What’s in a name?

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In 2015 the Caring Conversations Project changed it’s name to CLEAR Conversations. CLEAR is an acronym which encompasses the vision of the program within the letters, “Connect, Listen, Empathize, Align and Respect.” As our work continues to evolve, these five tenants remain at the core of all we do. We believe CLEAR conversations require each of the facets that the letters represent. Thank you for following us on our journey.

Caring Conversations in the Henry Ford Physicians News, October 2015

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More on Caring Conversations…

“The family is unreasonable.”

When faced with a family who is not in agreement with our plan, we are often left wondering, “why would a seemingly normal family choose a path that is so clearly ‘misguided?’” We can spend hours reviewing information in an attempt to get patients or families to agree with us on code status, hospice and other treatment plans. Often this results in fatigue, feelings of defeat and burn-out.

How can we do better? We have to recognize that there is conflict. Then we have to acknowledge our biases and perhaps most importantly the effectiveness of our own communication. Next time you find yourself in conflict with a seriously-ill patient or their surrogate decision-makers about the plan of care, take a pause and consider that people filter our words through their own beliefs and experiences. Rather than repeating medical facts, consider de-coding their behavior by listening to their experience across three realms: the facts, their feelings, and their identity. Using these tools to understand their position on all three levels will improve your chances of successfully navigating the difficult waters of conflict and help to establish a common ground.

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We have a responsibility to guide our patients/surrogates through the channels of decision-making in serious illness. We have the knowledge and we can improve our communication skills to maximize our effectiveness as physicians. A conflict between a physician and our patient/surrogate need not be the end of our value as physicians; it can be the beginning of a new conversation.

After you try this approach, please send an email and let us know how it goes.

For more reading on published evidence about managing conflict in medical care: Back, Anthony L.; Arnold, Robert M., “Dealing with Conflict in Caring for the Seriously Ill”; JAMA. 2005, v293(11): 1374-1381.

This is one of many skills that can be practiced with the Caring Conversations Program. Established by a group of Henry Ford physicians in 2012, the goal of the program is to improve conversations between providers and patients.

Caring Conversations has roots in the VitalTalk format and accordingly, utilizes highly skilled improvisational actors to create an ideal environment for experiential learning.

Henry Ford Health System Caring Conversations team members are: Rana Awdish, M.D.; Dana Buick, M.D.; Kristen Chasteen, M.D.; Michael Mendez, M.D.; Maria Kokas, Ph.D.; and Cari Williamson, BA.

Visit the Caring Conversations website for more information, or contact Cari Williamson, program administrator CWILLI30@hfhs.org.

Navigating Difficult Conversations with Patients and Families: Perspectives from the Fishbowl

2015Sept MHA

Dr. Rana Awdish led the Caring Conversations Team in an interactive presentation and demonstration of how communication education can be reinforced and embedded in daily ICU care at the Annual MHA Keystone ICU Workshop.  As part of a communication bundle, the team demonstrated how communication practice can be reinforced as part of a pre-huddle, during a meeting, and as part of the post-huddle.

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Third Annual Critical Care-Palliative Medicine Fellows Workshop, July 16-17

Dr. Dana Buick, of the Caring Conversations Team, leading the session.

Dr. Dana Buick, of the Caring Conversations Team, leading the session.

The Caring Conversations team hosted the third annual communication workshop for Henry Ford Hospital and Wayne State University Fellows at the Detroit Athletic Club on July 16-17, 2015.  The group of trainees was comprised of Critical Care Fellows from the Surgical, Medical, and Emergency Medicine Departments. In addition, fellows from the Henry Ford Hospital and Wayne State University programs also participated.

Caring Conversations in the Henry Ford Physician News, June 2015

Screenshot 2015-07-24 08.15.57

More on Caring Conversations…

 The next time you find yourself at a crossroads with a patient where the “old” treatment is not working, and the next step may have harms that outweigh benefits, consider this framework for communicating with your patients.

 “We’re in a different place,” or “we are at a crossroads,” can serve as a warning shot for the specific news about the treatment failure. Serious news naturally leads to an emotional reaction.  We can help our patients by expressing empathy.  One option is to name the emotions. Examples are:

·         “Hearing news like this can be shocking.”

·         “This is very sad news.

Patients may strongly dislike it when a physician begins by summarizing the list of treatments that we have attempted. It is often our instinct to begin a serious news discussion by reminding them (and ourselves) of our value. This approach may be perceived as defensive and can alienate our patients.  It can be helpful, and sometimes necessary, for patients or surrogates to hear in plain language that we are embarking on a new phase of their illness before they are able to engage in the discussion of next steps.

Even in the absence of a “next treatment” to offer, our patients rely on our expertise to guide them. Most patients want our recommendations to be concrete and specific, followed by time for consideration before decisions are required. Most need to hear statements like:

·         “This can be very hard to talk about.”

·         “When you feel ready, let’s talk about what we can do now.”

·         ”I can help guide you through the next steps.”

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We have a responsibility to help our patients understand where they are in their disease process, empathize when the news is serious and guide them through the decisions that follow. We have the knowledge and can improve our communication skills to help them find “a new place to land,” after a prior treatment regimen is no longer beneficial.

 The end of a treatment modality need not be the end of our value as physicians; it can be the beginning of a new conversation. After you try this approach, please send an email and let us know how it went.

 This is one of many skills that can be practiced with the Caring Conversations Communication Program. Established by a group of Henry Ford physicians in 2012, the goal of the program is to improve conversations between providers and patients.

 Caring Conversations has roots in the VitalTalk format and accordingly, utilizes highly skilled improvisational actors to create an ideal environment for experiential learning.

 Henry Ford Health System Caring Conversations team members are: Rana Awdish, M.D.; Dana Buick, M.D.; Kristen Chasteen, M.D.; Michael Mendez, M.D.; Maria Kokas, Ph.D.; and Cari Williamson, BA.