[02.17] Communication Skills_ CEA Model of Health Education, Convening to the Family V2.pdf

Five

According to Doherty and Baird, how many levels of physician involvement with families are there?

Level 1: Minimal Involvement

What level of physician involvement describes when the doctor hardly sees the family and the focus of treatment is individual patient care?

Medico-legal issues (e.g., getting informed consent for a minor or debilitated family member)

In Level 1 physician involvement, for what situations is the family typically involved?

Health education for both the patient and the family

What is the focus of treatment in Level 2 of physician involvement with families?

Ongoing Medical Information and Advice

Disclosure of a medical condition and ongoing prenatal check-ups are examples of which level of physician involvement?

Primarily cognitive in nature

What is the nature of clinical consultations in Level 2 of physician involvement?

Level 3: Provision of Medical Support

Which level of physician involvement includes health education, probing deeper into the emotional impact of illness, and offering emotional support to family members?

Family CEA

What is an example of Level 3 physician involvement, in addition to disclosure when the doctor-patient/family relationship is well-established?

Level 4: Systemic Assessment and Planned Intervention

Which level involves the doctor making a systemic assessment of family dynamics and planning interventions to change family structures?

Identifying enmeshed relationships or coalitions and intervening to re-align them

What is an example of an intervention in Level 4 physician involvement?

Level 5: Family Therapy

Which level of physician involvement requires additional specialty training and is typically needed for deeply rooted family issues like drug dependence or child abuse?

Referral to professionals

What action are average family physicians likely to take when confronted with family dysfunctions requiring Level 5 intervention?

Physical discomfort and distress/anxiety about what they are feeling

What are the two main reasons patients seek consultation?

Anxiety

In cases where there is no apparent physical or physiological cause for a symptom, what often becomes the patient's main concern?

Wholistic approach

Physicians are trained to have what kind of approach to patients, treating both physical symptoms and anxiety?

Counseling

What is defined as a set of techniques, skills, and attitudes to help people manage their own problems using their own resources?

Self-insight, behavior change, and symptomatic relief

What three outcomes does counseling seek to provide?

Providing information, advising, and coaching

What actions are not considered counseling, though they are complementary and often necessary ingredients?

Catharsis-Education-Action (CEA)

What brief counseling method can be used in 10 to 15-minute office consultations and systematically deals with medical issues and patient perceptions?

It encourages patients to openly discuss the illness and their emotional responses to it.

How does the CEA method encourage patient participation?

Because their primary concern was not addressed

Why might a patient feel they were not really treated if dissatisfied with a consult?

Emotions and perceptions cloud rational judgment, and feelings may be due to misperceptions.

What two reasons highlight why it is important to deal with the emotional impact of illness?

Emotionally Critical Misperception (ECM)

What is the term for patients’ perceptions of their medical conditions that are incongruent with the real situation?

Explanatory models, media, and illness prototypes

Where do ECMs typically come from?

Catharsis, Education, Action

What does the acronym CEA stand for?

Active listening skills

What skills does the CEA method integrate into doctor-patient interaction and health education?

10-15 minutes

What is the typical duration for the CEA counseling technique?

Accurately identify misperceptions that are most anxiety-provoking

Using active listening skills, what can a physician achieve in the CEA method?

Becoming aware of hidden emotion, giving it a name, and allowing it to be experienced fully

What is catharsis about, beyond just crying?

Clarifying or defining the problem

What does catharsis help with?

Knowledge, Feelings, Consequence, Summary

What are the four basic steps in catharsis?

"Ano ang naisip mo noong nakaramdam ka ng sakit?" (What came to mind when you started feeling your symptoms?)

What question corresponds to the "Knowledge" step of catharsis?

"Ano ang naging damdamin mo noong naisip mo ang mga ito?" (What feelings came out when these thoughts came to your mind?)

What question corresponds to the "Feelings" step of catharsis?

"Ano ang pinakanakakatakot na mangyayari sa iyo/sakit mo?" (What is the most frightening thing that could happen to you/your illness?)

What question can a doctor ask to probe for the "Consequence" step of catharsis, especially if the patient expressed fear?

ECM (Emotionally Critical Misperception)

In most cases, where will the answer to the "Consequence" question in catharsis be found?

Summarizing the ECM and the emotions that come with it

What is the final step in catharsis?

