Learning to be the Patients’ Advocates: Evaluation of an Evidence-Based Communication Skills Course.

Introduction: A communication skills course to prepare nurses for their roles as patient advocates in the informed consent process was developed based on evidence from education and healthcare research, mostly from Western literature, tailored with evidence from the local context in South-East Asia. This study aimed to evaluate the course and to investigate factors influencing the application of the skills in the real setting. Methods: This was a mixed method study. Subjects were 32 participants who were ‗champions‘ (opinion leaders) at their home institutions. We used a questionnaire to measure the participants‘ reactions, pre/post/follow-up test to measure knowledge, and Focus Group Discussions (FGDs) to investigate the transfer and impact of the course. Results: Participants perceived the course to be helpful for learning. The post test showed increased knowledge and the follow up test indicated retention. FGDs showed participants‘ approaches to apply the skills in the informed consent process and different areas of practice. Factors influencing implementation were similar to previous studies. Conclusions: Despite strong contextual factors, a well-designed course underpinned with evidence can contribute to the desired improvement. Application of evidence from Western literature in South- East Asia should be tailored to the local context. A thorough needs assessment is necessary to explore the context.

Developing and validating a guideline on doctor-patient communication for Southeast Asian context.

Introduction: In Southeast Asia there is a big gap between the partnership style now desired by patients and the reality of actual practice, which reflects a more paternalistic style. Asian culture, with its hierarchical social system, less autonomy for members of society and less verbally explicit communication style contributes to this difference. This paper describes the development and validation of a guideline to help doctors in the context of the study to become more patient-centered. Method: To develop a guideline, we triangulated results from previous studies on doctor-patient communication with in-depth interviews with communication skills teachers at an Indonesian School of Medicine. To validate the guideline, we interviewed international experts who had conducted research on this subject in an Asian context. Results: Southeast Asian patients expect more partnership in their consultations. In this respect they do not differ from Western patients. Three other distinct issues emerged from the data. Firstly, the social and cultural context of their communities is very important for Southeast Asian patients compared with patients from the West who, on the whole have more autonomy. Secondly, much of the communication expressed by patients and their families with doctors is non-verbal compared with Western patients. Thirdly, traditional medicine still holds an important place. Conclusion: There is a shifting paradigm towards partnership communication during doctor-patient consultations in Southeast Asian context. Our guideline alienates the skills needed to consult effectively also tabulates what needs to be taught to young doctors in order to enhance their responsiveness to Southeast Asian patients. It builds on Western models of the consultation enriched with contextual examples.