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Managing Difficult Communication

Managing Difficult CommunicationsIn the following video vignettes, the oncologist uses many of the strategies and protocols you have previously seen in the section on Basic Principles in approaching difficult and sensitive situations that arise during the course of cancer care. Each medical communication scenario contains an overview of the case and highlights key points to watch for. After the scenario a brief review with pearls and pitfalls helps to underscore take-home points.

Difficult Encounters

“Crossroads”: How to know when you have reached a point in an interaction where these "crossroad" techniques are needed.

Other stressful conversations can arise during the course of treating a patient's cancer. They often require patience, careful listening and negotiating skills on the part of the provider.

"An Error Has Occurred...": A woman's son is told that his mother got the wrong dose of chemo. (2 videos - 10 minutes)
"I'm Going To Mexico": A patient surprises her oncologist by stating she is going for alternative treatment. (2 videos - 13 minutes)
"My Mother's Not To Be Told": A new patient's son demands that his mother not be told she has cancer. (2 videos - 12 minutes)
"Don't Give Up On My Mother": A family member pleads for more treatment in the face of futility. (2 videos - 15 minutes)
"Your Father Has Died": A physician announces a sudden death of a patient to his daughter. (2 videos - 14 minutes)
"I Will Not Take Tamoxifen...": A patient has heard bad things about the tamoxifen she is prescribed. (2 videos - 12 minutes)
"We'd Like To Discontinue Ventilation": A family is told that their loved-one is "brain dead." (2 videos - 13 minutes)
"I'd Like More Information About Euthanasia": A patient expresses interest in assisted suicide. (2 videos - 12 minutes)
"How Much Time Have I Got?": The doctor must respond to a difficult question about prognosis. (2 videos - 17 minutes)
"The Patient Is Angry": A patient is very mad about a barium enema. (2 videos - 7 minutes)

Difficult Conversations Across the Spectrum of Cancer Care

Follow patient/physician interactions over the course of cancer illness for these three patients. They include medical communication situations that are common in oncology: discussing the initial cancer diagnosis, disease progression, explaining clinical trials and end-of-life interviews. They also include the management of difficult but not uncommon patient reactions: disbelief, denial, anger.

Mr. Carter: A man with lung cancer struggles to accept his illness and this presents multiple communication challenges for his oncologist. (8 videos - 41 minutes)
Mrs. Anderson: A patient with locally advanced breast cancer is followed from her initial discussion of a clinical trial to the end of life and "saying goodbye." (6 videos - 68 minutes)
Mrs. Wright: An oncologist must guide a woman with colon cancer through adjuvant chemotherapy, recurrence and palliative care. (6 videos - 46 minutes)

Special Situations

Telephone Conversations: Three types of situations which call for different strategies in communicating test results. (4 videos - 11 minutes)
Genetic Counseling: How to assess the need for genetic testing, evaluate the client and disclose the results. (5 videos - 67 minutes)
Culturally Competent Care
: We must recognize the impact of culture on the patient-physician relationship and understand how cultural competence builds trust and improves communication.  This module is designed to help enhance your skills in cross cultural communication. (5 videos - 14:33 minutes)

Complementary Therapies and Cancer

Should physicians talk with patients about complementary medicine? This series of videos depicts experts in cancer care discussing the use of complementary therapies among cancer patients and provides useful guidelines for initiating a dialogue in this regard. It was awarded the 2005 FREDDIE Award (International Health and Medical Media Award) in the category of Health & Wellness. These videos were produced by the Integrative Medicine Program's education component.

Talking With Patients About Complementary Therapies – This video describes why it is important for the physician to ask what complementary therapies patients are using and useful strategies of how you may go about it. (33 minutes)
Patients Talk About...Complementary Therapies And Cancer – These videos describe the experiences that some patients have had in using complementary medicines. It will assist you in understanding why these therapies are important to patients. (6 videos - 14 minutes)
What You Must Ask, And Why – This video emphasizes the importance of communicating with patients about complementary therapies in regard to interactions these therapies may have with conventional treatment, the physician’s legal and ethical responsibility, and how to provide guidance to the patient. (20 minutes)

Doing It Wrong... (Just for fun)

These are non-examples. You may wish to use them for discussion-starters or just a bit of levity in your teaching.

View: Med Speak (1:12) (with actor, John Cleese)
View: Mr. Simon (0:40)

Free CME Credit Available

Certain material on this site is available for Continuing Medical Education Credit. To obtain credit you must use the “Earn Free CME Credit Online” link on the left.

Risk Management Education (RME) Credit Available

Certain material on this site is available for Risk Management Education Credit for physicians enrolled in the The University of Texas Professional Liability Insurance Plan only. To obtain credit you must use the “Earn Free Risk Management Credit Online” link on the left.  RME is only available to those who have UT Professional Liability Insurance.

Applying for both CME and RME?

If you are applying for both CME and RME for the same module, you MUST view the video through the CME link   The Fundamental Principles section and Managing Difficult Communication section will now allow you to register and print both RME and CME certificates upon completion of the module.  All other modules you must view the videos and then print both the CME forms (found on the right side of the video page) and the RME forms (found below the video window) and send to the appropriate offices.  NOTE:  RME is only available to those who have UT Professional Liability Insurance.

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