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A “Carer’s Experience” is an integral component in healthcare and encompasses the range of interactions that a carer observes or receives as they assist a patient receiving care within the health care system. This report will demonstrate to the readers the effects of implementing communication principles in healthcare on patient centred care. Its importance is stressed and emphasised through the positive results that will be mentioned and discussed throughout this report. The quality of radiation care from the carer’s perspective will be explored and analysed.
Mary-Ann Carmichael, the Discipline Leader for Medical Radiations at RMIT University, virtually interviewed the son of a bowel cancer patient. The interview was conducted in an informal manner as the son recalled and reflected on his observed experience on his mother’s cancer diagnosis and treatment. There was no fixed structure to this interview and the son, who acted as a carer for his mother throughout her battle with cancer, provided his personal insight and experiences chronologically as they had occurred. The method being used by the interviewer was allowing the son to reflect on his experience from the initial diagnosis of his mother’s bowel cancer and from there on systematically describing her appointments, her recovery, her remission and significant events that took place on this journey. The interviewer then prompted him by asking him how certain situations made him feel and encouraging him to describe those emotions and struggles in order to be provided with a greater personal insight from the son.
In 2009, a 46-year-old Vietnamese single mother of three children was diagnosed with bowel cancer after presenting symptoms of fatigue, anemia and bloating. From mid 2009 to late 2010 she went through ongoing treatment and care which included adjuvant chemotherapy, physiotherapy and dietitian appointments. From late 2010 to mid 2012 she experienced a period of remission. In late 2012, PET/CT scans confirmed there was a recurrence of cancer within the bowel and her remaining life expectancy was estimated to be 2 years. In early 2013 to late 2013 she was administered palliative chemotherapy and radiotherapy. However, the chemotherapy treatment was ceased due to her flaring as a reaction to the radiotherapy. Throughout August her condition progressively worsened which resulted to her passing away late September. The overarching themes of this report are elements necessary for effective communication and collaboration between healthcare practitioners, level of empathy during experience, level of rapport built between healthcare practitioner and patient and the carer’s perspective.
Effective communication and collaboration between health practitioners
Effective patient practitioner communication describes the exchange of information between a patient and their healthcare provider. This is not limited to the patient and includes communications with the family and carer of the patient. Throughout their diagnosis, treatment and care a cancer patient will interact with a multitude of healthcare professionals all of whom will provide them with a particular service. Evidence of the many different interactions made by patients is seen as the patient received the services of physiotherapists, dieticians, medical oncologist, radiographers, surgeons, and sonographers on her cancer journey. The number and range of health care professionals throughout her journey created many moments of transitions of care. Transitions of care is when the patient’s care is transferred between healthcare providers and the level of risk of communication errors in this period typically increases. In periods of transition of care the communication can be a highly variable process and can add upon the patients pre-existing worries regarding the service being provided to them. To improve this lack of communication during this period many healthcare facilities have implemented the use of their own structured clinical handovers. Despite their structuring there is a degree of flexibility to these clinical handovers which helps healthcare professionals tailor their handover to fit the service and patient and improve the efficiency and effectiveness.
The Australian Commission on Safety and Quality in Health Care lists key principles under ‘Communication at Clinical handover’ that each facility must incorporate in their transition of care to improve the efficiency and effectiveness of clinical handovers. When patient care is being transferred between services, health care practitioners are required to define the minimum information content. In which they ensure that relevant information is being communicated during the transferring of services. This key principle ensures that relevant, current and accurate information regarding a patient is transferred to the correct person, but it also helps stress the importance of maintaining continuity of care. Being aware of the patient’s goals and preferences is a key principle during transition of care that requires health care practitioners to do some preparation prior to a patient’s appointment. The son who now works in the field of oncology described how the lack of cohesiveness he had experienced when his mother was receiving care for bowel cancer has changed how he now approaches patient care and preparation. Throughout the interview he voiced his displeasure in the Vietnamese translator they provided his mother throughout her treatment. This resulted in his mother asking that the translator be removed and placed heavy responsibility on the son to be not only a means of transport for his mother but also her personal translator. He now recognises through his mother’s cancer journey that health care practitioners have to not only incorporate these key principles but also find a way to tailor their interactions and provide their services depending on the patient’s needs.
Establishing a rapport with patients
Developing a rapport between health care practitioners and patients is vital in achieving patient satisfaction. The road to building a positive communication with patients begins upon the first introduction. For patients like the mother with bowel cancer, who interacted with multiple healthcare practitioners, all providing her with different services, it can be alarming. Healthcare practitioners introducing themselves and informing the patient of their role on the clinical team is important for building a positive practitioner patient relationship. As previously mentioned, the effective collaboration between healthcare practitioners allows for better communication and patient care. It is evident to the patient and carer when a healthcare practitioner has ensured their preparation prior to a patient’s appointment. This allows practitioners to provide information to patients regarding their treatment that is both adequate and accurate. This puts the patients mind at ease and thus improves the rapport between patient and health care practitioners. Validation of patients fears, and concerns can also have positive impacts on patient-practitioner relationships. This can be shown to the patient through the practitioner’s body language when the patient expresses her concerns. Through open body language which would mean giving the patient undivided attention and maintaining eye contact as they communicate their worries. This creates a trusting relationship, reduces a patient’s worries as they receive their treatment and improves patient satisfaction. This was evident with the mother who had positive relationships with multiple healthcare professionals during her treatment process. In particular she had a positive relationship with the chemotherapy nurses who she spent at least 6 hours a day 3 times a week. A positive relationship such as the one the patient had with many of the health practitioners invokes patients with confidence in the care they receive from the health practitioners. This was evident as the son recalls that his mother expressed her trust for her healthcare workers and felt confident that they were specialists in her treatment whom she relied upon.
Level of empathy during experience.
Empathy is a vital communication skill in healthcare specifically in the field of oncology. Empathy in healthcare involves taking great measures to understand a patient’s perspective and is described by the society for general internal medicine as the “the act of correctly acknowledging the emotional state of another without experiencing that state oneself.” Empathy in healthcare is more than just a suggested approach or an afterthought but rather it has proved to have a number of tangible results. In 2012 a study from Italy found that diabetic patients treated by doctors with more empathy had “a significantly lower rate of acute metabolic complications.” In addition, health workers who display empathy towards their patients get better patient satisfaction. The negative impact lack of empathy can have on patient satisfaction was demonstrated through the poor relationship between the mother in the case study and her GP. The GP’s inability to validate her distress and mental wellbeing throughout her cancer treatment, due to his lack of belief in the biopsychosocial model of medicine, resulted in bad rapport between him and her. This led to her seeking elsewhere and relying upon her medical oncologist who helped provide her a social worker. In comparison to the GP, the medical oncologist displayed the ability to understand and share her patient’s emotions and recognise the toll the cancer treatment was having on her patient was not only physical but very mental. Better patient compliance is also a tangible result of health workers displaying empathy. This is evident as the son describes how his mother would express that she trusted her healthcare workers and felt confident that they were specialists in her treatment. When patients are treated with empathy trust builds between them and their healthcare workers and patients are more likely to listen and comply with the instructions given to them.
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Reflective practice is a fundamental component of continuing professional development and is required by all regulatory bodies of healthcare professionals in order to retain registration (Atwal & Jones, 2009). However, Driscoll (2006) notes that reflective practice is often represented as a choice for health professionals, whether to be reflective or not to be, about their clinical practice.There are benefits of incorporating reflection in a clinical setting.