6.3 Communication between professionals

Question 1

Provide 6 examples of the outcomes of poor communication between health care providers

Answer 1

inferior palliative care, including medication errors, delays in treatment, wrong-site surgeries, higher patient mortality rates, longer hospital stays, and worse pain control and functional status, higher nursing turnover, negative feedback, and demoralization of colleagues

Question 2

Provide four examples of outcomes from successful communication between providers

Answer 2

better outcomes for patients and health-care teams including improved understanding by clinicians of patient care goals, improved team morale, higher staff retention, positive feedback from colleagues, and increased productivity

Question 3

Provide 3 reasons why palliative care physicians are well positioned to enhance communication between health care providers

Answer 3

1. A palliative care clinician’s initial assessment includes an evaluation of the patient’s overall clinical status and the roles of and relationships with the providers involved
2. Palliative care clinicians are often consulted for complex patients with difficult to manage symptoms and emotional suffering, leading to team distress, interpersonal conflict, ethical dilemmas, and lack of clarity about the plan of care.
3. Most palliative care clinicians have had some communication skills training, and while their focus of care is patients and their families, many of the same communication techniques are effective with colleagues.
4. Palliative care clinicians are accustomed to working in interdisciplinary teams, where open, respectful communication is the expectation.

Question 4

Communication skills have not been shown to improve from clinical experience alone. However communication skills have been shown to be what two things that allows them to improve?

Answer 4

Communication skills are both teachable and learnable

Health-care providers that participate in communication skills training manifest changes in their behaviour that enhance communication, increased confidence as communicators, improved assessment of interprofessional communication, and have increased patient satisfaction rates

Question 5

List three guiding principles for communication in general

Answer 5

1. Good communication begins by adopting an attitude of curiosity.
2. Communication happens on many levels simultaneously.
3. Good communication requires skill in managing conflict.

Question 6

What three attributes allow for good communication in an interdisciplinary palliative care team?

Answer 6

1. Having mutual goals and a process for evaluating team function in pursuit of those goals
2. Members of a team that communicates well have a clear understanding of individual responsibilities and roles.
3. Have standards for communication among providers, including conflict negotiation

Question 7

What are three standards for communication that must exist in an interdisciplinary team to facilitate good communication?

Answer 7

Interprofessional relationships are based on respectful communication, trust in one another’s motives, and commitment to accountability when discord arises

Question 8

List three barriers to communication in an interdisciplinary PC team

Answer 8

1. Practical and organizational issues such as staffing, geography, and caseloads.
2. Barriers related to information value, hierarchy, and provider insight
3. Barriers related to professional education and identity

Question 9

List four strategies for enhancing communication in an interdisciplinary team

Answer 9

1. Use of structured communication tools -> for example, structured team rounds have been shown to encourage meaningful contributions from all providers
2. Have designated forums for discussion and feedback. Difficult patient cases should be debriefed either in real time or soon after to help the team grieve, air misgivings, provide support, and assess team process
3. Reduce hierarchy - each team member’s contribution is sought and valued, leading to empowerment for every team member to participate and voice suggestions and concerns
4. Cultivate an open, no-fault culture in addressing medical errors

Question 10

List four markers of effective communication and function (Table 6.3.1); provide an example of each

Answer 10

Team leadership - Facilitate problem-solving, Create effective systems for conflict resolution, Communicate performance expectations, Clarify roles

Mutual performance monitoring - Debrief difficult cases, Use peer assessment tools

Supportive teamwork behaviour - Anticipate, communicate, and respond to one another’s needs, Adjust workload distribution, Accept shared responsibilities

Adaptability - Ability to modify processes as new information arrives

Shared mental model and team process - Acknowledge interdependence, Agree on team goals and how they will be achieved, Commit to reaching team goals

Closed-loop communication - Acknowledge information received, Clarify requests, Follow up on outcomes

Mutual trust - Discuss mistakes and accept feedback
Practise constructive (not blaming) communication

Clear and respected boundaries - Communicate roles and responsibilities, Acknowledge and communicate when boundaries are blurred or crossed

Comfort with conflict and error - Raise concerns freely and openly, Recognize that conflict is inherent in healthy team process

Standardization of communication - Prioritize frequent face-to-face communication, Use of structured models for interprofessional collaboration (e.g. team rounds), Participates in interprofessional education

Accountability - Examine and take responsibility for own actions and those of colleagues.

Question 11

A colleague notices that their recommendations in palliative consultation letters are not being taken. They ask for feedback. What six tips can you give them to increase compliance with recommendations?

Answer 11

◆ Response within 24 hours
◆ 5 or fewer recommendations
◆ Identification of critical recommendations (versus routine ones)
◆ Focus on central issues
◆ Specific, relevant recommendations
◆ Definitive language
◆ Specificity in drug dosage, route, frequency, duration
◆ Frequent follow up including progress notes
◆ Direct verbal contact
◆ Therapeutic (versus diagnostic) recommendations
◆ Severity of illness

Question 12

Provide 3 reasons why clear communication is especially important for palliative care consultants with colleagues

Answer 12

1. Some providers in other specialties are sometimes uncertain about what palliative care is and which patients might benefit from palliative care consultation
2. Some referring clinicians worry that there is a ‘palliative care agenda’ to stop aggressive treatments or to encourage patients to sign on to hospice.
3. Palliative care addresses whole pt not just single organ including physical, emotional, social, spiritual aspects. The role of consultant can see, restricting where the focus of evaluation is limited by scope of request. Can feel restricting to consultant

Question 13

When communicating with other physicians what are the five core themes that increase good communication

Answer 13

Curiosity
Humility
Transparency
Clarity
Judiciousness