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

2. 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.

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

4. What do you think is a difficult conversation?

5. What do all these conversations have in common?

6. https://www. google. com/search

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

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

9. Emotions Running High

10. https://www. google. com/search

11. https://www. google. com/search

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

14. 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

15. 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

16. 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;

17. 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

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

19. 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

20. Unmet Expectations

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

22. 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

23. 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 ) APhA. Page 20

24. 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

25. 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 ) APhA. Page 20

26. 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.
Langewitz W, Denz M, Keller A, et al. Spontaneous talking at start of consultation in outpatient clinic: cohort study. BMJ ;325:
Marvel MK, Epstein RM, Flowers K, Beckman HB. Soliciting the patient’s agenda: have we improved? JAMA 1999;281:
Biglu M-H, Nateq F, Ghojazadeh M, Asgharzadeh A. Communication Skills of Physicians and Patients’ Satisfaction. Mater Sociomed. 2017;29(3): doi: /msm

27. 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: doi: /
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): doi: /j.pec 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): doi: /JAC
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: /jrms.JRMS_205_16.