Table 1 EPSCALE tool score descriptors
EPSCALE | 0 | 1 | 2 | 3 |
|---|---|---|---|---|
Building the relationship | ||||
Respects patient | Shows no interest or concern OR is overtly offensive | Little interest and concern for patient’s well being | Some interest and concern for patient | Clear interest and concern for patient as a person |
Empathy | Ignores patient’s feelings and predicament | Minimal (only non-verbal) response to patient’s feelings and predicament | Some verbal response to patient’s feelings and predicament | Sensitive verbal and non-verbal response to patient’s feelings and predicament |
Uses appropriate non-verbal behaviour | No eye contact OR inappropriate non-verbal behaviour | Little eye contact OR some inappropriate non-verbal behaviour | Good eye contact, generally appropriate non-verbal behaviour | Good eye contact, substantial and appropriate non-verbal behaviour |
Providing the correct amount/type of information for the individual patient | ||||
Chunks and checks, using patient’s response to guide next steps | Gives long, uninterrupted speech | Occasional pauses but does not elicit patient’s response | Pauses, with some effort to gauge patient’s response before proceeding | Repeatedly chunks and checks, using patient’s response to guide next steps |
Assesses the patient’s starting point | No attempt to gauge patient’s starting point | Attempts to find out starting point but still gives info as prepared | Discovers starting point, some adjustment to info-giving | Discovers starting point and patient’s preference for amount of information, carefully tailor’s explanation |
Discovers what other information would help patient | No effort to discover what extra information would help | Little effort to discover or respond to patient’s info needs | Makes some effort to discover and address patient’s info needs | Carefully and repeatedly seeks and addresses patient’s needs |
Aiding accurate recall and understanding | ||||
Organises explanation | No organisation of explanation | Minimal organisation of explanation | Organises explanation, but no overt signposting/summarising | Organises explanation, with overt signposting/summarising |
Checks patient’s understanding | Does not check patient understanding | Minimal checking that patient has understood | Carefully checks that patient has understood | Asks patient to restate information given |
Uses clear language | Frequent use of unexplained jargon and confusing language | Some unexplained jargon and confusing language | Majority of language used clear (1–2 unexplained jargon words only) | Clear language used throughout |
Achieving a shared understanding: incorporating the patient’s perspective | ||||
Relates explanations to patient’s illness framework | No reference at all to patient’s ideas, concerns, expectations | Little attempt to relate explanation to patient’s ideas, etc. | Makes reasonable attempt to relate explanation to patient’s ideas, etc. | Sensitively relates explanation to ideas, etc. |
Encourages patient to contribute reactions, feelings and own ideas | No opportunities for patient to contribute | Limited opportunities for patient to contribute but no response | Several opportunities for patient to contribute with some response | Actively encourages patient to contribute and responds well |
Picks up & responds to patient’s non-verbal & covert verbal cues | No response to patient’s non-verbal and covert verbal cues | Minimal response to patient’s non-verbal and covert verbal cues | Some response to patient’s non-verbal and covert verbal cues | Sensitively responds to patient’s non-verbal and covert verbal cues |
Planning: shared decision making | Â | Â | Â | Â |
Explores management options with patient | No exploration of available options, only directives given | Offers options in cursory fashion | Carefully explores options with patient | Fully explores options and dilemmas, signposting position of equipoise or own preferences |
Involves patient in decision making | No involvement or resists involvement of patient in decision making, directives given | Makes suggestions rather than directives but limits patient involvement in decision making | Actively encourages patient involvement in decision making | Establishes level of involvement patient wishes in decision making: if appropriate, fully encourages patient to make choices & decisions |
Appropriately negotiates mutually acceptable action plan | Presents plan without checking with patient | Presents plan with cursory check for patient’s approval | Reasonable and appropriate negotiation of plan with patient | Full and appropriate negotiation of plan with patient; final agreement checked |