Explanation and planning

Providing the correct amount and type of information

 Aims: to give comprehensive and appropriate information

           to assess each individual patient’s information needs

           to neither restrict or overload

 ·         Chunks and checks: gives information in assimilable chunks, checks for understanding, uses patient’s response as a guide to how to proceed

·         Assesses patient’s starting point: asks for patient’s prior knowledge early on when giving information, discovers extent of patient’s wish for information

·         Asks patients what other information would be helpful e.g. aetiology, prognosis

·         Gives explanation at appropriate times: avoids giving advice, information or reassurance prematurely

 Aiding accurate recall and understanding

 Aims: to make information easier for the patient to remember and understand

·         Organises explanation: divides into discrete sections, develops a logical sequence

·         Uses explicit categorisation or signposting (e.g. “There are three important things that I would like to discuss. 1st...” “Now, shall we move on to..”)

·         Uses repetition and summarising: to reinforce information

·         Use of language: uses concise, easily understood statements, avoids or explains jargon

·         Uses visual methods of conveying information: diagrams, models, written information and instructions

·         Checks patient’s understanding of information given (or plans made): e.g. by asking patient to restate in own words; clarifies as necessary

Achieving a shared understanding: incorporating the patient’s illness framework 

Aims:   to provide explanations/plans that relate to the patient’s perspective of the problem

           to discover the patient’s thoughts and feelings about the information given

           to encourage an interaction rather than one-way transmission

·         Relates explanations to patient’s illness framework: to previously elicited ideas, concerns and expectations

·         Provides opportunities and encourages patient to contribute: to ask questions, seek clarification or express doubts; responds appropriately

·         Picks up verbal and non-verbal cues e.g. patient’s need to contribute information or ask questions, information overload, distress

·         Elicits patient's beliefs, reactions and feelings: re information given, terms used; acknowledges and addresses where necessary  

Planning: shared decision making

 Aims:   to allow patients to understand the decision making process

           to involve patients in decision making to the level they wish

           to increase patients’ commitment to plans made

·         Shares own thoughts: ideas, thought processes and dilemmas

·         Involves patient by making suggestions rather than directives

·         Encourages patient to contribute their thoughts: ideas, suggestions and preferences

·         Negotiates: negotiates a mutually acceptable plan

·         Offers choices: encourages patient to make choices and decisions to the level they wish

·         Checks with patient: if accepts plans, if concerns have been addressed

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