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Handout 4: Skills descriptors

Communications Skills Descriptors
Reflection/Empathy
Let the patients know you are listening by paraphrasing important statements back to them “So, is sounds like… “ Identify feeling, label it and express concern.
Explore agenda/priority
Acknowledge the reason for visit given to staff, “What were you hoping to accomplish at this visit today?”. . . “Something else?” and summarise the patient’s concern.
Explore agenda: Clarify boundaries
Clarify those items that can be accomplished at the current consultation and offer another consultation to “do justice to” concerns that are less urgent
Explore beliefs about self-management
Invite the patient to discuss how they view their role in managing their long-term condition, “What are you doing to maintain or improve your health?”
Explore importance 0-10
Ask about the patient’s beliefs about the importance of specific self-management tasks. “On a 0 to 10 scale, how important is it for you to keep a log of your present activities?”
Explore confidence 0-10
Enquire about patient beliefs in their confidence in their ability to perform self-management skills. “On a 0-10 scale, how confident are you that you can use your puffers twice a day?”
Support autonomy and choice
Whenever patients indicate their preference about how to manage their condition (even if it is not a choice you would endorse), acknowledge that they are making decisions and taking charge of their life.
Double-sided reflection
Empathising with the patient’s dilemma of self-care can also help the patient to explore choices. “What a dilemma you have, On one hand, you want to avoid the long-term consequences of diabetes, on the other hand, indulging in take-away food is one of the pleasures you have”.
Explore ambivalence
Ask the patient both the positive and negative aspects of changing and positive and negative aspects of not changing
Invite goals
As you explore the things the patient might do to self-care, ask him which one he would like to start with. When the patient has been frustrated in trying to accomplish his goal, ask him what he thought was blocking him. When discussing solutions for unblocking goals, invite the patient’s ideas about what might help
Ask-before-advise
Before giving information or advice, ask the patient what she knows, has already tried and wants to know.
Problem solving
When patients encounter challenges in carrying out self-management, invite their solutions and ask which one they would like to try first
Action planning
Collaboratively develop a plan for next steps in self-management that is specific and achievable. Check that patient confidence is “7” or higher.
Ask the patient about the plan made at the last visit
Ask the patient how the plan they made for care has been going since their last visit (with you or another clinician)

Handout 4: Skills descriptors 2