Communication skills include both verbal and non-verbal messages that people use when interacting with others. Nobody likes to be sick, and when some people are, they can be quite difficult to deal with since it becomes a barrier to communication. Healthcare professionals need excellent communication skills when dealing with difficult patients. Using effective communication skills makes it much easier to accomplish such tasks as obtaining medical histories, performing physical examinations and administering treatments. Take into account your patient’s cultural background when communicating with them, whenever possible. In the end, as healthcare professionals, we must put ourselves in the other person’s place when communicating with them and try to understand why they are behaving the way they are and what we can do to help them feel a little better. Finally, continue to look around this website for other ways to learn to improve your communication skills and the keys for effective communication. Your website is nice and helpful especially to medical students because the communication skills can be applied to patients and other aspects of life. While nurse-to-patient communications is vital, the same could be said for nurse-to-nurse communications.
Original Editor - Your name will be added here if you created the original content for this page. According to the HCPC it is the responsibility of all healthcare professionals to interact effectively with patients and service users [1]. To highlight the need for ongoing communication skill development for AHPs and provide a resource which can be used to facilitate this process. This package is designed to help all Allied Health Professionals improve and develop their communication skills. According to the Mental Health Foundation, in any given year one in four people will experience a mental disorder[4]. The World Health Organization reports that in 2008, over 1.4 billion adults over the age of 20 were considered overweight or obese [13].
Effective communication between AHPs and patients is essential and can influence the effectiveness of any conversations regarding weight loss  [16]. A lack of knowledge and skill in relaying information about terminal illness and death is a major barrier to effective communication between AHPs and terminal patients [23]. Sexuality and intimacy are components of patients lives which are often avoided, overlooked and under-treated when rehabilitating patients.[27]Sex is a topic of conversation which is commonly avoided both by health professionals and patients as many people are not comfortable discussing sexual issues openly. The traumatic nature of situations in which healthcare professionals often become involved may cause interactions with patients and their loved ones to become fraught with tension [32].
It is commonly thought that physician- patient communication within the NHS has been generally adequate and of no cause for concern. The way in which health practitioners communicate information to patients is as important as the information being communicated [41].
The choices of questions, words, silences, tones and facial expressions used by the clinician can greatly influence their relationship with a patient.
Motivational interviewing (MI) is a cognitive-behavioural technique, which aims to help patients identify and change behaviours that may be putting them at risk of developing health problems or may be hindering the management of an ongoing condition [44]. Expressing empathy – by demonstrating empathy, a real and understanding picture is conveyed of what the person is going through. Rolling with resistance – a skillful technique that can help change a persons’ perspective. Some examples of these can include praising an obese patient that has lost weight or by asking a patient what they can achieve, or what they’d like to achieve from their overall goal [45]. Assess readiness to change – Assessing their eagerness to change, will give an insight into their level of motivation. The delivery of bad news is a difficult challenge when working in health care environment, especially with established patient friendships and family involvement. A study was conducted on a patient population with a terminal illness; they interviewed the patients regarding the first diagnosis of their illness[47].
Primarily the AHP should have the basic level of communication skills to use with their patient.
An effective strategy to respond to the important implications mentioned above is the recruitment of the SPIKES communication approach. As previously stated, zero tolerance or any form of physical restraint in VAB situations is only going to result in an escalation of conflict in the healthcare environment[50].
A major barrier to the above interventions is that often in these situations a stand-off can occur between the individual and the AHP.
Critical Conversations provides direction and solutions for deficits in healthcare that exist in verbal and non-verbal communication as well as scripting tool kits that can be applied in various situations and health care settings between nurses and colleagues and nurses and patients. OR Manager does not accept returns for any of the OR Manager books and special reports. These messages can include such things as words, phrases, facial expressions, sign language, body language, gestures and voice tones. This is because they help to build and maintain strong relationships between both healthcare professionals and patients, and healthcare professionals and their associates. Nobody likes to feel ignored and patients and their families can become quite upset if they feel they are not being heard or attended. Make sure that if you hold a patient’s hand in sympathy, for example, that it is not considered an inappropriate gesture in his or her culture.
