Krista Dominguez-Salazar, PharmD, PhC Implementation of a Relationship Centered Communication Framework within the Pharmacists’ Patient Care Process (PPCP) Krista Dominguez-Salazar, PharmD, PhC

Learning Objectives RPh Relate and respond to patient needs using a time effective patient-centered communication framework. Negotiate a patient care plan by partnering with patients and other health care providers. Assess patient understanding using a communication strategy to reduce medication related errors.  CPhT Negotiate a patient care plan by partnering with patients, pharmacists and other health care providers. Assess patient understanding using a communication strategy while partnering with pharmacists to reduce medication related errors.

How to Implement the Pharmacists’ Patient Care Process (ISBN 978-1-58212-256-4) APhA

What do you think is a difficult conversation?

What do all these conversations have in common?

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What We Can Do? Care for ourselves Relinquish control Focus on the relationship

Difficult Conversations Breaking bad news Presence of high levels of emotion. (i.e. anger) Distrustful patients Unmet expectations

Emotions Running High https://www.google.com/search?q=anger&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjgkpDJ_rrbAhWrxlQKHavgDMEQ_AUICigB&biw=1920&bih=950#imgrc=qYZl2e-KKUkLnM:

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What was going on? The Patient Experience Impatience Frustration Fear Physical Pain Personal story Symptom story Emotional story

Shhh. Attentive Listening Reflective Listening PowerPoint Handouts Shhh. Attentive Listening Echo Request Summarize Reflective Listening Symptom Story Emotional Story Echo: “Sounds like you . . .” “What I’m hearing you say is . . .” (Repeat the word or phrase) Request: “Say more about . . .” Summarize: “Let me see if I have this right . . “ “So, two days ago…, then….” Personal Story 14

Recognize and Name the Patient’s Emotion Patients almost always have emotions accompanying their symptoms/illnesses Recognize expressed emotion Nonverbal emotional expression Emotional cues Statements of feeling Elicit Emotion Ask explicitly Hypothesize about the patient’s emotion Symptom Story Emotional Story Personal Story Stewart, et al, 1995

Pop Quiz How quickly do you think we interrupt our patients? How long do you think they will speak if given the opportunity? Langewitz W, et al., BMJ, 2002; Marvel MK, et al., JAMA, 1999;

How to Respond PEARLS Shift agenda Support, not agreement P artnership E mpathy/ E motion A pology/ A ppreciation R espect L egitimation S upport Shift agenda Support, not agreement

Delivering bad news Nothing is routine Nothing is minor … from a patient’s perspective

How to Respond ART Chunk and check Minimum amount of information A sk R espond with empathy T ell Chunk and check Minimum amount of information

Unmet Expectations

How to Respond Remember this is bad news Use PEARLS Recognize and Name Emotion Reflective listening ART loops Set boundaries in an empathic way

Better Outcomes for Patients Diabetes Blood Pressure Pain management Adherence to medications Satisfaction with care Relief of suffering Young et al, J Ambul Care Manage 2016; Nafradi et al, Chronic Illn. 2017; Biglu et al, Materia Sociomed 2017; Dwamena et al, Cochrane Database Syst Rev 2012; White et al, Patient Educ Couns 2015; Kennedy et al, Pat Experience J 2014

PPCP Example of Measurement Areas for Health Care Outcomes Clinical measure Blood Pressure HbA1c Medication problem resolution Adverse drug event Adherence Humanistic Measure Patient medication knowledge Patient functioning Self-management capability Satisfaction Economic Measure Hospitalizations Emergency department visits Medication costs How to Implement the Pharmacists’ Patient Care Process (ISBN 978-1-58212-256-4) APhA. Page 20

Better Outcomes for Patients Diabetes Blood Pressure Pain management Adherence to medications Satisfaction with care Relief of suffering Young et al, J Ambul Care Manage 2016; Nafradi et al, Chronic Illn. 2017; Biglu et al, Materia Sociomed 2017; Dwamena et al, Cochrane Database Syst Rev 2012; White et al, Patient Educ Couns 2015; Kennedy et al, Pat Experience J 2014

PPCP Example of Measurement Areas for Health Care Outcomes Clinical measure Blood Pressure HbA1c Medication problem resolution Adverse drug event Adherence Humanistic Measure Patient medication knowledge Patient functioning Self-management capability Satisfaction Economic Measure Hospitalizations Emergency department visits Medication costs How to Implement the Pharmacists’ Patient Care Process (ISBN 978-1-58212-256-4) APhA. Page 20

References Adapted from presentation A Relationship-Centered Approach to Difficult Clinical Conversations by Jenni Levy, MD, FACH, ACH Faculty. TheACHonline April 11, 2018. Relationship-Centered Communication: Improving Patient and Clinician Experiences. Academy of Communication in Healthcare. www.ACHonline.org Langewitz W, Denz M, Keller A, et al. Spontaneous talking at start of consultation in outpatient clinic: cohort study. BMJ 2002;325:682-683. Marvel MK, Epstein RM, Flowers K, Beckman HB. Soliciting the patient’s agenda: have we improved? JAMA 1999;281:283- 287. Biglu M-H, Nateq F, Ghojazadeh M, Asgharzadeh A. Communication Skills of Physicians and Patients’ Satisfaction. Mater Sociomed. 2017;29(3):192-195. doi:10.5455/msm.2017.29.192-195. https://www.ncbi.nlm.nih.gov/pubmed/29109665

References Náfrádi L, Kostova Z, Nakamoto K, Schulz PJ. The doctor-patient relationship and patient resilience in chronic pain: A qualitative approach to patients’ perspectives. Chronic Illn. January 2017:1742395317739961. doi:10.1177/1742395317739961. https://www.ncbi.nlm.nih.gov/pubmed/29096534 White RO, Eden S, Wallston KA, et al. Health communication, self-care, and treatment satisfaction among low-income diabetes patients in a public health setting. Patient Educ Couns. 2015;98(2):144-149. doi:10.1016/j.pec.2014.10.019. https://www.ncbi.nlm.nih.gov/pubmed/?term=Health+communication%2C +self-care%2C+and+treatment+satisfaction+among+low- income+diabetes+patients+in+a+public+health+setting Young SA, Azam LS, Meurer JR, Hill RS, Cui C. The Influence of Patient and Provider Communication on Diabetes Care Delivery. J Ambul Care Manage. 2016;39(3):272-278. doi:10.1097/JAC.0000000000000119. https://www.ncbi.nlm.nih.gov/pubmed/27232688 Mahmoudian A, Zamani A, Tavakoli N, Farajzadegan Z, Fathollahi-Dehkordi F. Medication adherence in patients with hypertension: Does satisfaction with doctor-patient relationship work? J Res Med Sci. 2017;22:48. doi:10.4103/jrms.JRMS_205_16. https://www.ncbi.nlm.nih.gov/pubmed/28567067 https://www.newyorker.com/news/news-desk/curiosity-and-the-prisoner