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Table 1 EPSCALE tool score descriptors

From: A realist evaluation exploring simulated patient role-play in pharmacist undergraduate communication training

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     
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