Table 1.
Skills for tailored information provision*
| Sub-tasks for tailoring | Skills |
|---|---|
| 1.Estimate of patients’ knowledge level | Use questions such as: e.g. Can you tell me briefly what you already know about.., so I may try to provide additional information, if needed? |
| 2. Estimate of patients’ health literacy, intellectual skills |
Use Teach-back: Ask the patient to describe in their own words what they understood/ remember from the information provided thus far • “I gave you quite a lot of information, what would you consider the most important?” • “To check whether I have been clear, can you please tell me; what do you remember?” • “Shortly you will go home. Suppose your partner asks ‘what did the doctor tell you’?. What will you tell him/her?” |
| 3. Estimate of and tailoring to patients’ monitoring coping style/ information need |
Use questions such as: • “There is a lot to discuss …. Some patients want to have as much information as possible, others prefer not to know too much. How is this for you?” • “Will you please tell me if you feel you have had enough information?” Discuss the outline if the patient indicates a limited need for (additional) information: • “I will discuss the main points. Should you wish more information on a specific issue, please feel free to interrupt me” Consider exploring patients’ reason for a limited wish for information (relevant for 8). - If patient indicates a lack of understanding, then adapt information to intellectual level (relevant for 2) - If patient indicates to find additional information too confronting, to provoke too much anxiety, to fear it will reduce hope, then refrain from more detailed information . If the patient appears ambivalent: - Make this ambivalence explicit - probe for clarification - offer the different information topics you can provide (e,g, about treatment procedure, about short and/or long term side-effects, about prognosis Prioritize, if patient expresses a high need for information yet time does not permit extensive discussion, • “I notice you have many issues to discuss. Unfortunately, we will not be able to discuss these all during this consutation. What would you consider the most important issues that we certainly need to address.” |
| 4. Assess patients’ stress level to adapt information giving accordingly |
Take notice of (non-verbal) signs and make these explicit • “I notice it all becomes a bit overwhelming for you. Am I correct?” |
| 5. Assess which information the patient finds relevant |
Involve the patient in setting the agenda for the consult • “Are there any issues you would like to discuss now, so we can make the best use of our time? Ask-tell-ask: Announce an information topic and ask whether the patient is interested (at this point in time), tell, and ask the patient to respond to this information - Examples of an information starters: • “Would you mind if I tell you something about … …” • “What would you like to be informed about?” - Examples of probes for a response: • “Is there anything more you’d like to hear about?” • “What do you make of this?” • “I don’t know what this means to you?” • “Is this what you expected?” |
| 6. Assess how the patient wants to be informed (e.g. by you, by a nurse, in writing, via internet) |
At the end of the consultation, ask • “I gave you a lot of information, would you also like to read about this, for example in a brochure or the internet? |
| 7. Assess when a patient wants to be informed |
Ask for example • “Would you mind if I tell you something about … …” • “Would you like to hear more?” • “Is it ok with you if I get back to this the next time we meet? .. At a follow-up consultation, ask • “Do you have any questions as a result of what I told you last time?” |
| 8. Tailor information to the patients’ personal context |
Probe for patients pre-existing knowledge (see 1) and his opinion about the information (see 5) Stimulate patients’ question asking: • “If you have any questions, please let me know.” Repeatedly invite the patient to share his thoughts, reflections, feelings (see 5): • “What do you think about what I just told you?” |
| 9. Check whether your information aligns with patients’ information need. |
Ask-tell-ask (see 5), in between your information giving. Do not wait for the end of the consultation • “Is this enough information for you?” • “Which questions do you have?” • “Did I forget anything you might want to know?” |
| 10. Check whether the patients has understood your information | Teach-back (see 2) |
*References and sources for these recommendations: Silverman, Kurtz, Draper. Vaardig communiceren in de gezondheidszorg. 2000; Remke van Staveren Patientgericht Communiceren, de tijdstroom, 2013; Back and Arnold, Discussing prognosis, JCO 2006; 24: 4209–4217; C.L. ter Hoeven, L.C. Zandbelt, S. J. Franssen, E.M.A. Smets, F.J. Oort, E.D. Geijsen, C.C.E. Koning, J.C.J.M. de Haes. Measuring cancer patients’ reasons for their information preference: Construction of the Considerations Concerning Cancer Information (CCCI) questionnaire. Psycho-Oncology, 2011;20:1228–1235