113 Educating Patients: Creating Teaching Moments in Practice
CASE STUDY: MRS. JONES
Mrs. Jones is a 48-year-old Asian American female who is a new pa- tient at an ambulatory cancer clinic. She has stage two breast cancer, hypothyroidism, and relapsing–remitting multiple sclerosis. Mrs. Jones is at the clinic for a consult on management options, including surgery, chemotherapy, and radiation therapy. She is a homemaker with two chil- dren, ages 12 and 14, and is currently separated from her husband. Her sister has accompanied her to this appointment and has been helping her with the registration paperwork.
Question 1: What are some initial considerations going into the meeting with Mrs. Jones? What are some strategies that will promote rapport development and successful communi- cation? Commentary on question 1 : The environment should be calm, with adequate lighting and noise levels. Mrs. Jones wants to be addressed as Cathy. The use of empathy is impactful when seeking to develop a relationship with Mrs. Jones. Open-ended questions are import - ant and encouraging questions and dialogue will also build rapport. Plain language should be used, as should visual aids and written information. Effective communication skills such as active listening and clear speech are vital. Sitting at the same level as Mrs. Jones and being courteous and responsive while conversing will show respect. A new diagnosis such as cancer can be frightening and emotional for anyone. Mrs. Jones already has a chronic condition (multiple sclerosis), in addition to the cancer diagnosis and changes in family dynamics. This may be a potential barrier to readiness to learn, depending on how Mrs. Jones is currently coping. This is an area to investigate further. There is a red flag for health literacy in that Mrs. Jones had help with her paperwork. However, the help with her registration may be due to other factors, such as the familial re- lationship with her sister, stress and anxiety, or a language barrier. Health literacy assessment is required to determine Mrs. Jones’s health literacy level. There should also be exploration of Mrs. Jones’s culture and language. Her learning style must be assessed. Discussion of who she would like to be involved in her care is required. Mrs. Jones may even want her children included in some aspects, so planning for that future education can be done. During the initial communication with Mrs. Jones, she states that she wants her sister in- volved in her education and care. In the future she would like her children to have education as well as her estranged husband. Mrs. Jones says she is still processing her new diagnosis and is very afraid of dying. She states she really wants to learn but doesn’t want to get over- whelmed. Assessment shows that Mrs. Jones has a low level of health literacy and is an auditory learner. English is her primary language for learning. She also says that she wants to incor- porate complementary and alternative medicine into her care plan. Mrs. Jones uses some technology, such as the Internet for searches and her smartphone for texting and video chats. She does not use any apps, and feels she has minimal computer skills.
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