The art of interprofessional psychosocial communication: Optimizing patient interfaces with psychiatric specialists in liver transplantation

“But I didn’t drink!”: What to do with discordant phosphatidylethanol results

“…We take care to preserve a solemn and respectful tone when this occurs (ie, minimizing interruptions, maintaining attention on the person, communicating our interest in what they have to say, encouraging them to elaborate, avoiding abrupt interjections or topic changes, etc.). [35] We acknowledge their courage in discussing sensitive information amidst the high stakes of LT and express our appreciation for trusting the team with accurate information about their alcohol use. require according to established criteria.…”

“…Communication skills are analogous to medical procedure tools and, like poor hand hygiene and contaminated instruments, stigma and poor communication can complicate an LT course. [35] Most liver clinicians (51%) receive <1 month of addiction training and a majority (90%) indicate a desire for more. [36] Accordingly, positive PEth results can be distinctly challenging experiences, particularly when labs contradict self-reported abstinence and clinical stakes are high.…”

“…Our group has previously described processes by which liver teams can build psychiatric and addiction expertise and consultation and improve teamwork as a foundation for future productive psychosocial discussions, including alcohol use and PEth 43,44 . We have also written about communication skills, personal emotional awareness, and interpersonal intuition, which may equip liver clinicians to better assist patients through serious psychosocial challenges in LT, like alcohol use 35 …”

“…[43,44] We have also written about communication skills, personal emotional awareness, and interpersonal intuition, which may equip liver clinicians to better assist patients through serious psychosocial challenges in LT, like alcohol use. [35] During patient interaction Regardless of positive or negative PEth results, patients commonly view toxicology negatively compared with other LT-related labs obtained by the team (eg, "It is insulting that you all keep screening me for alcohol and drugs"). We commonly discuss toxicology with patients as part of our typical clinical work and we must often rapidly improve rapport and de-escalate conflict with already frustrated patients and families before moving into PEth-specific discussions.…”

“…Clinicians' artful use of techniques like self-effacement and reflective listening are helpful to incrementally lower tension and maintain rapport. These simple maneuvers can be particularly useful early strategies during PEth discussions to (1) humanize the clinician and the patient, (2) equalize perceived asymmetry in the clinician-patient relationship, (3) confirm that the clinician acknowledges and validates the patient's point of view, and (4) establish the clinician's clear interest in the T A B L E 2 Practical insights and communication strategies regarding phosphatidylethanol (PEth) results in liver transplantation, particularly when results are positive and/or discordant with self-report [25,26,35] Prior to patient interaction Given the clinical importance of language, destigmatize the interaction by using neutral terms (eg, blood and urine are "positive/negative" rather than "clean/dirty," alcohol "use" rather than "abuse," "alcohol-associated" rather than "alcoholic") Maintaining professionalism, establish and maintain rapport using appropriate self-effacement (eg, "We ask a ton of questions which can be a bit of a pain") or mild humor (eg, "I don't know anyone whose first choice would be to begin the day with a discussion like this") Inform the person that PEth discussions are common in LT, myriad substance-related challenges exist in LT, and strong emotions are typical and understandable Express authentic compassion and an enduring desire to understand and help the person (eg, "I want you to know that we care about you regardless of whether you are drinking or sober. Of course, we want you to be sober for health reasons but our compassion and desire to help you are permanent and have nothing to do with whether you are drinking.")…”