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Communication Education, Modeling, and Protocols Transform Clinicians to Agents of Empowerment

Ubel and colleagues correctly note that communication style, and a lack of clarity in what is being communicated, often lead to ineffective patient empowerment (Ubel, Scherr, and Fagerlin 2017). Fortunately, over the past few decades, increased efforts to rectify these shortcomings have become commonplace. Palliative medicine providers are consistently a key component with these efforts (Levine et al. 2017). Herein, we discuss several communication tools that have been developed for clinicians and are a routine part of palliative medicine practice. [Note. We utilize the term “clinician” throughout, to emphasize that these communication pitfalls are actualized by physicians, advanced practitioners (nurse practitioners, physician assistants), nurses and social workers at the bedside, among other groups. We agree that physicians may ultimately be responsible for promoting activation of autonomy, but communication by all health care providers (clinicians) often needs improvement as well.] The goal of each communication tool is to help clinicians move from what Ubel, Scherr, and Fagerlin (2017) describe as an “ethic of information” to a joint partnership. Therein, discussions begin with and are framed within the context of the patients’ goals and values, as well as those of their families and/or surrogate decision makers. We expect that as palliative care and communication skill practicums become more established in clinical and medical education settings, learned communication tools will transform clinicians’ communication skills which will lead to effective shared decision making among patient–clinician dyads. Protocol-driven or procedural thinking has long been critical within medical pedagogy. Surgical or anatomic interventions are taught with evidence-based technical frameworks, grounded in experience, such as “see one, do one, teach one” (Krautter et al. 2011; Romero et al. 2017). Each stage within these frameworks offers and reinforces an explicit understanding of the procedure’s anatomic, physiologic, and technologic foundation. In contrast, effective communication skills are often not subject to the same rigors of procedural thinking. Nevertheless, this topic has received increased emphasis in modern medical curricula and the efficacy of each strategy has been subject to methodologic inquiry and investigation. As Ubel and colleagues suggest, clinicians have been asked to be good communicators “without being taught how to do so effectively” (2017). Fortunately, this is changing. Several formal communication tools have been developed recently, to train clinicians how to communicatemore effectively. These efforts are led by palliative care specialists but are applicable to a broad interdisciplinary team. The tools move beyond a vague directive to “be empathic” and emphasize the importance of following a protocol or “talking map,” particularly in difficult conversations that involve conflict and end-of-life decision making. Much like learning how to do a procedure, these talkingmaps reinforce skills via a methodical format that helps clinicians stay focused, track essential components of a conversation, and avoid getting lost when complications arise. The map helps identify where to begin with a patient or family and where to go, while eliciting patient-derived values earlier in the conversation. Ideally, these skills are practiced first in lowimpact scenarios such as small groups with other trainees, reinforcing the concepts (i.e., creating “muscle memory”), so