Many of us invest much of our energy, time and resource related to our careers into education, and increasing and building on our technical skills in our respective industries in order to ‘move up the ladder’. However, according to the Carnegie Institute of Research and Technology, 85% of our financial success is due to our personalities, skills in ‘human engineering’, and our ability to communicate, negotiate and lead. Only the remaining 15% results from our technical knowledge (Jensen, 2012).
Communication during a prescribing consultation plays an essential role in ensuring that patients understand their pharmacological and non-pharmacological options, the purpose of each and what can be expected in what approximate timeframe, any potential side effects and how the patient's symptoms, illness trajectory and quality of life are affected by their treatment.
It is also central to determining a patient's needs, empowering a patient to make lifestyle modifications or adhere to medications, facilitating shared decision-making and to delivering safe and effective care and outcomes (Shaikh, 2023). Communication can be optimised by creating a strategy for each individual patient, to achieve truly person-centred prescribing (Shaikh, 2023).
‘Prescribers should become aware of the characteristics of the setting in which they work, and be conscious of how this may influence communication and patient interactions’
Macro influences
Shaikh (2023) delves into both macro and micro factors that can influence communication. Macro influences include the following (Shaikh, 2023):
- Composition and dynamics of the workforce: staff shortages, workplace pressures, clarity or lack thereof around roles, and whether or not teamwork is effective are all examples of workforce dynamics that can impede or support communication with patients
- Policies and legal regulations: regulations dictate what prescribers can, must or cannot do, and will thus influence communication, such as with regards to patient consent or documentation and record keeping
- Clinical setting and service design: the clinical setting, such as background noise and lighting, and the way services are designed and delivered, such as the frequency of interruptions, can impede or support effective dialogue. Prescribers should become aware of the characteristics of the setting in which they work and be conscious of how this may influence communication and patient interactions
- Demographics, cultural and language factors: cultural competence and sensitivity are important in identifying and addressing the needs of various types of people from differing cultural or religious backgrounds, across different age groups and levels of ability
- Organisational culture: organisational culture and values affect patient safety, and should be consciously compassionate and inclusive at every level
- Societal change: societal expectations of standards of care, as well as of increased patient knowledge and involvement affect communication. Evolving technology also influences communication, and the way information is shared and accessed.
Micro influences
Meanwhile, micro influences identified by Shaikh (2023) include:
- Clinical competence: a comprehensive understanding of medications, indications and contraindications, and potential side effects can facilitate trust, support patient understanding and informed decision-making
- Interpersonal skills and communication techniques: active listening, empathy and compassion, motivational interviewing, clear language and explanation, and effective use of verbal and non-verbal (body language) cues are important in supporting patients with behaviour change, and improved treatment adherence and outcomes
- Patient and prescriber views and beliefs: it is important to identify views, beliefs and biases, of both the prescriber and the patient, that may influence communication
- Physical and emotional factors: communication can be impacted by how both the prescriber and the patient may be feeling, physically and emotionally. The patient's condition, related symptoms and even inadequaute nutrition and hydration, may inhibit their ability to meaningfully contribute to the coversation
- Patient–clinician relationship and power imbalance: building a therapeutic relationship based on trust, respect and shared decision-making can enhance communication and help to mitigate imbalances stemming from a perceived authority of the prescriber.
Being aware of the above influences on communication allows the prescriber to tailor their approach to fit the specific needs of each patient encounter (Shaikh, 2023). Some examples of strategies to use to achieve this include establishing a welcoming environment (e.g. for various patient groups), enhancing language access, prioritising patient education and practising empathic care (Shaikh, 2023).
Environment
Everything from the lighting, noise level and décor to the availability and accessibility of patient information can have an impact on the patient experience, and how welcome they feel, as well as enhance or hinder communication.
Creating a welcoming environment might include wall décor and patient brochures that display images of patients and health professionals from various racial and culturally diverse backgrounds, ages, sexual orientations and gender identities. There is also guidance about how to optimise the environment with a multisensory approach for people who may have cognitive impairments, mental health issues or behavioural challenges. Such environments both calm and stimulate in a controlled way (Mendes, 2017).
Accessibility
In addition to the environment, patient information can be made welcoming and accessible. Leaflets addressing common health concerns should not only display inclusive imagery but also contain straightforward, easy-to-understand language, rather than jargon.
Where there are language barriers, translators, technology and family members may be involved in order to facilitate a more accessible experience (Shaikh, 2023). Furthermore, verbal communication should also be tailored to the patient and what would be optimal based on their personal circumstances.
Education
Patient education and support are central to encouraging patient self-management and empowerment. Materials should be in plain language and be explained verbally in clear language, with time and space for patients to ask questions.
Some treatments may require demonstration, such as the best way to put on compression hosiery for lymphoedema, with solutions if the patient encounters difficulty, such as household rubber gloves to improve grip, as well as resources to turn to for support once the patient is at home. Tools tailored to each patient can also be presented to support their adherence, such as pill organisers and reminders for patients who may have trouble remembering or keeping track of various medications and timings.
Empathy in care
Empathy, and being able to ‘put oneself in the patient's shoes’ in an attempt to understand their experiences and emotions without actually taking them on, plays a central role in the therapeutic relationship (Shaikh, 2023). This should be differentiated from sympathy, which is inherently subjective, potentially compromising ethical and logical decision-making and professional boundaries (Shaikh, 2023), and can also be perceived as ‘pity’ by the patient rather than support. Empathy in contrast, can validate the patient's concerns and feelings and improve their overall satisfaction as well as enhance communication by creating a supportive environment in which patients feel heard and understood, and are comfortable expressing further concerns that can then be supportively addressed by the prescriber (Shaikh, 2023).
Conclusion
People with acute conditions, and particularly those living with chronic conditions, are more likely to comply with treatment recommendations and actively self-manage their condition on a day-to-day basis if they are actively involved in decision-making around their care, are provided with adequate information about their condition, and feel confident about how they can manage it at home.
Non-medical prescribers can play a vital role in equipping patients with the necessary information about their condition as well as practical information and support about self-managing it in order to see improved outcomes, patient empowerment and quality of life.
Self-management leads to improved patient knowledge and understanding, confidence, coping ability and health behaviours, and possible improvements in adherence to treatment recommendations, health outcomes, reduced hospital admissions and cost-effectiveness (National Voices, 2014).
National Self-Care Week took place 13-19 November 2023.