Table 1 Potential components for communication skills improvement
Item | Potential components for communication skills improvement (for training) | Sources of evidence | Description | |
|---|---|---|---|---|
Findings from systematic review | Findings from qualitative studies | |||
1 | Active listening | √ | √ | Listen attentively to the patient’s opening statement, without interrupting or directing the patient’s account. When asking questions, leave space for patient to think before answering, or to pause for thought before going on |
2 | Express empathy | √ | √ | Deliberately show your understanding and appreciation of the patient’s feelings or predicament; overtly acknowledge patient’s views and feelings |
3 | Share bad news |  | √ | Become skilled at breaking bad news to patients who have started or already developed complications, such as a diagnosis of diabetic nephropathy, retinopathy, or associated foot problems. Giving bad news is a complex challenge in communication that involves a series of preparations and steps |
4 | Use examples |  | √ | Use examples to share relevant information with diabetes patients and help their understanding by using materials such as stories or pictures (such as pictures of diabetic foot problems) |
5 | Idea, concerns and expectations |  | √ | In people with diabetes, explore their beliefs, their concerns about current problems and how these problems affect them. Ask about their expectations for solutions, and their willingness to take personal action to achieve them |
6 | Nonverbal skills: body language, facial expressions, eye contact, speed, tone, and silence |  | √ | Convey and receive information and understanding in ways outside direct verbal communication |
7 | Negotiation of behavioral change | √ | √ | Use negotiation as a method to help patients make lifestyle changes (such as addressing obesity, adherence to treatment, smoking cessation, and physical activity) to improve their health |
8 | Evaluate the patients’ confidence, support patients’ self-efficacy and optimism | √ |  | Assess the individual's confidence in his or her own ability to perform specific tasks required to reach a desired goal. To cope effectively with the complex demands of the diabetes treatment regimen, a sufficient sense of self-efficacy is required. Self-efficacy is a dynamic, changeable belief, which may be enhanced by behavioral interventions, resulting in an increased motivation for behavioral efforts |
9 | Motivational interviewing | √ | √ | Use motivational interviewing (MI) as a person-centered strategy to guide patients towards changing a specific negative behavior. There are four processes: 1) engaging, which requires an understanding of the patient's point of view to develop a working alliance with them; 2) focusing, the process of developing one or more clear goals for change; 3) evoking, calling forth the patient’s own motivation for, and ideas about, change; 4) planning, which involves the collaborative development of the next steps that the individual is willing to take |
10 | Shared decision making | √ |  | Shared decision making is a key component of patient centered health care. It is a process in which clinicians and patients work together to make decisions and select tests, treatments and care plans based on clinical evidence that balances risks and expected outcomes with patient preferences and values. There are four major processes: 1) clinician informs patient that decision is to be made and patient’s opinion is important; 2) clinician explains the options and the pros and cons of each (relevant) option; 3) clinician and patient discuss patient preferences and clinician supports deliberation; 4) clinician and patient discuss the patient’s wish to make the decision and discuss follow-up |
11 | Discuss blood glucose monitoring and explanation |  | √ | Carefully communicate blood sugar figures with patients, and guide patients to consider the significance of different indicators based on evidence. Be aware of tension, anxiety, depression, and other emotions caused by fluctuations in blood sugar or glycosylated hemoglobin and seek to reduce these |
12 | Diabetes complications and cardiovascular disease risk communication | √ | √ | Discuss the risk of complications such as problems with the heart, kidneys, and eyes and how these can be reduced by an adequate treatment with medication and by adopting a healthy lifestyle. Learn how to help patients understand the risks of developing severe diabetes related complications to enable them to make informed choices. It is important to provide a clear and very simple message, tailoring the explanation of risk and frequency statistics in a way that the patient can understand, such as using visual aids or discussion of absolute risk across a 10-year period. Messages about risk should consist of information on what causes the risk, the consequences of the risk, and what can be done to prevent or treat the problem. Positive framing, by highlighting the benefits of behaviour change (rather than focusing on the effects of not changing), appears more likely to increase patients' motivation |
13 | Medication adherences | √ | √ | Look out for poor medication adherence, by checking on whether prescriptions have been requested and dispensed, and by asking patients directly. Poor adherence can be linked to key nonpatient factors (e.g., lack of integrated care in many health care systems and clinical inertia among health care professionals), patient demographic factors (e.g., young age, low education level, and low-income level), critical patient beliefs about their medications (e.g., perceived treatment inefficacy), and perceived patient burden regarding obtaining and taking their medications (e.g., treatment complexity, out-of-pocket costs, and hypoglycemia). There are several communication skills: 1) elicit patients` beliefs (e.g. perceived benefits and harms of taking medicines); 2) assess patients’ medication adherence; 3) assist patients’ in overcoming barriers to treatment adherence (include discussing healthcare system issues); 4) ask patients to generate and write down the exact circumstances in which they would take their medication. Be aware that poor adherence to treatment may be a signal for other psychosocial problems (see Sect. 16) |
14 | Follow up or referring | √ | √ | Know when to refer diabetes patients to endocrinologists and how to make appropriate communication, in line with local guidelines and in accordance with patient wishes. Ensure that you coordinate different doctors' diabetes treatment plans and arrange regular follow-up of diabetes patients with specific time |
15 | Cultural biases and patients background awareness | √ | √ | Be aware that patients from different regions (such as urban and rural areas) may have different perceptions of diabetes and treatment options, and it is necessary to consider the patient's background, family or economic factors and other problems that bring difficulties to diabetes patients. The dialect used by patients is also a cultural difference, and some patients prefer their doctors to communicate in dialect |
16 | Explore the patient's emotional and psychosocial (mental health) problems |  | √ | Specifically ask about psychosocial problems in diabetes patients, which often result in serious negative impact on patient's well-being and social life, if left un-addressed. Patients can feel overwhelmed with the demands of self-management. Feelings of frustration, fatigue, anger, burn out, and low mood can be experienced due to complexities in the routine of self-management of the control of blood sugar. Family members may not understand the feelings of the patient, and food differentiation and restriction of food by family members may lead to further distress. Avoid the over-simplification of a label of ‘noncompliance to treatment’. It is important to incorporate psychological screening and management at every level of diabetes care |
17 | Use online or telephone communication technic |  | √ | Make use of online communication, or text communication, in line with what suits each patient best in each situation. Online communication is becoming more and more common, making it easier and faster for patients to find and call doctors, reduces unnecessary travel time, and costs, and also increases the frequency of contact with doctors. Online communication, or texting communication, is very different from face-to-face communication, particularly as non-verbal communication between doctor and patient can be restricted. When interacting online, active listening, multiple acknowledgements, and positive responses are essential for online communication |
18 | Health education |  | √ | Develop skill in sharing diabetes-related health knowledge with patients in various forms, e.g., written material, online resources etc. Be aware of different knowledge sources and ensure that those used by your patients are reliable, safe, and up to date. When discussing topics, check on your patient’s knowledge and sources of advice |
19 | Patient held health record management |  | √ | Each time the patient visits, primary care physicians acquire the patient's personal health record book, consult the previous medical information, and record the information of this visit, so that the patient can use one patient's personal health record book to record the condition of diabetes in different hospitals as far as possible |