KFCS (Knowledge, Feelings, Consequence, Summary)

What acronym can be used to remember the four steps of catharsis?

Reflecting Skills (Reflecting Content, Reflecting Feeling, Reflecting Experience) and Probing/Focusing Skills

What active listening skills must be used during catharsis?

For the patient to articulate and ventilate their emotions and clear their mind

What is the primary purpose of catharsis for the patient?

The patient will have enough space in their mind to listen to what the physician has to tell them.

What benefit does catharsis provide before the education step?

Emotionally Critical Misperception (ECM)

What should the education step of CEA start with?

It communicates to the patient that the doctor has been listening and understands their concerns, creating an emotional "connection."

Why is addressing the ECM first in education important?

Pathophysiology and pharmacology/therapeutic plans

What topics are discussed after the ECM has been addressed in the education phase?

Speak in the language of the patient, use analogies, avoid evidence-based medicine language

What are key pointers for patient education?

Reassure the patient and then correct the misperceptions.

What should a physician do if a patient exhibits too much anxiety?

Ask concern questions (e.g., "Doesn't it concern you that…?", "Hindi po ba kayo nababahala na…?").

What should a physician do if there is insufficient anxiety in a patient who should be taking their condition seriously?

Challenging the patient to rethink their condition/actual situation

What is the purpose of asking "concern questions" when there is insufficient anxiety?

Propose an action plan to relieve the ailment.

What must the physician do after educating the patient about the illness?

Management, diagnostic examination, pharmacological and non-pharmacologic treatment

What does the action plan in CEA include?

Agreed upon by both the patient and the doctor

What characteristic must the action plan have?

Re-check for other ECMs

What is an important step to take during the action phase regarding misperceptions?

Ask for questions/clarifications, ask for important learning, do a feelings check, set a specific date/time for follow-up.

What are the steps in the closing and follow-up phase of individual CEA?

To adequately assess the patient and the family, anticipate the impact of health issues, and come up with a comprehensive plan of action.

What is the purpose of bringing family members together for a family meeting?

All families have strengths and weaknesses, they are experts on themselves, they deserve dignity and respect, they can make informed decisions when supported, and outcomes can improve when families are involved in decision-making.

What are the basic assumptions about families when convening them?

A team

Which is often more capable of creative and high-quality decision-making: a team or an individual?

Family Group Conference, Family Unity Meeting, Family Decision Meeting, Team Decision Meeting, Family Team Conference, Family Team Meeting

Name some different family meeting models mentioned in the source.

When there are lots of conflicts in the family

When is a "Family Unity Meeting" typically used?

Bridge knowledge and information gaps, validate feelings and needs, identify and prioritize problems, explore solutions, match appropriate services to needs, identify strengths and weaknesses, foster coordination of support.

What are the seven goals of family meetings?

Who, When, How often, How long, Where

What structural questions need to be considered for family meetings?

Physician (attending or other involved), social worker, nurse, family, anyone in the healthcare scenario who sees and validates the need.

Who can call for a family meeting?

Specific agenda, significant stakeholders, primary caregiver(s), disciplines involved

What factors determine who must be present at a family meeting?

At least once within the patient encounter period (at the start), when crucial decisions need to be made, agreed follow-up meetings, when there is a recognized need or request.

When should a family meeting be convened?

Pre-set by the group

How is the duration of a family meeting determined?

For more complex health needs or conditions, to require decision-making and mobilize family resources.

Why is it always better to convene the family in certain situations?

Neutral venue, comfortable room free of interruptions, conducive seating arrangements, environment that maintains confidentiality.

What are ideal conditions for where to conduct a family meeting?

Separate them

If there are family members with conflicting views, how might seating arrangements be planned to avoid fights?

In home care settings

When might family meetings be conducted at home instead of strictly in hospitals?

Welcome and Introductions, Purpose, Expected Outputs, Non-negotiables/confidentiality, Ground Rules, Family Story, Strengths to Achieve Outcomes, Identification of Individual and Family Needs, Brainstorm How to Meet Needs, Develop Agreement for Plan, Assessing What Can Go Wrong, Next Steps, Summarizing and Closing.

List the 13 steps in conducting a family meeting.

At the beginning of the meeting

When should the purpose and expected outputs of a family meeting be stated?

Being acknowledged first before speaking

What is an example of a ground rule for family meetings?

