Training to enhance psychiatrist communication with patients
                        with psychosis (TEMPO): cluster randomised controlled trial

McCabe, Rose; John, Paula; Dooley, Jemima; Healey, Patrick G. T.; Cushing, Annie; Kingdon, David; Bremner, Stephen; Priebe, Stefan

doi:10.1192/bjp.bp.115.179499

Cited by 66 publications

(40 citation statements)

References 30 publications

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“…Communication skills training packages for mental health clinicians have already been successfully tested [40] and could be adapted in order to incorporate the additional difficulties related to facilitating a three-way conversation, involving not only patients but also carers. Cultural sensitivity is also an important issue and, in increasingly multicultural services, clinicians need to be able to understand and discuss views from different cultural backgrounds and belief systems.…”

Section: Discussionmentioning

confidence: 99%

How to make carer involvement in mental health inpatient units happen: a focus group study with patients, carers and clinicians

et al. 2017

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BackgroundCarers are family members or friends who support people with a mental health problem without being paid. Carer involvement in mental health treatment has been consistently supported by research evidence and promoted by policies but its implementation rates are poor. Particularly when patients are treated in inpatient units, carers often report being left without information or being excluded from decisions about treatment. In this study we have explored, along with staff perspectives, views of patients and carers who had a recent experience of inpatient mental health care on how to improve the implementation of carer involvement in inpatient care.MethodsSixteen focus groups were held with carers, patients and clinicians in London, United Kingdom. We included staff working in inpatient units and patients and carers who had experience of inpatient care in the last five years. Data from focus groups were analysed using thematic analysis.ResultsEighty six participants in total (31 service users, 22 carers and 33 clinicians) attended the focus groups. Participants identified that generally, carer involvement should happen as soon as possible after admission, although this may be challenging in some cases. Carer involvement should include receiving information, participating in decisions about care and discharge and receiving emotional support by staff. When carers are involved, their personal knowledge of the patient’s condition should be utilised. Challenges to carer involvement may include problems with identifying carers during a mental health crisis, obtaining valid patient consent, sharing appropriate information, and contacting and engaging carers. Additionally, it was perceived that all the ward staff need to be actively engaged in order to make carer involvement happen and this cannot be left only to specifically trained clinicians.ConclusionsThese findings identify basic components that all family interventions in inpatient units should have. Further studies are needed to explore how and if purposively designed clinical interventions can improve carer involvement in inpatient treatment and, consequently, patient outcomes.

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Section: Discussionmentioning

confidence: 99%

How to make carer involvement in mental health inpatient units happen: a focus group study with patients, carers and clinicians

et al. 2017

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“…There are two main types of repair. First, a speaker initiating and completing repair on his or her own utterance while producing it (self‐initiated, self‐repair), for example, “I saw you three, no two months ago.” This is an “online” process of editing or reworking an utterance as it is being produced (McCabe et al., ). Self‐repairs are ubiquitous in naturally occurring dialog and appear to reflect how hard people are working to make their talk understandable and acceptable to their listener (Brennan & Schober, ).…”

Section: Shared Understanding and Repairmentioning

confidence: 99%

“…After training, psychiatrist effort in establishing shared understanding with their patients was significantly higher (McCabe et al., ). Psychiatrists receiving the intervention used 44% more self‐repair than the control group adjusting for baseline self‐repair: mean difference 6.4 self‐repairs per 1,000 words (95% CI [1.46, 11.33], p = .011), as displayed in Table .…”

