Client-Veterinarian Communication: Skills for Client Centered Dialogue and Shared Decision Making

2007 ◽  
Vol 37 (1) ◽  
pp. 37-47 ◽  
Author(s):  
Karen K. Cornell ◽  
Michelle Kopcha
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Communication Skills ◽  
Shared Decision

scholarly journals Using argumentation theory to identify the challenges of shared decision-making when the doctor and the patient have a difference of opinion

2012 ◽  
Vol 1 (2) ◽  
pp. 26 ◽  
Author(s):  
Claudia A. Zanini ◽  
Sara Rubinelli
Keyword(s):  
Decision Making ◽  
Dispute Resolution ◽  
Shared Decision Making ◽  
Communication Skills ◽  
Critical Discussion ◽  
Argumentation Theory ◽  
Shared Decision ◽  
Ideal Model ◽  
Difference Of Opinion ◽  
The Ideal

This paper aims to identify the challenges in the implementation of shared decision-making (SDM) when the doctor and the patient have a difference of opinion. It analyses the preconditions of the resolution of this difference of opinion by using an analytical and normative framework known in the field of argumentation theory as the ideal model of critical discussion. This analysis highlights the communication skills and attitudes that both doctors and patients must apply in a dispute resolution-oriented communication. Questions arise over the methods of empowerment of doctors and patients in these skills and attitudes as the preconditions of SDM. Overall, the paper highlights aspects in which research is needed to design appropriate programmes of training, education and support in order to equip doctors and patients with the means to successfully engage in shared decision-making.

scholarly journals An Immersive Virtual Reality Curriculum for Pediatric Providers on Shared Decision Making for Hydroxyurea

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 3402-3402 ◽  
Author(s):  
Lori E. Crosby ◽  
Francis J Real ◽  
Bradley Cruse ◽  
David Davis ◽  
Melissa Klein ◽  
...  
Keyword(s):  
Decision Making ◽  
Virtual Reality ◽  
Side Effects ◽  
Shared Decision Making ◽  
Communication Skills ◽  
Nurse Practitioners ◽  
Self Report ◽  
Preliminary Evaluation ◽  
Shared Decision ◽  
Parent Concerns

Background: Although hydroxyurea (HU) is an effective disease modifying treatment for sickle cell disease (SCD), uptake remains low in pediatric populations in part due to parental concerns such as side-effects and safety. NHLBI Guidelines recommend shared decision making for HU initiation to elicit family preferences and values; however, clinicians lack specific training. A HU shared decision-making (H-SDM) toolkit was developed to facilitate such discussions (NCT03442114). It includes: 1) decision aids to support parents (brochure, booklet, video narratives, and an in-visit issue card [featuring issues parents reported as key to decision-making about HU]); 2) quality improvement tools to monitor shared decision-making performance; and 3) a curriculum to train clinicians in advanced communication skills to engage parents in shared decision-making. This abstract describes the development and preliminary evaluation of the virtual reality (VR) component of the clinician curriculum. Objectives: The goals are to: 1) describe the development of a VR simulation for training clinicians in advanced communication skills, and 2) present preliminary data about its tolerability, acceptability, and impact. Methods: Immersive VR simulations administered via a VR headset were created. The VR environment was designed to replicate a patient room, and graphical character representatives (avatars) of parents and patients were designed based on common demographics of patients with SCD (Figure 1). During simulations, the provider verbally counseled the avatars around HU initiation with avatars' verbal and non-verbal responses matched appropriately. The H-SDM in-visit issue card was incorporated into the virtual environment to reinforce practice with this tool. The VR curriculum was piloted for initial acceptability with parents of a child with SCD and clinicians at a children's hospital. Evaluation: Hematology providers participated in the workshop training that included information on facilitating shared decision-making with subsequent deliberate practice of skills through VR simulations. Each provider completed at least one VR simulation. The view through the VR headset was displayed on to a projector screen so others could view the virtual interaction. Debriefing occurred regarding use of communication skills and utilization of the issue card. To assess tolerability, providers reported side effects related to participation. To assess acceptability, providers completed a modified version of the Spatial Presence Questionnaire and described their experience. Impact was assessed by self-report on a retrospective pre-post survey of confidence in specific communication skills using a 5-point scale (from not confident at all to very confident). Differences in confidence were assessed using Wilcoxon Signed-ranks tests. Results: Nine providers (5 pediatric hematologists and 4 nurse practitioners at 3 children's hospitals) participated. Tolerability: The VR experience was well tolerated with most providers reporting no side effects (Table 1). Acceptability: All providers agreed or strongly agreed that the VR experience captured their senses and that they felt physically present in the VR environment. Providers described the experience as "enjoyable", "immersive", and "fun". One provider noted, "It (the VR simulation) put me in clinic to experience what it felt like to discuss HU and use the tool." Impact: Providers' self-reported confidence significantly improved after VR simulations on 4 of 5 communication skills: confirming understanding, Z =1.98, p = .05, r = .44, eliciting parent concerns/values, Z = 2.22, p = .03, r = .50, using an elicit-provide-elicit approach, Z =1.8, p = .02, r = .50, minimizing medical jargon, Z = 1.8, p = .07, r = .40, and using open-ended questions, Z =1.98, p = .05, r = .44. Median scores changed by one-point for all responses and effects were medium to large (see Figure 2). Discussion: The VR curriculum was rated as immersive, realistic, and well-tolerated. Providers endorsed it as a desirable training method. Self-report of confidence in shared decision making-related communication skills improved following completion of VR simulation. Thus, initial data support that VR may be an effective method for educating providers to engage parents in shared decision making for HU. Disclosures Quinn: Amgen: Other: Research Support; Celgene: Membership on an entity's Board of Directors or advisory committees.

