Centre for Patient Communication
The Centre for Patient Communication is tasked with inspiring and contributing to the cultural, developmental and research activities that promote communication amongst patients, caregivers and healthcare professionals, with the aim of increasing the health literacy and vitality of the individual patient.
Based on interdisciplinary research on patient communication, the centre will breathe life into this research in close dialogue with patients, caregivers and healthcare professionals. Applying systematic implementation research, the centre will work to ensure that successful projects are subsequently put to use in the clinic.
The research is based on the research programme 'Healing Patient Communication - Relationships in Motion'. This programme builds on the assumption that, through specific communication initiatives, we can support the natural healing processes, thus helping to increase the vitality of the individual.
The aim is to ensure that the individual patient has the best possible life and level of activity.
Cure and healing
Our research is inspired by approaches utilised in health research and health communication, which unite the original two aspects of patient care: cure and healing
- Cure focuses on activities related to diagnosing and curing diseases and/or symptoms and achieving the best possible survival rates
- Healing focuses on activities aimed at helping the patient return to their own healthy life - with the highest possible level of health and well-being (1)
Our assumptions and hypotheses are particularly inspired by the 'Whole Person Care Programme’ at McGill University in Montreal, which has worked for several years to unite the two approaches.
This approach to patient care focuses on understanding the balance between what the disease does to the body and what it does to the patient (2).
This means that a healthcare provider should be able to handle both approaches in order to provide holistic patient care.
Our work is based on the hypothesis that if we combine the two approaches (cure and healing), we will be able to free up resources for patients, relatives and staff, which will promote healing.
In this context, healing can be understood as practices aimed at helping the sick person return to the highest possible level of well-being (1).
The effect of this approach on the tasks and roles of the health service is that health professionals are today expected to manage cure-related communication and - ever increasingly - to take responsibility for healing-related communication.
These methods cannot be standardised because they require skills that must be learned individually, with a focus on teaching healthcare providers to understand themselves, their feelings and their reactions so that they can apply them when caring for the patient (3). It is also important that they are aware of and acknowledge their own mortality and have a clear understanding of this concept(4). To prepare healthcare providers for this task, they need systematic training in skills such as active listening, self-reflection and awareness of their own non-verbal language, etc. (5-7).
“Physicians need to manage professional and personal stress to maintain their own health and well-being and to maximise their ability to provide quality health care to their patients” Derek Puddester (8)
Since 2007, we have initiated a number of research projects aimed at improving the communication skills of healthcare professionals (9, 10) and increasing the benefit to patients from the communication (11-13). For instance, we have developed a communications programme that includes training in communication skills for all employees at Lillebælt Hospital who have contact with patients (14). Around 3,500 staff have participated in the programme, which has increased staff self-efficacy and significantly improved their attitude towards involving patients (15).
Based on a randomised study of 4,349 patients, we have shown that patients given the chance to listen to recordings of their consultations again are more likely to feel satisfied with the level of information provided and the level of involvement in their treatment. They are more satisfied with the treatment and their relationship to the staff (16, 17). This study has led to further development of the technology and the launch of an implementation study involving patients from both Lillebælt Hospital and Odense University Hospital.
At the same time, we are working to identify patient needs (18, 19), develop coaching methods, (20, 21) and to develop and validate tools to monitor the impact (22, 23).
Dissemination and cooperation
Our research on communication has inspired colleagues, both in Denmark and abroad, to test and/or implement similar interventions, for example at hospitals in Region Zealand, a department at Rigshospitalet, University of Copenhagen, care centres in Sønderborg Municipality, Helse Bergen in Norway and Confluence Health Central Washington Hospital in the USA.
In addition, we are working on further development and dissemination of research in cooperation with our partners in Interreg Project Prometheus http://prometheus.care/ , as well as with other partners such as
the Research Unit for General Practice, University of Southern Denmark, the Centre for Innovative Medical Technology (CIMT), Odense University Hospital/University of Southern Denmark, Deakin University, Australia, and the International Association for Communication in Healthcare (EACH)
We also collaborate closely with the Danish Society of Communication in Healthcare http://sundhedskommunikation.nu/ . In addition, the Centre for Patient Communication continually highlights communication in its role as organiser of the biannual 'Art of Communication' conference at Hindsgavl Castle http://kunstenatkommunikere.dk/ and at the annual Vejle Symposia http://vejlesymposier.dk/.
Research in healing
Medical research is still primarily based on the biomedical mindset. Therefore, knowledge about the physiological effects of interventions with a holistic approach to patient care is limited.
However, the effect of patient-centred communication is now rather convincing when the overall goal is well-being(24-26). Many recent studies have ascertained the physiological effects of communication interventions based on very specific endpoints, including a long-term reduction in blood sugar, improved immune response and shortened duration of the illness (21, 27-31). Similarly, other studies indicate that elements such as trust, respect, exploration of the patient's values and positive reports about treatment, as well as providing reassurance and encouragement can help activate placebo-like effects that may supplement and, in some cases, even replace medical treatment (32, 33). These are causal relationships that can be partly explained by better treatment compliance, combined with a greater sense of control and satisfaction on the part of the patient (34, 35).
It also seems that the importance of and capacity for attachment plays a significant role. Recent studies have shown that a capacity for attachment - or lack thereof - can significantly affect the way symptoms are experienced and the extent of the stress reaction that often accompanies an illness (36-38). At the same time, it is assumed that the physiological response activated while under stress, and the impact it has on our immune system when stress is prolonged, may predispose patients to disease, or exacerbate medical conditions (39). Stress is defined as the individual experience of uncertainty about what can be done to protect physical, mental or social well-being (39). Animal research studies confirm these findings, as they have been able to demonstrate that less solicitous care may lead to gene expression of stress and arteriosclerosis (40, 41).
The Centre for Patient Communication’s research programme
Our current research programme, 'Healing Patient Communication - Relationships in Motion', is based on this knowledge and previously achieved results. The overall goal of the programme is the cure/well-being of the patient, and its aim is to support sick people on their road to maximum well-being - be it physical, psychological or social. To meet this goal, we will:
- Optimise healthcare providers’ skills in healing communication in order to strengthen their abilities to facilitate processes for optimisation of patients' well-being and healing.
- Develop, evaluate and implement methods and technical solutions to support patient and family engagement in communication with the healthcare system and in their own healing process.
This research plan consists of several independent projects, linked by an iterative research process based on Participatory Action Research (PAR) (42).
The link between individual focus areas and projects and the way in which they each contribute to the overall objective is illustrated below:
Within the four main focus areas (outlined on the left), there are five different research topics: patient experiences, mindful practice, data-guided health coaching, recordings of conversations and body and movement. The specific sub-projects related to these topics are also outlined. Sub-projects aim either to explore (E) or intervene (I) in relation to the overall objective.
There are examples of the endpoints related to the focus areas on the right-hand side of the figure.
Projects range from basic research, including hypothesis-generating studies and methodology development, to intervention and implementation studies.
The Centre for Patient Communication is a strategic research initiative based at Lillebælt Hospital.
The centre is organised under the Health Services Research Unit, and managed by the Head of Research, Professor Jette Ammentorp.
The Health Services Research Unit is an interdisciplinary unit at Lillebælt Hospital, affiliated with the Department of Regional Health Services Research, University of Southern Denmark.
An International Advisory Board - 'Healing Health Communication' - has been established for the research programme, and a User Panel has been set up for the Centre for Patient Communication.
“Perhaps the real goal of medicine should be to support patients in their healing journey, to help patients move towards life with a greater sense of connection and meaning, and a new relationship to wounding and suffering” Tom Hutchinson (43)
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