Via Research Recognition Day 2024 VCOM-Carolinas

Educational Reports

DRAI 2 Ned Q&A: A New Approach to Patient Counseling Gabrielle Aluisio, OMS-II; Alison Schultz, OMS-II; Tom Lindsey, DO Edward Via College of Osteopathic Medicine, Carolinas Campus, Spartanburg, SC.

Abstract

Results

Conclusions

As medical education evolves to meet the demands of contemporary healthcare, there is a growing need for innovative frameworks and materials to facilitate learning. This includes medical acronyms designed to expedite providers’ recall of necessary aspects of care when devising a patient’s treatment plan. However, current acronyms that are taught in medical education, such as MOTHRR, lack a patient-centered and empathetic approach. Thus, there is a need for the development of an acronym that integrates established successful patient satisfaction methods published in literature into comprehensive patient counseling. Goal: To develop a comprehensive medical acronym tailored for medical education, aiming to enhance the efficiency and empathy of a patient-centered diagnosis. We compiled a list of essential components required for effective patient communication to establish a thorough diagnosis and care plan. This list was then cross-referenced with existing medical acronyms. We performed a literature search and reviewed articles discussing methodologies that prioritize patient satisfaction during the counseling process. Our investigation of existing acronyms confirmed the absence of a patient-centered approach. Based on our analysis of successful patient interactions, we created the acronym “DRAI 2 Ned Q&A”, which adheres these proven methodologies while also incorporating the essential components for a comprehensive diagnosis. To effectively conduct a literature review and to compose an effective acronym, we first compiled a list of criteria that students at Edward Via College of Osteopathic Medicine (VCOM) are expected to inform their patients in the counselling portion of their standardized patient encounters. This list is as follows: ● Pertinent findings: ○ Presenting symptoms; findings from physical exam, labs, imaging studies ○ Negatives to rule out differential diagnoses ○ Etiology of their disease ● Admission to hospital/next steps: ○ Labs and/or imaging to be ordered ○ Medications that will be continued, stopped, or added ○ Consultations ● Humanism: ○ Ex: “Do you have insurance?” “Do you have someone here I can speak to about your diagnosis and plan?” ○ Questions We then performed a literature review to identify any existing acronyms that focused on patient centered counselling in medical education. This yielded no identifiable acronyms. We identified an acronym, ABCDE, that discussed the emotional aspect of delivering bad diagnoses, but did not focus on the objective facts of the patient’s condition or discuss methodologies to patient satisfaction (3). This further propelled our commitment to creating an acronym to fill this void. We directed our research to identify published methodologies to improve patient satisfaction and provider communication when a dismal diagnosis is given. We first identified SPIKES, an acronym that focuses on the patient’s perception of their diagnosis (1). It incorporates empathy but also reminds the physician to prioritize the patient’s understanding and feelings rather than emotionally overloading the patient. It ends by ensuring a tangible plan of action is made. Additionally, we analyzed the article “Delivering bad news to patients” which isolates the physician’s discussion of a bad diagnosis with their patient into stages, or phases (2). It discourages the physician from using emotion-centered approaches, but instead talking the patient logically through each component of their diagnosis and care moving forward. We aligned their criteria together and formulated a logical flow on which we synthesized our acronym, adding in our list of inclusion criteria. Methods We suggest that “DRAI 2 Ned Q&A” should be incorporated into medical education, such as Standardized Patient encounters, to improve provider counseling techniques and patient satisfaction.

Our acronym, DRAI 2 Ned Q&A, satisfies the hypothesis of the project, as it 1) includes all components listed for successful patient counseling at VCOM and 2) follows the methodologies established in literature to increase patient satisfaction upon counseling. DRAI 2 Ned Q&A may improve provider-patient interactions by providing medical students early on with a patient-centered, yet comprehensive, framework as they counsel standardized patients. It is an ideal candidate to be implemented into medical curriculum to prepare students for future patient interactions as a practicing physician. Limitations include scope of patient population and time constraint. Although we followed prevalent medical methodologies for delivering bad news, we acknowledge that this approach may not be optimal for everyone and may not apply to every diagnosis. An additional limitation may be time constraint, as practicing physicians may not be able to thoroughly address each component, leading to less than optimal patient satisfaction. This could be addressed by discussing DRAI 2 Ned Q&A with practicing physicians in South Carolina in terms of practical applicability to counsel patients. We plan to assess the efficacy of DRAI 2 Ned Q&A among OMS-I students at the Edward Via College of Osteopathic Medicine (Carolinas Campus). This will be done by comparing patient satisfaction/humanism scores during standardized patient encounters between previous encounters and those utilizing DRAI 2 Ned Q&A. If DRAI 2 Ned Q&A is proven to enhance patient satisfaction and deemed applicable to real world scenarios, it would provide health care professionals with a memorable acronym that is entirely comprehensive and patient-centered. Our ultimate goal is to integrate DRAI 2 Ned Q&A into curricula of medical schools, specifically for standardized patient encounters.

Figure 1 . DRAI 2 Ned Q&A Components and Explanation

DRAI 2 Ned Q&A is designed as an medical education acronym, combining essential components requisite for optimal efficacy in patient communication. Figure 1 explains each component, providing a comprehensive explanation of its scope.

Figure 2 details the components of two commonly employed methodologies in medical education for systematically delivering distressing information with empathy. SPIKES, a widely recognized acronym, is crafted for communicating distressing information, particularly for cancer patients [1,2]. Additionally, “How to Break Bad News: A guide of Healthcare Professionals” outlines five phases that physicians can follow to prepare for and deliver challenging information[3]. While these methodologies share a focus on the process of delivering bad news, it is important to note that they do not prescribe specific content for communicating with the patient.

References

1. Kaplan M. (2010). SPIKES: a framework for breaking bad news to patients with cancer. Clinical journal of oncology nursing , 14 (4), 514 – 516. https://doi.org/10.1188/10.CJON.514-516 2. Monden, K. R., Gentry, L., & Cox, T. R. (2016). Delivering bad news to patients. Proceedings (Baylor University. Medical Center) , 29 (1), 101 – 102. https://doi.org/10.1080/08998280.2016.11929380 3. Rabow, M. W., & McPhee, S. J. (1999). Beyond breaking bad news: how to help patients who suffer. The Western journal of medicine , 171 (4), 260 – 263.

Figure 2 . Components of patient communication methodologies compared to DRAI 2 Ned Q&A

We’d like to thank Dr. Tom Lindsey and Mrs. Stacey Stokes for their support, guidance, and valuable feedback. Thank you to VCOM for providing us with resources we need to conduct our project. This work is exempt from IRB as we have not collected any data.

As shown in Figure 2, DRAI 2 Ned Q&A is composed of crucial information for patient communication. The outlined components align with the steps specified in both the SPIKES and How to Break Bad News frameworks.

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2024 Research Recognition Day