My name is Melissa and I have built this website to help you improve your communication skills.
Allied Health Professionals (AHPs) use communication as a primary tool for gathering information in order to diagnose, counsel, rehabilitate and build a therapeutic alliance with patients [2]. Allied health professionals may treat patients with mental disorders as a primary condition or part of multiple co-morbidities [5]; [6]. There is a recognized need to discuss obesity with patients to promote health and well being, however, many AHPs are often uncomfortable communicating the need for weight loss to their patients [15] [16]. A focus group of physicians identified negative stigma and insufficient knowledge as major barriers to initiating the weight loss conversation, as well as frustration, lack of counselling skill and time constraints [15].
Student AHPs reported that discussing issues regarding terminal illness with patients to be difficult and uncomfortable, stating they lacked the appropriate communication training [24].
It is common in these situations for frustration, anxiety, uncertainty and helplessness to escalate into more aggressive and dangerous behaviours [32]; [33]. Patients have two fundamental needs in terms of communication, the need to know and understand and the need to feel known and understood [42]. The misuse of these interpersonal and communicative skills can become barriers not only to physician-patient relationship but also to the effectiveness of the treatment.The image below represents a number of barriers which may be experienced.


MI is to understand the patients perspective, accepting their motivation, or lack of motivation for changing and helping them find solutions to change [45].
Ideas should be offered, but not imposed, and statements can be lightly challenged but not argued [44]. Breaking bad news such as a poor prognosis, diagnosis, recurrence or transition to terminal care require a higher level of communication to ensure both patient and healthcare worker understand and deal with the circumstances appropriately.
The study focused on what the patients remembered to be an effective communication strategy recruited by their healthcare provider.
SPIKES[48] (table 1.), is specifically designed to deal with breaking bad news to terminally ill patients. As such the practise of avoiding interaction with individuals exhibiting VAB is more of a protective strategy for staff than a resolution for the developing issue[51]. Before physical restraint is used to ensure the safety of everyone proximal to the scene, a coordinated team effort should be made to calm the individual down, as a demonstration of team unity protects individual AHPs from being singled out and has been shown to effective in getting VA individuals to back down [53]. By using the SBAR, all staff have the opportunity to find out previous medical assessments and recommendations from other healthcare professionals, collated in one place rather than having to seek relevant information from individuals previously involved in the patients’ healthcare.
X was diagnosed with stage II nasopharyngeal cancer with lymph node metastasis three years before a readmission to hospital following poor health. Exploring barriers to primary care fo patients with severe mental illness: frontline patient and provider accounts.
Management of patients with mental health needs: Debbie Goode and colleagues assess whether staff are prepared to offer person-centred care to all people who present to emergency departments. Self-harm: The short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care. Physiotherapists' perceptions of their role in the rehabilitation management of individuals with obesity. Obesity: Guidance on the prevention, identification,assessment and management of overweight and obesity in adults and children.
A coping and communication support intervention tailored to older patients diagnosed with late-stage cancer.
Health care professionals' death attitudes, experiences, and advance directive communication behavior.
When and how to initiate discussion about prognosis and end-of-life issues with terminally ill patients.
A communication skills intervention for community healthcare workers: Perceived patient aggression is reduced.
A Safer Place to Work: Protecting NHS Hospital and Ambulance Staff from Violence and Aggression. Patient and visitor violence in the general hospital, occurrence, staff interventions and consequences: a cross?sectional survey. Reproduction in whole or in part in any form or medium without expressed written permission of Access Intelligence, LLC is prohibited. Some of them are even unwillingly brought to healthcare facilities by their family or friends. When medical personnel know how to communicate well with patients, they can better achieve their goal of treating and helping them. If you were unable to do as you had promised, then give them an explanation why it was not possible or ideal for their situation. This is especially so if a patient’s diagnosis is more complicated and harder to understand.
I usually hate going to hospitals or clinics because the nurses will just do things to me without explaining why or what they were doing.
AHPs that incorporate effective communication techniques into interactions with patients are able to enhance patients’ health outcomes and satisfaction [3].
Individuals with mental health disorders are more than twice as likely to have other chronic co-morbidities, such as diabetes, pulmonary disease and cardiovascular disease [5] [7] [8].
