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Communication (Research article: The REDE model of healthcare…

- - - - Given that people form first impressions very
        quickly and patients are discussing emotional and value-laden
        topics, how we set the stage for conversation matters, even it feels
        irrelevant to the clinical problem(s) at hand
    - - research has shown that sharing in agenda
        setting not only facilitates partnership but also improves visit
        efficiency, diagnostic accuracy and patient satisfaction.21 Sharing
        in the agenda setting helps minimize our tendency to presume
        what a patient’s concerns are and in what order of priority.
    - - In his book, “Empathy and the
        Practice of Medicine,” Howard M. Spiro, M.D., described
        empathy as “I and you becomes I am you or I might be you
        (p. 9).”22
      - without
        intervention, empathy declines through medical training, over
        time in practice and with task pressure
      - Demonstrate empathy using SAVE
        • Recognize emotional cues & respond “in
        the moment”
        • Allow space to be with the patient & their
        emotion without judgment
        • Clarify the emotion if needed
        • Recognize emotion evoked in you &
        refrain from trying to fix or reassure
        • Demonstrate verbally with SAVE
        • Support -“Let’s work together…”
        • Acknowledge -“This has been hard on you.”
        • Validate -“Most people would feel the
        way you do.”
        • Emotion naming -“You seem sad.”
        • Nonverbally - doing only that which feels
        natural & authentic to you
  - - - Obtaining the history of present
        illness (HPI) can quickly become a series of closed-ended
        questions that are of most interest to the provider.31
    - - Explore the patient’s perspective using
        VIEW
        • Vital activities –
        – “How does it disrupt your daily activity?”
        or
        – “How does it impact your functioning?”
        • Ideas –
        – “What do you think is wrong?”
        • Expectations –
        – “What are you hoping I can do for you
        today?”
        • Worries –
        – “What worries you most about it?”
  - - - Dialogue throughout using ARIA
        • Assess using open-ended questions
        – What the patient knows about diagnosis
        & treatment
        – How much & what type of education
        the patient desires/needs
        – Patient treatment preferences
        – Health literacy
        • Reflect patient meaning & emotion
        • Inform
        – Tailor information to patient
        – Speak slow & provide small chunks of
        information at a time
        • Use understandable language & visual aids
        • Assess patient understanding & emotional
        reaction to the information provided