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