General practitioners (GP) are often in the front line of patient contact, however, only 42% of overweight patients are advised by their GP to lose weight [15]. Negative stigma, also referred to in this context as weight stigma, exists between AHPs and obese patients with the perception that they are unable or unwilling to change their behaviours because they do not possess self-control [17][18]. Therefore, it is evident that conversations about terminal illnesses should not be avoided to improve patient anxiety and acceptance regarding their condition.
The study examined students with formal training in communicating terminal illness and found these students were more confident in addressing these sensitive issues [24]. Research suggests that verbal and physical violence in healthcare settings has not only become common, but has become an accepted part of certain healthcare professions, particularly for emergency department (ED) nurses [34]. These approaches are in accordance with zero tolerance policy, but have been demonstrated to be ineffective in combating VAB[37]. The onus of these complaints has been predominantly put on the breakdowns in communication and lack of satisfactory bedside manner of healthcare professionals. AHPs not trained regarding the correct communication strategy to use when delivering bad news may cause a patient to distort information, become overly optimistic and recruit a state of denial. Four main themes emerged from the qualitive study which the patients regarded as an important approach to breaking the news. The patient’s emotions should be addressed with an empathic, validated and clarified response. This protocol addresses issues such as a poor diagnosis, prognosis, and return of an illness, conversion to terminal care or even a medical error. An audio recording of a healthcare worker breaking bad news to a fictional patient was used. Current research demonstrates that the most sound strategy for de-escalation of VAB involves early identification of potentially volatile situations and the use of effective interpersonal skills to talk down the individual in question[50].
The second admission to hospital concluded the cancer had spread to his lungs and liver resulting in a poor prognosis. Therefore, healthcare providers must be equipped to treat patients with mental illness in a variety of settings including outpatient, inpatient and community [5] [6].
Therefore, more than half of the patients that would benefit from a weight loss conversation do not get the assistance they need from their healthcare provider. Furthermore, many AHPs believed that managing obesity was the responsibility of the patient and was not necessary to have medical intervention [19]. Therefore, education can positively influence an AHPs self-efficacy with regards to initiating conversations with patients about their terminal illness. While a probable explanation for this phenomenon is that ED staff deal with the most urgent and serious medical incidents, it has been shown that they are not isolated in their exposure to violent and aggressive behaviours (VAB) [34]. Communication using de-escalation strategies were found to be much more effective in coping with patients who are becoming aggressive [37].


Efficiently imparting information is therefore crucial to patient understanding and compliance.
The AHP may not deliver the news effectively to avoid causing the patient upset, or because the AHP is worried about being blamed for the treatment not having worked. This strategy has also proven to provide the healthcare messenger with an increased confidence in their ability to address negative information with their patient.
The recording where the SPIKES strategy was recruited was favoured by the patients, and popular aspects of the recording were noted.
These interpersonal skills consist of verbal and non-verbal communication of a willingness to collaborate with the aggrieved individual in search of an alternate solution to the current problem[52]. AHPs, especially those that work autonomously, cannot afford to shy away from sensitive issues when interacting with patients as they may miss key information or an opportunity to help the patient further [2]. However, individuals with mental health disorders still face inequalities with access and quality of healthcare compared to the general population, despite their increased needs [7]. This perception predisposes the AHP to be less active in the provision of weight-loss conversations as well as in counselling the patient on how to change their behaviours [19]. One study [35] found that 22% of radiographers, 19% of doctors, 10% of occupational therapists and 17% of physiotherapists had been assaulted within the last year. However, barriers such as fear, frustration, empathy and lack of skill or knowledge prevent AHPs from communicating with disgruntled patients[32]; [33].
Research has identified a number of key elements of communication as being fundamental to building patient-physician relationships. The healthcare provider use the approach to plan communicating the news in the best way, which holds a reflective role to reduce anxiety or fear for the AHP. The patients favoured how the healthcare providers using the strategy addressed the patient’s emotions; the empathetic response of the AHP was also valued by the patient. It is worth noting that these strategies place increased cognitive demand on AHPs working in an already demanding environment – a conscious decision must be made to address the developing situation before it gets out of hand. Our in-service training package was designed to aid AHPs in developing effective communication skills which can translate to difficult situations that may arise in their own healthcare setting.