Geriatric communication skills training: Shared decision making and care planning for the older cancer patient and the caregiver.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 80-80 ◽  
Author(s):  
Ruth Manna ◽  
Smita C. Banerjee ◽  
Megan Johnson Shen ◽  
Beatriz Korc-Grodzicki ◽  
Yesne Alici ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Communication Skills ◽  
Mental Health Professionals ◽  
Self Efficacy ◽  
Skills Training ◽  
Medical Decision ◽  
Comprehensive Cancer Center ◽  
Communication Skills Training ◽  
Shared Decision

80 Background: Medical decision-making is the process of shared understanding of a patient’s personal values and subsequent negotiation to reach a treatment decision. Discussing options and engaging patients in decision-making remains a challenge for many clinicians. The challenge is greater when treating older patients, who may be cognitively impaired, and may have family members or caregivers playing significant roles in their care. The geriatric communication skills training (CST) guides clinicians in effectively communicating with older cancer patients and their caregivers around pivotal cancer care decisions. Methods: A multidisciplinary team from a Comprehensive Cancer Center collaborated on the development of a one-day training program, consisting of three geriatric specific CST modules: Geriatrics 101, Cognitive Syndromes and Shared Decision Making. Each module included a brief didactic (30 min) with exemplary videos, followed by experiential role play (90 min) with standardized patients (SP), co-led by multi-disciplinary facilitators. These sessions were video recorded to enable reflective learning, group discussion, and feedback. We examined preliminary efficacy of the intervention on multiple outcomes, including participant course evaluations, self-efficacy and coded SP assessments. Results: 28 clinicians, including mental health professionals, oncologists, family practitioners, physician assistants, nurse practitioners, and social workers participated in the training. All participants reported strong satisfaction results with the workshop. Self-efficacy ratings increased significantly across all three modules, t(21) = -4.58, p < .001 between pre-training (M = 3.39, SD = .66) and post-training (M = 4.13, SD = .59). In SP assessments, participants also demonstrated significant uptake of agenda setting skills and increased responsiveness to caregiver concerns from pre to post training. Conclusions: The geriatric CST program was well received and demonstrated improvements in knowledge. Interdisciplinary training groups present for excellent case discussion and modeling opportunities for a variety of communication challenges.

Communication Skills and Shared Decision Making Measure

2010 ◽  
Author(s):  
Rajiv Samant ◽  
Inge Aivas ◽  
Jean-Marc Bourque ◽  
Tara Tucker
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Communication Skills ◽  
Shared Decision

scholarly journals iValidate: a communication-based clinical intervention in life-limiting illness

2019 ◽  
pp. bmjspcare-2018-001669
Author(s):  
Nicholas Simpson ◽  
Sharyn Milnes ◽  
Peter Martin ◽  
Anita Phillips ◽  
Jonathan Silverman ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Acute Care ◽  
Outcome Measures ◽  
Communication Skills ◽  
Health Professionals ◽  
Demographic Data ◽  
Education Programme ◽  
Shared Decision ◽  
Patient Values

ObjectivesReport the implementation, user evaluation and key outcome measures of an educational intervention—the iValidate educational programme—designed to improve engagement in shared decision-making by health professionals caring for patients with life-limiting illness (LLI).DesignProspective, descriptive, cohort study.ParticipantsHealth professionals working in acute care settings caring for patients with an LLI.Main outcomes measuredParticipant evaluation of learning outcomes for communication skills and shared decision-making; demographic data of participants attending education workshops; and documentation of patients with LLI goals of management, including patient values and care decision based on area in acute care and seniority of doctor.ResultsThe programme was well accepted by participants. Participant evaluations demonstrated self-reported improved confidence in the areas of patient identification, information gathering to ascertain patient values and shared decision-making. There was strong agreement with the course-enhanced knowledge of core communication skills and advanced skills such as discussing mismatched agendas.ConclusionsWe described the educational pedagogy, implementation and key outcome measures of the iValidate education programme, an intervention designed to improve person-centred care for patients with an LLI. A targeted education programme could produce cultural and institutional change for vulnerable populations within a healthcare institution. A concurrent research programme suggests effectiveness within the current service and the potential for transferability.

Oncology Residents’ Perspectives on Communication Skills and Shared Decision Making

2010 ◽  
Vol 25 (4) ◽  
pp. 474-477 ◽  
Author(s):  
Rajiv Samant ◽  
Inge Aivas ◽  
Jean-Marc Bourque ◽  
Tara Tucker
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Communication Skills ◽  
Shared Decision
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