CONSIDER THIS PIECE BY ANDY SARGENT

Questions for reflection or group discussion

  1. What do you see in this painting?

  2. Have you ever felt this way?

  3. This is self portrait by a patient with multiple health issues due to an accident. He titled it “Used, Abused Monster.” How does this change your impression of the painting, if at all?

IMPORTANCE OF COMPASSIONATE COMMUNICATION

Compassionate communication is communicating in ways that foster understanding, connection, and compassion.

Establishing trust and rapport with patients is critical for having a good therapeutic relationship with them. We can do this by remaining empathic and curious in our patient interactions. Where are they coming from? What do they value? What are their concerns?

It is also important to remain sensitive to the diversity of patients’ and families’ values, cultural preferences, as well as their health literacy and numeracy. To learn more about compassionate communication, explore the Sanford Institute for Empathy and Compassion.

HEALTH LITERACY AND NUMERACY

Health literacy refers to one’s ability “to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.”

Health numeracy refers to one’s ability to understand health care data to inform health-related decisions and actions for themselves and others.

These concepts are important because many patients have limited health literacy and numeracy (~1 in 3 U.S. adult, 59% of adults >65 years old). Clinicians have a tendency to communicate and create informational material that is well above the average reading level of patients (6-8th grade in the U.S.). We also have a tendency to use jargon and present data in ways that are difficult for many patients to understand.

We can significantly improve patient understanding and satisfaction by using plain language and starting conversations by first asking about patients’ and families’ understanding of their current health issue(s) and their care.

This helps you know where to start the conversation to make it more productive and better establish rapport. For example, they may have one main concern and will not be able to focus on other information you have to share until you address that concern. Some patients referred for a tumor ablation may have a good baseline understanding of the procedure from researching it online whereas other may think the ablation involves cutting out the tumor.

You can also get a sense of the person’s health literacy by listening carefully to how they describe their understanding. You can use this sense to adjust your language accordingly to not speak over their heads or come off condescending.

When describing data, people tend to better understand engaging infographics and descriptions such as 1 in 5 rather than 20%. So, it is better to describe a risk as happening in 1 in 5 cases or to 1 in 5 people rather than a 20% chance of X.

TEST YOURSELF - WRITE A DESCRIPTION OF A TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT (TIPS) AT A 6-8TH GRADE LEVEL

Reading Ease Score:

USE VIVID LANGUAGE, ANALOGIES, AND VISUALS

Much of what we do in healthcare is unfamiliar to many people. Vivid language and relatable analogies help people better understand a proposed intervention.

  • “Microwave on a stick” rather than “ablation probe”

  • “Tiny vacuum cleaner” rather than “thrombectomy device”

  • “The chance of having [complication] is about the same as being struck by lightning”

Many people are also visual learners, so it can be helpful to review their imaging with them. Engaging infographics and diagrams can also help people better understand their health issues and possible interventions.

USE PATIENT DECISION AIDS

Patient decision aids (PDAs) are resources such as handouts or videos that present balanced information about the benefits, risks, and alternatives of a healthcare decision. Ideally, PDAs should be written in plain language at the average reading level with engaging visuals.

PDAs have consistently been shown to significantly improve patient understanding and satisfaction while also having the potential to reduce lawsuits by standardizing and documenting information shared about a procedure.

Although many practices have informational material for patients, studies suggest that current PDAs for image-guided procedures tend to be written well above the average reading level with difficult readability scores. This is why we created better PDAs vetted by clinicians across practice environments and patient focus groups. Online versions are free HERE and printed versions can be ordered HERE.

REFERENCES