Tips to Master More Effective Communication with Patients and Caregivers. Dr. Martha Carmichael MD, M.Sc., FRCPC Fellow in Geriatric Medicine, University of Toronto Dr. Samir K. Sinha MD, DPhil, FRCPC Peter and Shelagh Godsoe Chair in Geriatrics and Director of Geriatrics Mount Sinai and the University Health Network Hospitals Assistant Professor of Medicine, University of Toronto and the Johns Hopkins University School of Medicine Health PEI - Making the Connection Conference 15 October 2015 Twitter: @DrSamirSinha

Why is Effective Communication is Important… Helps prevent medical errors. Better outcomes for patients and caregivers. Strengthens provider-patient/caregiver relationships. Increases patient/caregiver and provider satisfaction. Helps make the most of limited interaction time for all those involved. National Institute on Aging. 2011.

Misunderstandings Are Common From Our Interactions… Medical terminology is often poorly understood. Health Providers… Underestimate patients/caregivers’ needs for information. Overestimate patients/caregivers’ understanding of information. “You could die from this disease”. 46% disagreement (!) Misunderstandings can cause the entire encounter to fail. All ages! Lerner et al. 2000; Hancock et al. 2007; Fried et al. 2003.

With Older Patients… Health Care Professionals are felt to be: More condescending, authoritative Less patient Spending less time, giving less information Older Patients and Caregivers: Don’t ask questions, don’t want to be a bother May withhold symptoms that they think are “normal” Are more afraid to challenge their provider’s thinking. Older patients given LESS information than younger patients. Older patients allowed LESS participation in their care decisions. Symptoms like pain, etc. Gerontological Society of America. 2012.

Older Patients Are Unique… Often have Complex Health and Social Care Needs More health problems, medications, community supports Heterogeneous – No two are the same… Life Experiences, Ethno-Cultural Background, Education Fit vs. Frail Age-Related Changes May Be Present: Sensory Deficits: Hearing or Vision Impairments (25%) Slower Processing Speeds to Understand Things Decreased Functional Capacity. Cognitive Impairment May Be Present Over half of patients over 75 have hearing impairment

“At a time when older patients have the greatest need to communicate with their health-care providers, life and physiologic changes make it the most difficult” Robinson et al. 2006.

Familiar Scenarios? You are talking with an older woman who you think may have a hearing impairment. You talk louder, but she still seems to have some problems hearing and understanding you. As you talk with an older man and his wife who is caregiver, you get the feeling that neither of them really understand you, despite assuring you that they do when you ask them. When you explain things again, they simply smile and nod their heads “yes”. You are in the middle of an encounter that seems to be going well. All of a sudden, you sense that the older person has become quiet and withdrawn. You know you did something to contribute to the change in their demeanor, but you just can’t figure out what. Gerontological Society of America. 2012.

The Good News… Good Communication IS a teachable skill! Learning and Using Effective Communication Skills Leads to Improved… Communication with Patients and Caregivers One’s Ability to Build and Assess Relationships Time Management More satisfying relationships Become more skilled at managing patients’care Medical students taught communication skills National Institute on Aging. 2011.

Not Specific to Physicians… NPs, RNs, LPNs Home Support Workers, Resident Care Workers, Community Support Workers Managers Social workers Occupational Therapists Physiotherapists Dieticians Reception/Administrative Staff This is a paper directed at Family physicians, but these tips apply to all of us!

Our Challenge Today… Start Where You Are Comfort level varies Remember “One Size Fits All” Does NOT Apply Individualize An Approach that Works for YOU! Embrace and Use These Basic Tips!...

More Effective Communication… This is a paper directed at Family physicians, but these tips apply to all of us! Tips to Master More Effective Communication…

Allow extra time for older patients. Tip #1: Allow extra time for older patients.

Tip #2: Avoid distractions.

Tip #3: Sit face to face.

Tip #4: Maintain eye contact.

Tip #5: Listen.

Speak slowly, clearly and loudly. Tip #6: Speak slowly, clearly and loudly.

Use short, simple words and sentences. Tip #7: Use short, simple words and sentences.

Stick to one topic at a time. Tip #8: Stick to one topic at a time.

Simplify and write down your instructions. Tip #9: Simplify and write down your instructions.

Use charts, models and pictures. Tip #10: Use charts, models and pictures.

Frequently summarize the most important points. Tip #11: Frequently summarize the most important points.

Give patients an opportunity to ask questions and express themselves. Tip #12: Give patients an opportunity to ask questions and express themselves.

Our Takeaways Today… Start Where You Are + Practice Makes Perfect! Individualize an Approach that Works for YOU! Effective Communication Benefits EVERYONE! Effective Communication is Often Simple, Honest and Straightforward in Its Approach. Every Patient and Caregiver is Unique and Requires an Individualized Approach.

Thank You Samir K. Sinha MD, DPhil, FRCPC Peter and Shelagh Godsoe Chair in Geriatrics and Director of Geriatrics Mount Sinai and the University Health Network Hospitals Provincial Lead, Ontario’s Seniors Strategy ssinha@mtsinai.on.ca @DrSamirSinha 25

References Fried et al. 2003. Prognosis communication in serious illness: Perceptions of older patients, caregivers and clinicians. JAGS. 51:1398. Gerontological Society of America. 2012. Communicating with older adults: An evidenced based review of what really works. Hancock et al. 2007. Discrepant perceptions about end of life communicatio: A systematic review. Journal of Pain and Symptom Management. 34(2):190. Lerner et al. 2000. Medical Communication: Do our patients understand? American Journal of Emergency Medicine. 18(7): 764. National Institute on Aging. 2011. Talking with your older patient. Robinson et al. 2006. Improving communication with older patients: Tips from the literature. Family Practice Management.