To ensure everyone is on the same page and knows what is being talked about

Why is giving a brief background on the family story important?

Being able to conduct the family meeting and having the family members present

What is considered a very good start in emphasizing the family's strengths to achieve outcomes?

Especially those who play crucial roles and functions within the family

Whose needs should be identified during a family meeting?

Reschedule

What action can be taken if those present at a family meeting cannot make decisions or come up with a plan immediately?

Anticipate what could go wrong and make room for Plan B, Plan C, etc.

What should be assessed if time allows during a family meeting?

Assignments for specific family members, time and date for next meeting

What should be included in the summarizing and closing step of a family meeting?

Systematic way of dealing with medical issues and how they are perceived by the patient and the family

What is the Family CEA method?

It encourages the family to openly discuss the illness and their emotional responses to it.

How does the Family CEA method facilitate discussion?

Family counseling or family health education

What is the Family CEA method a strategy in?

Discuss the clinical problem, Define the clinical problem (Catharsis), Correct the misperceptions (Educate), Address the patient’s problem (Action), Closing and Follow-up.

What are the five steps in applying the Family CEA method to family meetings?

Asking for the reason for consult, doing a medical history (with family verification), assessing health conditions by physical exam.

What actions are part of discussing the clinical problem in Family CEA?

A child whose parents refused consent for a deworming program due to misperceptions about intestinal worms.

What is the example case used to illustrate the CEA method application?

Explore the patient and family’s health understanding, explore and identify the ECM, probe/reflect feelings.

What are the key actions in the "Define the Clinical Problem (Catharsis)" step of Family CEA?

"What do you call your/the illness?", "What do you understand about your/the illness?", "What do you think has caused the illness?"

What sample questions are used to explore health understanding and identify ECM in Family CEA catharsis?

"What does your sickness do to you?", "How do you feel about your illness?", "How does your family react to you because of your illness?"

What sample questions are used to probe patient feelings in Family CEA catharsis?

"How does his/her sickness affect you?", "How do you feel about his/her sickness?"

What sample questions are used to probe family members' feelings in Family CEA catharsis?

"What do you think will happen to the illness?", "What do you fear most about the illness?"

What sample questions are used for both patients and family members regarding the illness in Family CEA catharsis?

"Ang alam namin, nakakasama ito." (We know, it is harmful.)

In the deworming example, what initial response might parents give when asked about their understanding of deworming?

"Ang alam ko, maganda ang bulate sa pagtunaw ng pagkain, kaya pag binigay ang gamot na ito, baka hindi na matunawan ang anak ko." (I know that worms are good for digesting food, so if this medicine is given, my child might not be able to digest food anymore.)

In the deworming example, what specific misperception might the mother express after probing?

"Nag-aalala ako na baka mapanganib ang gamot na pampurga para sa anak ko." (I am worried that the deworming medicine might be dangerous for my child.)

In the deworming example, what specific feeling might the father express after probing?

Fear and anxiety

In the deworming example, what two emotions of the parents need to be addressed?

Share findings, summarize misperceptions, address ECMs immediately, explain management options.

What actions are part of the "Correct the Misperceptions (Educate)" step of Family CEA?

Intestinal parasitism

In the deworming example, what clinical finding would the doctor explain to the parents?

Misperceptions about intestinal parasites being part of the child's digestive system, safety profile of anti-helminthic drugs.

In the deworming example, what specific misperceptions would the doctor correct and what information would they provide?

Make recommendations for the plan, check for misperceptions towards the plan, involve patient and family, ask them to state needs, come to an agreement, set treatment plan with tasks for patient and family.

What actions are part of the "Address the Patient’s Problem (Action)" step of Family CEA?

"How do you feel about the treatment?", "What important results do you expect?", "What might make the treatment difficult to follow?", "What do you like your doctor to do for you?"

What sample probing/follow-up questions are used in the action phase of Family CEA?

Suggesting deworming, explaining benefits, explaining administration, and other instructions.

In the deworming example, what actions would the doctor take in the action phase?

Do a feelings check, set a specific date and time for follow-up.

What actions are part of the "Closing and Follow-up" step of Family CEA?

"How are each of you feeling right now?"

What question is a good example for a feelings check?

Go through CEA again and address said misperceptions.

If misperceptions are still present during follow-up, what should be done?