The communication of the diagnosis of schizophrenia. Focus group findings on psychiatrists' point of view

Improving clinician competency in communication about schizophrenia: a pilot educational program for psychiatry trainees

OBJECTIVE

Important gaps are observed in clinicians' communication with patients and families about psychiatric disorders such as schizophrenia. Communication skills can be taught, and models for education in these skills have been developed in other fields of medicine, such as oncology, providing a framework for training communication skills relevant to psychiatric practice. This study evaluated a pilot communication skills education program for psychiatry trainees, focusing on discussing schizophrenia diagnosis and prognosis.

METHOD

Communication skills training modules were developed based on an existing theoretical framework (ComSkil), adapted for discussing a schizophrenia diagnosis and prognosis. Pre-post training rating of self-reported confidence in a range of communication tasks was obtained, along with trainee views on the training methods.

RESULTS

Thirty-eight participants completed the training. Significant improvements in confidence were reported post training for discussing schizophrenia prognosis, including an increased capacity to critically evaluate their own communication skills. Participants reported high levels of satisfaction with the program.

CONCLUSION

This preliminary study provides support for the translation of a well-established educational model to psychiatric training addressing core clinical communication tasks and provides the foundation for the development of a more comprehensive evaluation and an extended curriculum regarding other aspects of care for patients with schizophrenia: ongoing management and recovery, dealing with conflict, and conducting a family interview.

Breaking bad news: schizophrenia

The aim of this paper is to help physicians deliver the diagnosis of schizophrenia by adopting and adapting the popular oncology protocol, SPIKES. Data sources for the paper are PubMed searches (1984-2009), entering the phrase "breaking bad news." Of the 269 articles retrieved, those with face relevance to schizophrenia were selected and references contained in them were further searched. The conclusion of the paper is that, as in oncology, revealing a serious psychiatric diagnosis is emotionally difficult for both physician and patient; guidelines help, but individualization is essential.

Involving patients in decisions during psychiatric consultations

BACKGROUND

Patient involvement in the decision-making process is a key element for good clinical practice. Few data are available on patient involvement in psychiatry.

AIMS

To assess in a psychiatric out-patient context how psychiatrists involve patients in therapeutic decisions and to determine the extent to which patient and psychiatrist characteristics contribute to patient involvement.

METHOD

Eighty transcripts from audiotaped first out-patient consultations, conducted by 16 psychiatrists, were rated with the OPTION (observing patient involvement) scale. Interrater reliability indices were obtained for 30 randomly selected interviews. Associations between OPTION scores and some clinical and socio-demographic variables were tested using t-test, ANOVA and Pearson's correlation coefficient where appropriate. The distribution of scores for each psychiatrist was assessed by intracluster correlation coefficients.

RESULTS

Interrater reliability and internal consistency of the OPTION scale in the psychiatric setting were satisfactory. The total score and the ratings for the single OPTION items showed a skewed distribution, with a prevalence of scores in the low range of abilities, corresponding to minimal attempts to involve patients or a minimal skill level.

CONCLUSIONS

The OPTION scale proves to be a reliable instrument to assess patient involvement in a psychiatric setting. Psychiatrists showed poor patient involvement abilities parallel to previous findings in psychiatry and primary care. They need to be encouraged to share treatment decisions with their patients and to apply patient involvement skills. Further research is needed to establish which patient variables and clinical settings in psychiatry are more amenable to shared decisions, and how participation of psychiatric patients in treatment decisions will affect the outcome.