take that time to think about it and reflect on, then later, what you did. (Nurse/Allied Health) |
[talking to a staff member] I said “I get a sense that you are uneasy about something” and they said “yes” and I said “can you tell me more” and this whole thing opened and the staff member said at the end “I just feel much better for having got that off my chest”. (Doctor) | |
One of the other things I probably gained that I hadn’t quite realized was these skills relate to not just your engagement with patients but with fellow staff. Just the value that it can have in having better, more meaningful conversations and communication with your peers and bosses (Nurse/Allied Health) | |
T2 | We were going to have to sit down [with a team member] and have very difficult conversations [relating to ongoing work]. I was going to draw on the structures that I learned from the workshop. First to signpost to say “this is a difficult conversation, it’s probably going to be a bit difficult for both of us and this is what it’s about.” And then do my pause and ask them the question; what are your plans [relating to ongoing work] what are you thinking? (Nurse/Allied Health) |
Most skills are applicable across the board, so deep listening, been reading about deep listening. But also trying to pick up cues and all those things are applicable when you’re interacting with your fellow staff members. (Doctor) |