All healthcare providers, especially those working autonomously, should be able to effectively communicate with patients about mental illness to ensure that the patient is receiving adequate care and is referred on to the appropriate care pathway [9].Providing treatment and care for patients suffering from mental disorders is emotionally demanding and requires a high level of communication [10].
AHPs with insufficient knowledge about weight loss methods or techniques feel uncomfortable approaching the conversation and tend to avoid it completely [18]. According to an interview conducted by Curtis and Patrick, one physician identified this barrier as, “an elephant in the room that you do not want to talk about”[26].
Although the UK government has introduced a zero tolerance policy towards VAB in all NHS settings, the incidence has only increased[36]. A survey of 64 AHP students found that more than half were involved in an incident of VAB, with 94% stating they did not feel adequately prepared to handle such a situation[38].
With these substantial influences on patient health outcomes, the importance of effective communication is further highlighted. These include verbal and non verbal communication, empathy, patient centred care, efficient transmission of information, good rapport, and collaborative and patient centred care [43]. The SPIKES approach is a short, suitable to all conditions approach, which is easy to understand and follow.
The AHP’s guidance and knowledge of future planning options was also presently addressed, not over-loading the patient with information or using confusing medical terms.
This includes understanding the benefits of effective communication, identifying barriers to initiating communication and selecting appropriate techniques to enhance communication. Aggression, confusion, and suicidal and self-harming behaviours are common symptoms of mental illness which AHP’s have reported as challenging to communicate about with patients [5] [6] [11]. In this case, AHP's may advise the patient that they may want to consider losing weight and give them pamphlets on obesity, however the conversation often never takes place [18].
Whether it is AHP discomfort or attempts to protect the patient, ambiguous statements regarding terminal illness can result in negative psychological consequences [21]. Therefore, there is a need for all AHPs to acquire the skills to de-escalate and cope with violent and aggressive patients and their family members.
Empathy is a barrier to communication often overlooked when dealing with violent or aggressive patients [32]. The AHP’s ability to address positive strengths for that individual patient was also acclaimed.
A study investigating the management of patients with mental health disorders found that a healthcare provider's perception of a patient as a possible ‘time waster’ affected the quality of care that the patient received [9].
The AHPs own perceptions of their weight will influence their willingness to part-take in a weight loss conversation [20]. Therefore, AHPs should strive to fully inform patients about their condition and prognosis, to allow the patient and their families to cope with and accept their situation[21].
Although some factors leading to aggressive behaviours are within the patients control, such as alcohol consumption, many environmental factors can cause anxiety, helplessness and frustration which can make the patient more prone to aggression[32].
A study on the challenges of treating mental health comorbidities in acute settings found that even if a practitioner was formally educated on mental illness, they were not immune to feelings of negative stigma towards patients [5]. A survey of 500 physicians found that those with a BMI between 20-25, what is considered normal, were more likely to initiate a weight loss conversation [20]. Therefore, professionals dealing with aggressive patients must be sensitive and empathetic to any environmental factors. The inability of healthcare providers to empathise with patients, especially with those having self-harming behaviours, was another major barrier to effective communication [7] [11]. Finally, patients and AHPs often believe that the current weight issue occur from different causes and this can be a source of frustration when trying to initiate behavioural changes [18]. Strensrud, Mjaaland and Finset analysed questionnaires sent to GP’s to rate their confidence in communicating with patients suffering from severe mental illness[12].
It was found that empathy was scored very low on self-appraisal and very high in areas which they believed specific training was necessary [12]. Time constraints, lack of knowledge about mental illness and frustration were also found to contribute to ineffective communication between patient and healthcare provider [5] [9] [11]. A study investigating the management of patients with mental health disorders found a consensus from the AHP’s that their needs to be formal training in communicating with patients who have mental health disorders in order to help healthcare staff provide better care for their specific needs [8]. In summary, the negative stigma associated with mental illness appears to be a major barrier to effective communication and treatment for this population.




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