Communication in Health Care
We collaborate on several projects with physicians and nurses at the British Columbia Cancer Agency, Vancouver Island Centre (BCCA/VIC) and other sites. Jennifer Gerwing, Sara Healing, and Christine Tomori are all doing projects aimed at the best possible communication between patients and their health-care providers.
Delivering Bad News
Our first study focused on how physicians solve the dilemma of delivering bad news honesty but as kindly as possible. Earlier experiments on the use of implicit language in difficult situations (Bavelas, Black, Chovil, & Mullett, 1990) led to Del Vento’s analogue experiment that compared physicians’ language when delivering bad versus good news. The good-news condition produced explicit, direct language, while the bad-news condition revealed the use of many subtle conventions for accomplishing a truthful but less harsh version.
- Del Vento, A. (2007) Physicians' use of indirect language to deliver medical bad news: an experimental investigation. Unpublished Master’s Thesis, Department of Psychology, University of Victoria.
Del Vento, A., Bavelas, J. B., Healing, S., MacLean, G., & Kirk, P. (2009). An experimental investigation of the dilemma of delivering bad news.
Del Vento, A., & Kirk, P. (Producers). (2008). How to break bad news. Practical tips for health care providers. DVD available firstname.lastname@example.org (at cost) or individual copies free with self-addressed stamped envelope sent to Dr. Janet Bavelas, Department of Psychology, University of Victoria, P.O. Box 3050, Victoria, BC, V8W 3P5.
Jennifer Gerwing is a researcher at the National Centre for Minority Health in Oslo, Norway (www.nakmi.no), where she is collaborating with Thor Indseth on a project to develop training materials to help medical emergency call operators communicate with ethnic minority callers. They’ve finished a quality assurance project that includes recommendations for communication and are now in the beginning stages of a formal research project building built on their findings. In addition, they are planning a project to apply and extend the findings to videotaped in-hospital, face-to-face clinical encounters between Norwegian health care professionals and ethnic minority patients.
Training DVD on evidence-based communication principles
In collaboration with Sara Healing, Christine Tomori, and Vancouver Island Health Authority Multi-media services, Dr. Gerwing has produced a three-module training DVD about communication for health care professionals. The modules are:
- Evidence-based Communication: Dispelling the myths”
- “Using questions effectively”
- “Achieving mutual understanding: Grounding in Communication”
Recognizing patient-centered information
Sara Healing has developed a method for recognizing the patient’s unique contributions to his or her medical consultations, using video recordings of actual consultations at the BCCA/VIC. Her analysis can reliably distinguish between when the patient is contributing biomedical information (e.g., the presence of a symptom) versus patient-centered information (e.g., how the symptom affects the patient’s daily life). Training health care professionals to recognize and attend to patient-centered information adds a new dimension to patient-centered care. That is, patient-centered care is not limited to unilateral actions by the health care professional; it also includes recognizing and incorporating the information that an individual patient can provide about his or her experience of the illness.
Patient-Centered Assessment of Symptoms and Activities (P-CASA)
Christine Tomori has developed an open-ended assessment, the P-CASA, which examines each individual patient’s symptoms within the context of his or her daily life. P-CASA obtains information about the activities most important to the patient, what interferes with these activities, and any coping strategies the patient may have. Based on initial validation with advanced cancer patients at the BCCA/VIC Pain and Symptom Management Clinic, the P-CASA elicits information about symptoms and their severity that is not available with a standardized symptom rating list, such as the Edmonton Symptom Assessment System. The tool and full details are available to practitioners and researchers who wish to collaborate on further validation. Contact ctomori [at] uvic [dot] ca or bavelas [at] uvic [dot] ca.