Practitioner communication: The psychological impact on families

Practitioner communication:
The psychological impact on families
Fleur-Michelle Coiffait
Specialist Clinical Psychology Practitioner | NHS Lothian
CAMHS Learning Disability Service & South East Scotland Clinical Genetics Service
Doctoral Researcher | University of Edinburgh
Thursday, 27 September 2012

Overview
Setting the context What are we talking about?

What does policy say? What do families say?

What does research say? Why does it happen?

What can practitioners do?

Summary Questions


Setting the context
Psychological assessment
Co-ordination and
Formulation
communication of
information
Clinical psychologists provide holistic support that:
Promotes children’s physical and emotional wellbeing and
development;
Enables them to access educational, social and leisure
opportunities;
Psychological Consultation
Helps the systems around the child to understand their needs and
intervention contribute to the above. and advice
We do this through direct work with children and families
and indirect work with wider systems.

Evaluation Supervision

Research Training


What are we talking about?
ts Situation
n
ve
Re
lat

e e ion
sh
lif
ips

e r
h
Ot Thoughts
How you interpret the
situation
What goes through your
mind
Behaviour Emotions
What you do How that makes you
How you respond feel

e
ur
ult
Pa
s
Changes in body ty
an
dc
te cie
xp
er
ien
Physiological so
f so
ce
ces reactions flu
en
In


Fear Surprise Loss
Relief Worry Dread Shock Anxiety
Disbelief Numbness
Emotional impact
Sadness Panic
Frustration Overwhelmed
Anger
Trauma Guilt
Detachment
…plus many more and often a mixture


What this means How we make Beliefs about
about us sense of the asking for help
situation
Dreams Fears
Expectations Information taken
Cognitive impact
in
Attitudes about the Beliefs about
world Beliefs about others
professionals and
Hopes Ambitions
services
Concerns Worries
Values


What does policy say?

Engagement and empowerment of children and families
Using universal services for prevention, early intervention
Services that meet needs of children and families


What do families say?
“They said ‘it was just one of
those things’ - what does that “Its always better to just
even mean? Why did it know the truth.”
happen to my child?”

“She asked me if I was ok and
“Looking back, I wish they’d that’s when I let it all out...
just been honest. I’m not throughout all this no-one had
stupid - I knew something asked me that and I hadn’t
wasn’t right, it was obvious.” even thought about it, and I
wasn’t.”


What do families say?
“It’s stayed with me - I can
remember the exact date, “...and I just thought, so it’s
what was in the room. I genetic and it comes from me,
remember that feeling of so that means I’ve given this
devastation as if it were to my son, this is my fault”
yesterday.”

“They said it was normal to
“I thought that because they feel like this and so I started
did a test for it, that it could to accept that it was ok to
be cured. Nobody actually need some support and I
said there was no cure.” wasn’t failing by finding this
hard.”


What does research say?
• Families want honesty
• Witholding of information can be unhelpful
• Providing false hope also unhelpful
• Want emotion accompanying information
• Body language important
Meert et al. (2008)


From: http://www.scotland.gov.uk/Resource/Img/207951/0061225.jpg


• How information is provided is important:
• Attentiveness to family’s information needs
• Comprehensiveness of information
• Pace of providing information
• Complexity of vocabulary
Meert et al. (2008)


• Desired and actual experiences differ
• Be caring, ask how they feel
• Allow more opportunity for families to talk
and share their own feelings
• Provide information they want, confidently
• Link to other families where possible
Sharp et al. (1992); Strauss et al. (1995)


Why does it happen?
• Apprehension and anxiety on part of family
• Belief that will be told all they need to know
• Unless invited, rarely ask questions
• Lack of knowledge
• Up to 80% of information given in
consultation forgotten immediately
• Maintain ‘good customer’ role
Jenkins et al. (2001); Kessels (2003); Leydon et al. (2000);
Luker et al. (1995); Faulkner and Maguire (1995)


Why does it happen?
• Practitioner vs family perceptions
• Lack of attunement to individual needs
• One size fits all approach
• Trying to help by encouraging hope
• Not being 100% sure
• Avoiding emotive discussions
• Stress, pile-up of demands, other pressures
• Inadequate supervision/reflection
Faulkner and Maguire (1995)