Section: Enhancing Communication Between Psychiatrists and Patients Wmentioning

confidence: 99%

Miscommunication in Doctor–Patient Communication

McCabe

Healey

2018

Topics in Cognitive Science

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The effectiveness of medical treatment depends on the quality of the patient–clinician relationship. It has been proposed that this depends on the extent to which the patient and clinician build a shared understanding of illness and treatment. Here, we use the tools of conversation analysis (CA) to explore this idea in the context of psychiatric consultations. The CA “repair” framework provides an analysis of the processes people use to deal with problems in speaking, hearing, and understanding. These problems are especially critical in the treatment of psychosis where patients and health care professionals need to communicate about the disputed meaning of hallucinations and delusion. Patients do not feel understood, they are frequently non‐adherent with treatment, and many have poor outcomes. We present an overview of two studies focusing on the role of repair as a mechanism for producing and clarifying meaning in psychiatrist–patient communication and its association with treatment outcomes. The first study shows patient clarification or repair of psychiatrists’ talk is associated with better patient adherence to treatment. The second study shows that training which emphasizes the importance of building an understanding of patients’ psychotic experiences increases psychiatrists’ self‐repair. We propose that psychiatrists are working harder to make their talk understandable and acceptable to the patient by taking the patient's perspective into account. We conclude that these findings provide evidence that repair is an important mechanism for building shared understanding in doctor–patient communication and contributes to better therapeutic relationships and treatment adherence. The conversation analytic account of repair is currently the most sophisticated empirical model for analyzing how people construct shared meaning and understanding. Repair appears to reflect greater commitment to and engagement in communication and improve both the quality and outcomes of communication. Reducing potential miscommunication between psychiatrists and their patients with psychosis is a low‐cost means of enhancing treatment from both the psychiatrist and patient perspective. Given that misunderstanding and miscommunication are particularly problematic in psychosis, this is critical for improving the longer term outcomes of treatment for these patients who often have poor relationships with psychiatrists and health care services more widely.

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“…Thirty-six psychiatrists from outpatient and assertive outreach clinics across three centres (one urban, one semi-urban, and one rural) were randomly selected, 31 consented (86%). One hundred and sixteen cases were also drawn from a cluster randomized controlled trial (McCabe et al, 2016), which assessed a communication skills training intervention for 21 psychiatrists and 64 patients with psychosis from outpatients clinics in East London and North East London. Patients assigned to clinicians who met Diagnostic and Statistical Manual – IV7 criteria for schizophrenia or schizoaffective disorder were asked to participate.…”

Section: Methodsmentioning

confidence: 99%

How Psychiatrists Recommend Treatment and Its Relationship with Patient Uptake

Thompson

2017

Health Communication

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Consultations for patients with chronic mental health conditions are conceived as meetings of experts: medical and experiential, respectively. Treatment decisions, in these terms, become a joint responsibility rather than handed down ex-cathedra. One resource for constituting decisions as ‘shared’ is the treatment recommendation – decisional authority can be invoked through its design. There is concern that people diagnosed with schizophrenia are infrequently involved in treatment decisions. However, the methods psychiatrists actually employ remain undefined. This article advances our understanding of psychiatric practice by mapping alternative methods used by psychiatrists to recommend treatment in outpatient consultations in situ. First, we unpack the types of treatments psychiatrists recommend. Then, we ask how psychiatrists recommend treatment? Applying a novel coding taxonomy, informed by the conversation analytic principle that recommendations represent different social actions, we identify the distribution of alternative formulations for psychiatrists’ recommendations (pronouncements, suggestions, proposals, and offers). We also propose one linguistic dimension, personal pronouns, on which recommending actions often depend, implicative for who is projected as ‘accountable’ for the decision. Finally, we examine the relationship between action type and patient uptake: is a particular type of recommendation more likely to attract acceptance/resistance from patients? And how does this relate to decisional accountability?

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Training to enhance psychiatrist communication with patients with psychosis (TEMPO): cluster randomised controlled trial

Abstract: Shared understanding can be successfully targeted in training and improves relationships in treating psychosis.

Cited by 66 publications

References 30 publications

How to make carer involvement in mental health inpatient units happen: a focus group study with patients, carers and clinicians

How to make carer involvement in mental health inpatient units happen: a focus group study with patients, carers and clinicians

Miscommunication in Doctor–Patient Communication

How Psychiatrists Recommend Treatment and Its Relationship with Patient Uptake

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