Patient-Centered Care & Communication

• Professional communication is a scientific introduction by Prof. An De Groef from the University of Antwerp.
• Patient-centered care focuses on treating a person receiving healthcare with dignity and respect.
• It involves including them in all decisions about their health.

Patient-Centered Care Components (Bower 2000)

• The biopsychosocial perspective is one of the components.
• "Patient-as-person" is a component.
• Sharing of power and responsibility is a component.
• The therapeutic alliance is one of the components.
• Also the "doctor-as-person" is a component.
• Patient-centered care in MSK PT is detailed with a case involving Joletta Belton, a firefighter paramedic whose career ended due to persistent pain (Belton et al 2022).

Effective Data Collection in Patient Interactions

• Practitioners should have a goal to reduce concerns and anxiety through verbal and non-verbal behaviors
• Clinicians should allow patients to tell their narratives.
• Understanding the impact of pain on life is vital.
• Elicit emotions and beliefs from patients.
• Clinicians should listen actively and avoid interrupting.
• Respond empathetically and show attentiveness, indicating importance.
• Generic reassurance should be avoided, especially with patients who have a history of pain and failed interventions.
• Practitioners should aim for explicit validation.
• They Recogniae suffering and distress
• Indicate that they understand all aspects of the narrative
• Acknowledge that the patient's distress is understandable.
• Effective cognitive reassurance is needed.
• Clinicians should describe possible causes.
• Discuss likely prognosis and negotiate possible interventions.

Pain and Uncertainty

• Effective reassurance is defined as a set of behaviors, both verbal and non-verbal
• Reducing concerns and anxiety in patients with pain is a goal
• There are four distinct components (Pinctus et al 2023) which are: good data collection, relationship building, avoiding generic reassurance, and exchanging information by cognitive reassurance.

Effective Data Collection (Evidence)

• Clinicians should follow narratives in the direction that person indicated.
• Clinicians should demonstrate they are listening and attentive through their eye contact, body posture.
• Active listening aims to build trust, reduce anxiety, and create rapport.
• Physiotherapists sometimes spend twice as long as patients talking in the first consultation, which is concerning.

Relationship Building

• This includes a practitioner asking the patient to tell their story.
• The patient might be surprised at the story that they eventually tell.
• It is important to validate the patient felt/are feeling.

Relationship Building (Evidence)

• Empathy is considered fundamental for good physical therapist interpersonal and communication skills.
• Lack of empathy from the clinician is a major barrier to bonding for patients.
• Empathetic therapeutic relationships improve clinical outcomes for musculoskeletal conditions, pain, and function), patient satisfaction, and adherence..

Avoiding Generic Reassurance

• Reassurance in the absence of sense-making and validation can be unhelpful.
• Statements like "there's nothing wrong" can feel invalidating to someone whose life and career have been significantly altered by their condition.

Avoiding Generic Reassurance (Evidence)

• Non-specific empathic, reassuring statements lead to worse outcomes.
• Optimistic reassuring statements are perceived as patronizing and are often incorrect.
• Generic reassurance offers an immediate lowering of anxiety, but no new coping tools to manage their pain.

Cognitive Reassurance

• Cognitive reassurance involves creating patient narratives.
• It offers hope and a way forward.
• The understanding of pain itself is key to acceptance and moving forward.
• There should be an increasing sense of control, confidence, acceptance, trust, and patient satisfaction.
• Cognitive reassurance can reduce anxiety and feelings of isolation.
• Patients should get information and education about possible prognosis and management options

Validation

• To have your thoughts be “believed, validated, acknowledged, heard and feeling seen” can create a life-changing experience
• The human being may require validation in order to regain capacity to use new information

Validation (Evidence)

• This yields greater patient satisfaction with consultations
• It creates improvements in mood, more open discussion and disclosure, plus promotion of shared-decision making
• Validation is the foundation to a collaborative relationship based on trust and mutual assurance.

Recommendations for Practice

• Ask open-ended questions and allow patients to tell their story.
• Exploring the whole person, and making sure people know clinicians have listened is key. Avoid generic reassurance unless you know it’s true.
• Be clear and acknowledge the fact that you believe the patient.
• Use simple language and make sure conversation flows both ways.
• Discuss ways forward together to make progress.
• Patient centered communication evokes and understands a patients perspective (worries, ideas, expectations, needs, feelings/functioning)

Patient-Centered Communication

• Practitioners must understand a patient within their unique environment.
• Practitioners should reach a collaborative understanding of the problem that is aligned with patient goals

Patient-Centered Communication in PT Practices

• Patient-centered communication is often under-valued, under-recognized, and under-trained in PT and other healthcare practices.
• Patient-centered communication is considered less important than technical skills/knowledge.
• Continuous communication is needed in the physiotherapy processe.
• Patients must come first and their perspective validated.

Why Focus on Communicating with Patients

• Healthcare providers perform 200,000 consultations during their working life.
• Good communication results in more effective consultations.
• Empathetic communication can increase the effectiveness of interactions over time and in therapy.
• This can lead to more effective self-care and the prevention of burnout.
• Accurate diagnoses and increased patient satisfaction can be gained.
• Understanding the patient increases their knowledge of health issues, improving the therapeutic relationship.

Patient-Therapist Relationship

• It is important to build a trustworthy relationship with your patient.
• Results of good patient-Therapist relationships are better adherence to exercise programs.
• Patients may follow the advice given easier plus the patient receives a better treatment effect.
• Patient satisfaction is strongly related to the empathic contact.
• Therapists are generally more satisfied with their work and the value if empathy is implemented.
• Prognosis is better for patience with lower lower back pain who view the interaction with their physician positively

Empathy

• Empathetic relationships have a positive relationship on many factors: patient satisfaction, adherence, and reduction in anxiety and stress.
• Compassionate physicians can reduce instances of patient anxiety.
• A short moment of compassion (40 seconds) can make a big difference on whether or not a patient feels comfortable
• Physicains that implement empathy as a tactic for handling the common-cold shows a reduction in severtity and the duration of sickness
• Empathy influences health care decisions, which also may positively influence patient factors such as their immune system

Empathy Facilitators

• Qualities of good communication, relationship building, and interprofessional collaborative practice helps to improve patient satisfaction.
• Positive environment
• Love for the healthcare profession
• professionalism
• There are also barriers to empathetic relationships.
• Challenging situations plus working conditions can have a negative influnce
  • lack of training -lack of professionalism/personal-development -Health Professionalism's personal problems