 EXPLANATION AND PLANNING

 CLOSING THE SESSION

Traditional view vs Modern changes
› Patient will not understand
› Patient should be protect
› Patient can not cope

› Better education
› Information availability
› Disease trends
 DOCTOR PATIENT
CENTERED CENTERED

COMMUNICATION
DOCTOR PATIENT

UNDER
DIAGNOSIS
STANDING

TREATMENT COMPLI
PATIENT
ANCE
SATISFACTION
Explanation and Planning are significant
indicator of:

 Recall and understanding

 Compliance
 Satisfaction
 Health problem: diagnosis (provisional
diagnosis)
› etiology, pathogenesis, signs and symptoms,
diagnosis

 Test or investigation
› name, steps or procedures, value and
purpose, possible side effects, result
 Treatment
› Options recommended, risks and benefits,
steps or procedures, possible side effects

 Prevention
› value and purpose, how to conduct, relation
to disease

 Complication
› re illness or treatment

 Prognosis
› Predicted outcomes, provide spesific
numbers if possible
Principles:
 Important information
› Etiology
› Diagnosis
› Treatment
› Prognosis
 Account patient’s perspective
 Simple, concise, and understandable
 Be spesific
 Summarize patient’s problem

 Give explanation

 Summarize agreed plan

1. Providing correct amount, type, and
time
2. Aiding accurate understanding and
recall
3. Achieving a shared understanding
4. Planning – decision making
1. Giving information at appropriate time
Avoid giving explanation early in the interview
Ex:
I understand your curiousity, but before i could explain
about it, i need to do some examinations to have
better information regarding your illness

2. Assesing patient previous knowledge

Ex:
Are you familiar with the disease?
How many have you already known about it?
3. Ask other information
Ex:
Are there anything left in your mind
that you need to discuss about?

4. Chunks and checks

Divide information and regularly check
understanding
1. Categorization and signposting
Ex:
my explanation will comprise three points...first....,
second.....and third....

2. Chunking and checking

providing information step by step will
be recalled better
3. Labelling important information
Ex: i would like to stress on this issue because it is
very important for your therapy
4. Repetition
› Repeat important information
› Asked patient to repeat information given
5. Languange
› Avoid/explain medical jargon
› Simple words and sentences
6. Spesific explanation
Ex:
You need to exercise regularly!
It would be helpfull to lower your blood pressure if you
spend 30 minutes to exercise at least 3 times a week!

7. Using visual methods

Diagram, picture, interactive media,
written information
1. Elicit patient’s beliefs, reactions and
concerns
Ex:
How do you feel right now after knowing what was
going on...?

2. Pick up verbal non-verbal cues

Ex:
It looks like you are worried by the information...
3. Provide opportunities and encourage
patient to contribute
Ex:
Is there anything else that you need to be explained?
4. Relate explanation to patient’s illness
framework
Ex:
I understand that you are worried of having cancer,
but from the examination it doesn’t show any sign of
malignancy..
1. Share thoughts
Ex:
Your complaints and examination indicates disease A
or B. We need to perform further test to exclude the
possibilities......
2. Offer choices
Ex:
There are several treatment options regarding your
illness.. First...second...
3. Involves patient
Ex:
What do you think about the treatment options i
suggest?

4. Encourage patient to contribute

Ex:
It will be helpful if you could share with me your
difficulties following my instructions..
5. Negotiates
Ex:
I see that it is difficult for you to adjust with the
treatment plan. How would you prefer so it could suit
you better?
6. Check with patients
Ex:
So, you agree with the plan that...
 Use short words or senteces
 Active form
 Positive sentences
 Attractive
Guidelines:
 Informed the procedures, risk and
benefits
 Patients need to understand clearly
 Consent must be voluntarily and no
coercion
 Patient should be competent to give
consent
1. Summarizing
2. Contracting
3. Safety netting
4. Final checking
 Summarize briefly
 Clarifies plan

Contracting
Ex:
I will give you this recommendation letters for the
laboratory test and look forward to see you with your
test result in our next appointment...
 Informed the unexpected outcomes
 Step should be taken if it does happen

Final checking
 Understanding
 Questions left in mind
 Plan agreed