Breaking bad news to patients with cancer: A randomized control trial of a brief communication skills training module incorporating the stories and preferences of actual patients.

Objective: This study tested the effectiveness of a brief, learner-centered, breaking bad news (BBN) communication skills training module using objective evaluation measures.

Methods: This randomized control study (N=66) compared intervention and control groups of students (n=28) and residents' (n=38) objective structured clinical examination (OSCE) performance of communication skills using Common Ground Assessment and Breaking Bad News measures.

Results: Follow-up performance scores of intervention group students improved significantly regarding BBN (colon cancer (CC), p=0.

Found in translation: exporting patient-centered communication and small group teaching skills to China.

The Chinese Medical Doctor's Association asked us to develop a train-the-trainers program in doctor-patient communication and in teaching skills for a select group of Chinese health care professionals, who would then serve as trainers for practicing physicians throughout China. The request came in the context of increasing doctor-patient friction related, in part, to the dissolution of the socialist health care safety net in China. In this article we recount the implementation of our 5-day training program in Beijing.

International medical graduate-patient communication: a qualitative analysis of perceived barriers.

Purpose: International medical graduates (IMGs) represent a substantial portion of all medical residents in the United States. Yet, IMGs may be disadvantaged in their communications with U.S.

Patients prefer the method of "tell back-collaborative inquiry" to assess understanding of medical information.

Purpose: The goal of this study was to determine which approach to assessing understanding of medical information patients most prefer and perceive to be most effective.

Methods: Two videos were shown to participants: (1) a physician explaining a medical condition and its treatment and (2) a physician inquiring about patient understanding of the medical information the patient had been given using 3 different types of inquiry: Yes-No, Tell Back-Collaborative, and Tell Back-Directive.

Results: The Tell Back-Collaborative inquiry was significantly preferred over the other 2 approaches.

Detecting potential intimate partner violence: which approach do women want?

Introduction: Screening for or detection of intimate partner violence (IPV) in women is recommended, but no published studies compare respondent preferences for how screening should occur. This study sought to determine women's preferences for IPV detection.

Methods: Using a video stimulus method, 97 women viewed a short videotape portraying an encounter between a female physician and an established female patient.

The Appalachian Preceptorship: over two decades of an integrated clinical-classroom experience of rural medicine and Appalachian culture.

There is a need to encourage careers in rural medicine and to prepare potential rural physicians for life in rural communities. The authors describe a program that addresses this need, the Appalachian Preceptorship Program, and report the program's experience from 1985 to 2004. The Appalachian Preceptorship is a four-week summer elective conducted by the Department of Family Medicine of East Tennessee State University (ETSU) that offers students clinical preceptorships in rural areas of southern Appalachia.

Patients with worry: presentation of concerns and expectations for response.

Patients with the same underlying concern express this with different styles that predict preference for physician responses. One hundred primary care patients imagined having chest pain and selected from a videotape, the most likely response which they would tell their physician: (1) symptoms only--no disclosure of underlying concern; (2) symptoms and a "Clue" to an underlying concern; or (3) symptom with an explicit concern. Depending on their preferred expression, they were presented videotaped doctors responses to that disclosure and ranked their response preferences.

Assessing communication competence: a review of current tools.

Background: The assessment of communication competence has become a major priority of medical educational, policy, and licensing organizations in the United States and Canada. Multiple tools are available to assess communication competence, but there are few studies that compare the tools.

Methods: A consensus panel of six family medicine educators evaluated 15 instruments measuring the physician-patient interview.

Determining Component Weights in a Communications Assessment Using Judgmental Policy Capturing.

Objectives: Tools are needed for determining appropriate weights for complex performance assessment components in medical education. The feasibility of using judgmental policy capturing (JPC), a procedure to statistically describe the information processing strategies of experts, for this purpose was investigated.

Methods: Iterative JPC was used to determine appropriate weighting for the six core communication skill scores from a communications objective structured clinical examination (OSCE) for medical students using a panel of four communication skill experts.

Making decisions with families at the end of life.

Because advance directives are not yet the norm, end-of-life decisions for patients without medical decision-making capacity are made regularly within discussions between the patient's physician and family. Communication and decision making in these situations require a complex integration of relevant conceptual knowledge of ethical implications, the principle of surrogate decision making, and legal considerations; and communication skills that address the highly charged emotional issues under discussion. The most common pitfalls in establishing plans of care for patients who lack decision-making capacity include failure to reach a shared appreciation of the patient's condition and prognosis; failure to apply the principle of substituted judgment; offering the choice between care and no care, rather than offering the choice between prolonging life and quality of life; too literal an interpretation of an isolated, out-of-context, patient statement made earlier in life; and failure to address the full range of end-of-life decisions from do-not-resuscitate orders to exclusive palliative care.

Communication assessment using the common ground instrument: psychometric properties.

Background And Objectives: Recent guidelines from the Association of American Medical Colleges and from the Accreditation Council for Graduate Medical Education strongly suggest that communications teaching and assessment be part of medical education at all levels. This study's objective was to validate an instrument to assess communications skills. This instrument, Common Ground, is linked to the core, generic communication skills emphasized by the consensus statements of Toronto and Kalamazoo.

Teaching medical communication skills: a call for greater uniformity.

Background And Objectives: Evidence suggests that strategies used in teaching communication skills vary widely among, and within, medical education programs. Such variance also exists in the amount of emphasis placed on specific communication skills. This study examines the degree of variability among medical faculty in identifying opportunities for teaching communication skills.

Responding effectively to patient anger directed at the physician.

Background And Objectives: Patient anger because of a long wait is a common occurrence, but few studies have looked at how the anger should be addressed. This study determined patient levels of satisfaction, rating of importance, and preference for a variety of approaches for addressing anger being directed toward a physician.

Methods: A video trigger tape of an angry patient and 12 physician responses to the angry patient were shown to 130 participants who then rated the physician responses based on four approaches, alone or in combination (apology, explanation, self disclosure, and acknowledgment) for satisfaction and importance of the response.

Sequenced questioning to elicit the patient's perspective on illness: effects on information disclosure, patient satisfaction, and time expenditure.

Background: During the medical interview, clinicians frequently overlook the patient's perspective on illness (PPI), ie, the patient's explanations and concerns about the presenting symptoms and expectations for the encounter. Without special efforts, the PPI surfaces spontaneously in only about one fourth of medical interviews. We determined whether asking the patient a series of sequenced questions would elicit the PPI and what effect such questioning would have on patient and physician satisfaction and on the length of the clinical encounter.

Interviewing when family members are present.

The presence of family members at an office visit creates unique opportunities and challenges for the physician while interviewing the patient. The physician must address issues of confidentiality, privacy, and agency. Special skills are required to respectfully and efficiently involve family members, while keeping the patient at the center of the visit.