Why does it happen?
• Feeling unprepared when faced with emotion
• Not knowing what to say
• Not wanting to make the situation worse
• Lacking skills/knowledge to know how to help
• Not being able to solve/cure the problem
• Not being able to reduce/take away the pain
• Feeling inadequate, powerless, helpless
Nichols (1993)


• Be empathetic – ask what the family are
feeling or thinking, try and understand the
issues raised from their perspective.
• Adopt a non-judgmental stance – accept the
family’s opinions/values without evaluating.
• Be genuine – be yourself with the child and
family and avoid playing out a ‘role’.
• Acknowledge difficult situations and feelings
NHS Education Scotland (2011)


• Ask families what they think they need
• Seek supervision (formal or informal) and
opportunities to debrief/reflect with colleagues
• Seek training and learning opportunities to
develop your skills/practice if required
• Use clinical psychology for advice/consultation
• Think about your own values, reasons for career
• Look after yourself or you’re no good to anyone!


Useful resources

Local NHS Paediatric Psychology Service
and/or Child Learning Disability Service


Summary
• Communication affects outcomes
• Clear and caring communication
• Meeting the family/individual’s information
needs
• Acknowledgement and expression of emotion
• Open the proverbial can of worms!
• Awareness of what we bring to the situation
• We can’t always fix it, but we can be there


Questions?
fmcoiffait@gmail.com

slideshare.net/fmmc27

twitter.com/PMLDresearch
mendeley.com/profiles/fleur-michelle-
coiffait/
uk.linkedin.com/pub/fleur-michelle-coiffait/
28/961/459


References
Davis, H. (1993). Counselling parent of children with a chronic illness or disability. Leicester: British Psychological Society.
Edwards, M. & Titman, P. (2010). Promoting psychological well-being in children with acute and chronic illness. London: Jessica Kingsley.
Faulkner, A. 7 Maguire, P. (1995). Talking to cancer patients and their relatives. Oxford: Oxford Medical Publications.
Fitton, P. (1994). Listen to me: Communicating the needs of people with profound intellectual and multiple disabilities. London: Jessica Kingsley.
Jenkins, V., Fallowfield, L. & Saul, J. (2001). Information needs of patients with cancer: Results from a large study in UK cancer centres. British
Journal of Cancer, 84, 48-51.
Kessels, R.P.C. (2003). Patients’ memory for medical information. Journal of the Royal Society of Medicine, 96(5), 219-222.
Leydon, G.M., Boulton, M., Moynihan, C., Jones, A., Mossman, J., Boudioni, M., & McPherson, K. (2000). Cancer patients’ information needs and
information seeking behaviour: In depth interview study. British Medical Journal, 320(7239), 909-913.
Luker, K.A., Beaver, K., Leinster, S.J., Glynn Owens, R., Degner, L.F., & Sloan, J.A. (1995). The information needs of women newly diagnosed with
breast cancer. Journal of Advanced Nursing, 22, 13-141.
Meert, K.L., Eggly, S., Pollack, M., Anand, K.J., Zimmerman, J., Carcillo, J., Newth. C.J., Dean, J.M., Willson, D.F., & Nicholson, C. (2008). Parents’
perspectives on physician -parent communication near the time of a child’s death in the pediatric intensive care unit. Pedatric Critical Care
Medicine, 9(1), 2-7.
Nichols, K.A. (1993). Psychological care in physical illness (2nd Edition). London: Chapman and Hall.
Sharp, M.C., Strauss, R.P., Lorch, S.C. (1992). Communicating medical bad news: Parents’ experiences and preferences. Journal of Pediatrics, 121
(4), 539-546.
Strauss, R.P., Sharp, M.C., Lorch, S.C., & Kachalla, B. (1995). Physicians and communication of “bad news”: Parent experiences of being informed of
their child’s cleft lip and/or palate. Pediatrics, 96(1), 82-89.

Building partnerships between parents and practitioners document: www.ncca.ie/en/Curriculum_and_Assessment/Parents/Early_Childhood/
Aistear_Partnership_guidelines.pdf
How do you want me to talk to you? and How does it feel? Videos/DVDs and resources:
www.cen.scot.nhs.uk/how-do-you-want-me-to-talk-to-you
Psychosocial interventions for improving adherence, self-management and adjustment to physical health conditions in children and young people
resource:
www.nes.scot.nhs.uk/education-and-training/by-discipline/psychology/multiprofessional-psychology/paediatric-psychology-psychosocial-
interventions.aspx


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