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2 - Foundational Communication Skills

Published online by Cambridge University Press:  05 April 2024

Robert M. Arnold
The University of Pittsburgh School of Medicine, Pittsburgh
Anthony L. Back
University of Washington Medical Center
Elise C. Carey
Mayo Clinic, Minnesota
James A. Tulsky
Dana-Farber Cancer Institute, Boston
Gordon J. Wood
Northwestern Memorial Hospital, Chicago
Holly B. Yang
Scripps Health, San Diego, California
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Four core communication skills are “Ask-tell-ask”, recognize and respond to emotion, ask permission to move forward, and “Tell me more…” “Ask-tell-ask” is asking what the patient or surrogate knows about the medical situation, telling them the headline (information and meaning), and asking what they are taking away from your conversation. Recognizing and responding to emotion, both verbal and nonverbal, can allow patients to discuss additional medical information, builds connection between clinician and patient, and can clarify what is important to the patient. Responding to emotion may be nonverbal or verbal (e.g., NURSE statements), and may include simple or complex reflections or “wish statements”. Asking permission to move the conversation forward signposts that there is a transition, allows patients control, and helps you judge if they are ready. Finally, “Tell me more…” helps clarify informational needs or allow a deeper view into a patient’s reasoning or emotional space, giving the clinician guidance on where to direct the conversation. In telemedicine, communication skills need to be adapted as some of the in-person nonverbal skills are less effective or impossible.

Navigating Communication with Seriously Ill Patients
Balancing Honesty with Empathy and Hope
, pp. 15 - 35
Publisher: Cambridge University Press
Print publication year: 2024

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Further Reading

Back, A. L. and Arnold, R. M., “Yes it’s sad, but what should I do?” Moving from empathy to action in discussing goals of care. J Pall Med, 2014, 17(2):141–4.CrossRefGoogle Scholar
Chua, I. S., Jackson, V., and Kamdar, M., Webside manner during the COVID-19 pandemic: Maintaining human connection during virtual visits. J Pall Med, 2020, 23(11):1507–9.CrossRefGoogle ScholarPubMed
Coulehan, J. L., Platt, F. W., Egener, B., et al., “Let me see if I have this right … ”: Words that help build empathy. Ann Intern Med, 2001, 135(3): 221–7.CrossRefGoogle ScholarPubMed
Epstein, R. M., Mindful practice. JAMA, 1999, 282(9): 833–9.CrossRefGoogle ScholarPubMed
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Jacobsen, J., Jackson, V., Greer, J., and Temel, J., What’s in the Syringe? Principles of Early Integrated Palliative Care. Oxford University Press, 2021.CrossRefGoogle Scholar
Kripalani, S. and Weiss, B. D., Teaching about health literacy and clear communication. J Gen Intern Med, 2006, 21(8): 888–90.CrossRefGoogle ScholarPubMed
Kruser, J. M., Pecanac, K. E., Brasel, K. J., et al., “And I think that we can fix it”: Mental models used in high-risk surgical decision-making. Ann Surg, 2015, 261(4): 678–84.CrossRefGoogle ScholarPubMed
Levinson, W., Gorawara-Bhat, R., and Lamb, J., A study of patient clues and physician responses in primary care and surgical settings. JAMA, 2000, 284(8): 1021–27.CrossRefGoogle ScholarPubMed
Miller, W. R. and Rollnick, S., Motivational Interviewing: Helping People Change (3rd ed.). Guilford Press, New York, 2013.Google Scholar
Quill, T. E., Arnold, R. M., and Platt, F., “I wish things were different”: Expressing wishes in response to loss, futility, and unrealistic hopes.” Ann Intern Med, 2001, 135(7): 551–5.CrossRefGoogle ScholarPubMed
Silverman, J., Kurtz, S. M., and Draper, J., Skills for Communicating with Patients. Radcliffe Medical Press, Oxford, 2005.Google Scholar
Stone, D., Patton, B., and Heen, S., Difficult Conversations: How to Discuss What Matters Most. Penguin Books, New York, 2010.Google Scholar
Suchman, A. L., Markasis, K., Beckman, H. B., et al., A model of empathic communication in the medical interview. JAMA, 1997, 277(8): 678–82.CrossRefGoogle Scholar

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