EXPLANATION

The original meaning of the word doctor was teacher. At one time the main role of the physician was to explain disease processes to patients and families.

“During my illness I was struck by the great need for information that both patients and their families had ... they often needed explanation again and again.” (Vicky Clement-Jones, a doctor and cancer patient)

«  Explanation is an essential part of good hospice and palliative care.

The aims of explanation are:

• To convey information

• To reduce uncertainty

• To increase trust

Clear explanation can be analgesic. For example, abdominal pains are more bearable when it is explained that they are due to constipation and not the spread of cancer. Any new symptom can be very frightening when you have cancer. Even explaining that it is part of the same disease process can make the situation feel more manageable.

In explaining, the following points are important:

1. Ask questions first

2. Categorize

3. Be simple and specific

4. Avoid jargon and euphemisms

5. Repeat (and get the patient to repeat)

6. Use diagrams

7. Use booklets and pamphlets

«  Information is not retained if the patient is anxious, frightened or naked.

«  Facts alone do not reduce fears. Explanation is only one part of reassurance. Fears have to be expressed before they can be worked through. (see Reassurance)

1. Ask questions first. The first step in explaining anything is to find out what the person already knows. This highlights misunderstandings and areas of ignorance, and also gives some ideas about a person’s belief system. Explanations have to take into account (and “fit”) a person’s deeply held beliefs.

Questions also help to clarify whether in fact the person wants any further information at all. Do not give unrequested information. It may cause anxiety or anger and is rarely helpful.

2. Explicit characterization ("I’m going to tell you two things. First, ...") provides a helpful framework and improves retention of the information.

3. It is important to be clear and simple. A person can rarely retain more than two to three new pieces of information at once. First words are remembered best.

4. Avoid jargon. Even words that become commonplace to the professional (catheter, injection, suppository) can be jargon. Assume nothing. We tend to make assumptions all the time about another person’s knowledge. It is safest to assume a person does not understand your words and you do not understand his.

5. Repeat important information. Repetition helps the memory but it is also a message that you think this information is particularly important. It helps to allow the patient to repeat the information if he wishes, to help confirm that your message was clear.

6. Diagrams can be very helpful in explanation. Drawings and pictures (for example, a diagram of where the tumor is inside him and what it is pressing on) can be given to the person to keep, and this can sometimes help a person to feel more in control of the situation.

7. Booklets and pamphlets giving concise explanations or general information can be very helpful. These can reinforce a discussion, improve compliance, and increase patient satisfaction. (see Prescribing)

«  Find out what the patient wants to know.

«  Avoid giving unrequested information. (see Advice)

«  Explanation of important information may need to be given to the whole family. (see Breaking Bad News, Communication Problems)

The author and publisher have taken precautions to ensure that the information in this book is error-free. However, readers must be guided by their own personal and professional standards of good practice in evaluating and applying recommendations made herein. The contents of this book represent the views and experience of the author, and not necessarily those of the publisher.