Information for doctors and nurses

Introduction to the Consultation Support Tool

The short video below describes the development of the consultation support tool and explains how you might help us collect some data about the tool to support our service evaluation project.  You can either watch the video or read the script of the video by clicking on the link below.

Script for the video clip introducing the consultation support tool.

My name is Lynn and I want to introduce you to a consultation support tool that we developed in the cancer department of a large teaching hospital in the East Midlands.  This research was funded by NIHR Research for Patient Benefit and was  supported by the University of Leicester and the hospital Trust.

A group of patients who were diagnosed with cancer and some carers were very much involved in the design and conduct of this research project from the start and helped with the final design of the consultation support tool.

If you want to read about this study then please go to the publications page on this website and select the paper published in the British Journal of Cancer called Improving consultations in oncology. The link will take you straight to the paper.

In summary though, we wanted to develop a tool which could be used jointly between patients diagnosed with cancer and their doctors or senior nurses.  We wanted a tool  to help improve communication and the sharing of information in the consultation and to create a positive consultation experience for all involved. As a team of clinicians and academics working in cancer services we recognised a need for a tool such as this.

At the start of the study we had no idea what the tool would look like or what information it would contain. The final product would be determined by what patients and doctors told us about their consultation experiences with each other and what we learned from the audio recordings of these consultations.

We found that despite advances in the way doctors are taught communication skills some doctors were often uncertain or hesitant about what information they could share with patients. They were uncertain about what patient’s had been told about their cancer diagnosis and possible prognosis (which is a doctors opinion of the likely or expected progression of a disease or of a patient’s chances of getting better). This is often a difficult conversation to have with patients. Some uncertainty came from the fact that they didn’t always know what information their colleagues in other departments might have told patients before they saw them or they could not tell how much information a patient may want to know. This was not a new finding and is a challenge mentioned in a number of medical journals.

We also found that patients’ needed to be better informed about what happens in consultations, and how the conversations may unfold. They often didn’t know what to expect. Patients’ also needed to be better informed about how they might want to prepare for a consultation. By this we mean, think about what level of involvement they may want to have, what they specifically wanted to know, whether or not they wanted detailed information and how involved they might want to be when making decisions about their care and treatment plan.

When we analysed the data, we designed the tool and ran some  focus groups with doctors and patients to explore what they thought about the consultation support tool. Their views were very positive and a number of patients told us that they wished they had had such a tool to use when they were first diagnosed with cancer.

The tool is in three parts.

1. There is a booklet called Your consultation which is designed for patients and their families to read. The information in this booklet is taken from patient accounts and what they wish they had known.

2. There are two leaflets: One is called your first consultation with the cancer doctor (oncologist) and the second is called a follow up consultation to be used when the patient feels the need to use it. The idea behind these forms are to help patients  be clear about what they already know, what they want to know and how involved they might want to be in terms of making decisions about their care and treatment. They can  then share this information with the clinical team prior to seeing the cancer doctor. For further information about this see the video clip for patients about how we suggest the leaflets are used.

3. The third part of the tool is a booklet called a guide for doctors which has been produced to remind doctors of the basics of communication based on the findings of our research study. For further information about how we think doctors and senior nurses might use the consultation support tool please see the video clip for healthcare professionals about how we think you might want to use the consultation support tool in your clinics or if presented with it by one of your patients.

We have used the tool in a couple of small pilot studies but the tool isn’t routinely used in clinical practice yet. We want to design and carry out a much larger research project using the tool but before we can do that we want to invite patients diagnosed with cancer and their doctors or senior nurses to use the consultation support tool with each other. We want to know if using the consultation support tool has been useful and if it is easily accessible online.

We have included a short questionnaire we hope you would complete to help us develop this work further and if possible we would be interested in chatting to some of you to find out about your experience of using the tool and/or accessing it in this way.

If you are willing to talk to one of the team then please indicate this on the questionnaire or use the contact page on this website to get in touch with us if that is easier. Any chat would be kept brief and can be conducted over the phone, via email or on skype for example.

Thank you for taking the time to watch this video and we look forward to hearing from you. If you have any questions please don’t hesitate to contact us via the contact us section of the website.

Professional Guidance Introduction

We have observed the tool used in a handful of consultations and listened to doctors describe their experiences of using it.  We thought it might help to share these insights with you in the following short video.

Advice for doctors or senior nurses using the consultation support tool

Hopefully, you have been able to watch the introduction video about the consultation support tool before watching this one. You might also find it helpful to watch the patient one too.

To recap, we developed the consultation support tool during a research project funded by the National Institute of Health Research, Research for Patient Benefit fund.  Following on from this initial project  we conducted a couple of small pilot studies. We wanted to see how doctors and patients used the tool in practice, to capture their experience of using the tool and to see if it was acceptable for use.

 Some doctors were concerned that using the tool might lengthen their consultations. They found however, that some of their consultations were shortened because they could read what the patient wanted to know and address their needs or concerns upfront. This meant that they could acknowledge the patients need for information early on in the consultation and show that they were willing to listen and engage with the patient. They were starting from a much stronger base and didn’t have to, for want of a better phrase ‘pussy foot around’ at the start of the consultation to cautiously explore what the patient understood about their illness or need for information.

 With this in mind, we saw the flow of the consultation change. For example, in a number of consultations the issue of prognosis is raised towards the end of the consultation but with the use of the tool, in some cases the issue was discussed at the start of the consultation, with good effect. In one case, the patient wrote that she didn’t want to know anything about her prognosis but in the consultation asked if she could be told about her prognosis. The doctor was able to use the completed leaflet to check with the patient what they really wanted to know before proceeding to share this information.

In other cases, we witnessed some patients who were angry or particularly anxious about their treatment plan because they did not feel that they had been involved in the decision making process in a previous consultation. In these cases, the doctors reported that it was helpful reading about the patients concerns on their leaflet so that they could read through their notes in more detail up front and have answers ready for them in the consultation. In each of these events, they described feeling professional, organised and prepared and able to enter into a positive dialogue with the patient by indicating up front that they acknowledged their concern and addressed it. So our advice would be to ensure that if the patient does present you with one of these leaflets that you:

pay attention to what they have written
let the patient know that you have read what they have written
when possible tailor the consultation to the patients needs rather than your own.
 We found that some patients felt empowered to complete the form and if they felt the doctor hadn’t looked at it, then it was a wasted exercise and they felt disengaged. When the tool was used to good effect, patients were more likely to be satisfied with the consultation experience and this didn’t necessarily change if they received bad news in the consultation. They felt that they were respected and listened to.

At the end of the consultation, you may want to ask the patient what they want to do with the completed leaflet. We suggest that you might want to keep a copy of it for the patient’s notes so that other members of your clinical team can see what the patient has previously written and can come back to this if they need to in subsequent consultations.

The doctors booklet can be viewed by clicking on the link below.  The following words are a quotation from a Consultant who participated in the research and it sums up nicely what this book is about:

‘A lot of what is in the booklet is what we already do, but it is just keeping it fine tuned. I think you do need constant feedback.  The main points are very important and pertinent.  The booklet is something you can use to refer back to maybe every 3 or 4 months  or if you have had a bad consultation you might want to refer to it to see what you could have done differently.’

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A Guide for Doctors

Can you help us out?

As we explained earlier we would like to hear your thoughts about either the tool itself or how you used the tool.  This information will really help us make recommendations for improving how we share information in consultations.  It would be really helpful if you could complete the form below and indicate to us if you would be happy to chat to us about your experience of using the tool.