10 - Calming Patients’ Fears: Communications Skills for Breast Imagers
Saturday, April 4, 2020
2:05 PM – 2:35 PM
Location: Forum 134
Evolution of Patient-Centered Care: Breast Imaging Model The role of the breast imager in breaking bad news has expanded over the years – historically rads had little to no patient interaction Breast imaging has long had requirements per MQSA to notify patients in written lay language of results within 30 days of the exam
Breast imaging as the model for recent initiatives – ACR Imaging 3.0 and RSNA Radiology Cares – emphasis on patient-centered care
From the Start: Inclusion of Communication in Physician Training ACR and SBI curriculum for resident and fellow education in breast imaging includes “communication issues”
Communication is Key to Patient Centered Care
Predictors of Patient Satisfaction: Donelan JGIM 2010 Timeliness Better communication Equity and Patient-centeredness
Difficult Communication: Need for Biopsy
Risk Factors Associated with Anxiety at Time of Biopsy
Role of the Radiologist
Communication Prior to Biopsy Procedure
Patient Anxiety pre and Post Imaging-Guided Biopsy Procedure Better communication with radiologists recommending biopsies was significantly associated with lower levels of prebiopsy anxiety After the biopsies, women's anxiety significantly decreased Better communication with radiologists performing biopsies was associated with lower postbiopsy anxiety after accounting for patients' baseline anxiety levels
Patient satisfaction with treatment prior to procedure correlates with the perception that caregivers did everything they could to control pain, over the actual pain
Radiologist Training: Communicating “bad news”: Acad Radiol 2009 Few radiologists have had training in this form of communication Comfort levels declined as the severity of news increased Radiologists in the study routinely discussed bad news with their patients but a majority (85%) had never received training 68% had no interest in acquiring training
Adler: Examples of “bad news” strategies listed by respondents Survey of Radiology Resident’s Experiences Communicating Results to Patients: 2018 83.6% described no training in communicating radiology results to patients Yet over 90% had had to communicate results with patients Diagnostic imaging, biopsies Majority of residents expressed interest in obtaining additional communication training
Radiologist-Patient Communication: JACR 2019 93% of rads reportedly directly communicate abnormal diagnostic mammo results A majority reported to be completely comfortable with directly communicating results to patients when: Recommending additional imaging (92%) need for biopsy (93%) delivering biopsy results (86%) 71% rated skills communicating with patients as excellent 26% rated skills as above average, 3% reported average skills
Methods of Addressing Anxiety: Mindfulness Meditation
Active listening Common patient responses include shock, disbelief, denial, fear, anger, and guilt Providing perspective about the risk for breast cancer or the characteristics of the cancer if early may instill hope without giving false reassurance Establishing a plan, (appointment with a breast surgeon) in the setting of breast cancer, allows a patient to have a sense of control Offering additional support also demonstrates empathy
Summary Changing role of the radiologist comes with greater responsibility for the satisfaction of patients includes communication with patients
Upon completion, participant will be able to understand the patient’s perspectives and feelings when presenting for the breast imaging appointment.
Upon completion, participant will be able to identify methods to incorporate in practice for improved patient communication.
Upon completion, participant will be able to understand how to approach communication in difficult scenarios.