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Add Empathy, Improve Patient Experience

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   October 01, 2015

One of the nation's leading cancer centers is breaking ground with research that aims to prove that physicians can be taught to communicate with more empathy.

A curt but accurate answer may inform a patient of her prognosis and options, but it does little to build a solid relationship between physician and patient.

From peer-reviewed to studies to personal observations at the bedside, there is enough evidence to show that patients do better when the relationships with their physicians are strong. Communication is key.

Hospitals and health systems have been bent on improving physicians' communication skills ever since the HCAHPS surveys began measuring for it. And HCAHPS, for all its shortcomings, is still a top priority. In the HealthLeaders Media Intelligence Report, Patient Experience: Cultural Transformation to Move Beyond HCAHPS, 67% of organizations named HCAHPS scores as one of their top three improvement areas in order to meet patient experience goals.

Philip Bialer, MD

How can you improve HCAHPS scores without improving communication?

You can't.

Teaching Empathy
At Memorial Sloan Kettering Cancer Center, where a prognosis can be life-altering, physicians learn new phrases and communication techniques. "We've identified different challenging communication situations and divided them into discrete modules: breaking bad news, discussing prognoses, shared decision making and so on," says Philip Bialer, MD, interim director of the Communication Skills Training and Research Laboratory at MSKCC.

Physicians 'Missing the Mark' on Shared Medical Decisions

The lab is known as Comskil, and it trains fellows, residents, interns, and physicians in the art of communicating with patients.

"Empathy is part of all the individual modules," says Bialer. "As a cancer center, this is an emotionally charged situation. Patients and families can react very emotionally. If they ignore the prognosis or don't understand it, the patient won't hear the next thing their [doctor] is saying."

Training Physicians for Empathy

In addition to the modules Bialer named, physicians are also trained in communication techniques that address patient anger, interpreters, transition to palliative care, end-of-life goals, and family meetings.

Course Structure
MSKCC's Comskil lab began its structured training program in 2007. Since then, it has trained more than 500 residents, fellows, and interns. Two years ago nurses were added into the mix. Each module starts off with a 25- to 30-minute presentation that includes evidence supporting the best way to communicate in each situation.

"We go through specific strategies we recommend," says Bialer. After the presentation small groups form and actors come in to portray patients. "Age, type of cancer, marital status, work, are traits included in the character the actor plays," Bialer says.

The scenes are tailored for the audience-in-training. For example, medical oncology fellows will have a medical oncologist facilitating the "Breaking Bad News" module.

Physicians try out the strategies presented in the initial overview and each interaction is recorded.

"It's a very safe way of trying out these communication strategies," says Bialer who comments on physicians' progress during the video playback.

Physicians are taken through six core modules over two days.

Bialer and his team are now analyzing data collected on the training over the last four years to determine its effectiveness. A five-year National Cancer Institute grant funded this study, and Bialer says the preliminary data is promising.

Allison Applebaum, PhD

"Physicians are picking up new skills," he says. "There is significant improvement in empathic skills, and patients are overall more satisfied. We're excited that once we finish analyzing all the data, we'll show the program is successful."

Caregiver Support
Though caregiver communication isn't explicitly part of the communication training, MSKCC is committed to that dynamic, too. Its Caregivers Clinic provides psychiatric care—individually and in group therapy—only to caregivers of cancer patients.

"I help caregivers communicate with physicians and their families. Cancer is a disease of the family. I work to empower caregivers about their concerns and help them learn to ask the oncologist the right questions," says Allison Applebaum, PhD, director of the Caregivers Clinic.

Understanding the communication dynamic between caregiver and patient helps the physician. Speaking clearly about a diagnosis and what it means to a family member reduces confusion. Getting bad news about a loved one's health can be shocking and the patient's questions may not come until later. A caregiver can speak up when a patient can't, but the physician has to make room for those concerns.

"Caregivers are so fearful of asking questions," says Applebaum. "They're fearful of interjecting during the appointment. When physicians learn to communicate better and caregivers become more empowered, there is going to be better communication. And we already know that more information is better. It's associated with lower depression and lower anxiety in patients."

Some physicians already have a good bedside manner; others may believe they don't need it.
It's up to leadership to drive home the message that a good balance of clinical and social skills are what patients demand today.

Jacqueline Fellows is a contributing writer at HealthLeaders Media.

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