INITIATING THE SESSION Establishing initial rapport 1. Greets patient and obtains patients name 2.

Introduces self, role and nature of interview; obtains consent if necessary 3. Demonstrates respect and interest, attends to patients physical comfort Identifying the reason(s for the consultation 4. Identifies the patients problems or the issues that the patient wishes to address with appropriate opening !uestion (e.g. !hat problems brought you to the hospital"# or !hat would you li$e to discuss today"# or !hat %uestions did you hope to get answered today"#& '. "istens attentively to the patients opening statement, without interrupting or directing patients response (. #onfirms list and screens for further problems (e.g. so thats headaches and tiredness; anything else))"#& *. Negotiates agenda ta$ing both patients and physicians needs into account GATHE$ING IN%O$&ATION E'ploration of patient(s problems +. Encourages patient to tell the story of the problem(s& from when first started to the present in own words (clarifying reason for presenting now& ,. )ses open and closed !uestioning techni!ue, appropriately moving from open to closed 1-. "istens attentively, allowing patient to complete statements without interruption and leaving space for patient to thin$ before answering or go on after pausing 11. %acilitates patient.s responses verbally and non/verbally e.g. use of encouragement, silence, repetition, paraphrasing, interpretation 12. *ic+s up verbal and non/verbal cues (body language, speech, facial e0pression, affect&; chec+s out and ac+no,ledges as appropriate 13.#larifies patients statements that are unclear or need amplification (e.g. 1ould you e0plain what you mean by light headed2& 14. *eriodically summarises to verify own understanding of what the patient has said; invites patient to correct interpretation or provide further information. 1'. )ses concise, easily understood !uestions and comments, avoids or ade%uately e0plains 3argon

1(. Establishes dates and se!uence of events Additional s+ills for understanding the patient(s perspecti-e 1*. 4ctively determines and appropriately e'plores5 6 patients ideas (i.e. beliefs re cause& 6 patients concerns (i.e. worries& regarding each problem 6 patients e'pectations (i.e., goals, what help the patient had e0pected for each problem& 6 effects5 how each problem affects the patients life 1+. Encourages patient to e'press feelings *$O.IDING ST$)#T)$E &a+ing organisation o-ert 1,. Summarises at the end of a specific line of in%uiry to confirm understanding before moving on to the ne0t section 2-. 7rogresses from one section to another using signposting/ transitional statements; includes rationale for ne0t section Attending to flo, 21. 8tructures interview in logical se!uence 22. 4ttends to timing and $eeping interview on tas$ 0)I"DING $E"ATIONSHI* )sing appropriate non1-erbal beha-iour 23. Demonstrates appropriate non2-erbal beha-iour 6 eye contact, facial e0pression 6 posture, position 9 movement 6 vocal cues e.g. rate, volume, tone 24. :f reads, writes notes or uses computer, does in a manner that does not interfere ,ith dialogue or rapport 2'. Demonstrates appropriate confidence De-eloping rapport 2(. Accepts legitimacy of patients views and feelings; is not 3udgmental 2*. )ses empathy to communicate understanding and appreciation of the patients feelings or predicament; overtly ac+no,ledges patient3s -ie,s and feelings 2+. *ro-ides support5 e0presses concern, understanding, willingness to help; ac$nowledges coping efforts and appropriate self care; offers partnership 2,. Deals sensiti-ely with embarrassing and disturbing topics and physical pain,

including when associated with physical e0amination In-ol-ing the patient 3-. Shares thin+ing with patient to encourage patients involvement (e.g. !hat :m thin$ing now is....#& 31. E'plains rationale for %uestions or parts of physical e0amination that could appear to be non;se%uiturs 32. <uring physical e'amination, e0plains process, as$s permission E4*"ANATION AND *"ANNING *ro-iding the correct amount and type of information 33. #hun+s and chec+s5 gives information in manageable chun$s, chec$s for understanding, uses patients response as a guide to how to proceed 34. Assesses patient(s starting point5 as$s for patients prior $nowledge early on when giving information, discovers e0tent of patients wish for information 3'. As+s patients ,hat other information ,ould be helpful e.g. aetiology, prognosis 3(. Gi-es e'planation at appropriate times5 avoids giving advice, information or reassurance prematurely Aiding accurate recall and understanding 3*. Organises e'planation5 divides into discrete sections, develops a logical se%uence 3+. )ses e'plicit categorisation or signposting (e.g. =here are three important things that : would li$e to discuss. 1st...# >ow, shall we move on to.#& 3,6 )ses repetition and summarising to reinforce information 4-. )ses concise, easily understood language, avoids or e0plains 3argon 41. )ses -isual methods of con-eying information5 diagrams, models, written information and instructions 42. #hec+s patient(s understanding of information given (or plans made&5 e.g. by as$ing patient to restate in own words; clarifies as necessary Achie-ing a shared understanding5 incorporating the patient(s perspecti-e 43. $elates e'planations to patient(s illness frame,or+5 to previously elicited ideas, concerns and e0pectations 44. *ro-ides opportunities and encourages patient to contribute5 to as$ %uestions, see$ clarification or e0press doubts; responds appropriately 4'. *ic+s up -erbal and non1-erbal cues e.g. patients need to contribute

information or as$ %uestions, information overload, distress 4(. Elicits patient3s beliefs/ reactions and feelings re information given, terms used; ac$nowledges and addresses where necessary *lanning5 shared decision ma+ing 4*. Shares o,n thin+ing as appropriate5 ideas, thought processes, dilemmas 4+. In-ol-es patient by ma$ing suggestions rather than directives 4,. Encourages patient to contribute their thoughts5 ideas, suggestions and preferences '-. Negotiates a mutually acceptable plan '16 Offers choices5 encourages patient to ma$e choices and decisions to the level that they wish '2. #hec+s ,ith patient if accepts plans, if concerns have been addressed #"OSING THE SESSION %or,ard planning '3. #ontracts with patient re ne0t steps for patient and physician '4. Safety nets, e0plaining possible une0pected outcomes, what to do if plan is not wor$ing, when and how to see$ help Ensuring appropriate point of closure ''. Summarises session briefly and clarifies plan of care '(. %inal chec+ that patient agrees and is comfortable with plan and as$s if any corrections, %uestions or other items to discuss O*TIONS IN E4*"ANATION AND *"ANNING (includes content I% discussing in-estigations and procedures '*. 7rovides clear information on procedures, eg, what patient might e0perience, how patient will be informed of results '+. ?elates procedures to treatment plan5 value, purpose ',. @ncourages %uestions about and discussion of potential an0ieties or negative outcomes I% discussing opinion and significance of problem (-. Affers opinion of what is going on and names if possible (1. ?eveals rationale for opinion (2. @0plains causation, seriousness, e0pected outcome, short and long term conse%uences (3. @licits patients beliefs, reactions, concerns re opinion

I% negotiating mutual plan of action (4. <iscusses options eg, no action, investigation, medication or surgery, non;drug treatments (physiotherapy, wal$ing aides, fluids, counselling, preventive measures& ('. 7rovides information on action or treatment offered name steps involved, how it wor$s benefits and advantages possible side effects ((. Abtains patients view of need for action, perceived benefits, barriers, motivation (*. 4ccepts patients views, advocates alternative viewpoint as necessary (+. @licits patients reactions and concerns about plans and treatments including acceptability (,. =a$es patients lifestyle, beliefs, cultural bac$ground and abilities into consideration *-. @ncourages patient to be involved in implementing plans, to ta$e responsibility and be self;reliant *1. 4s$s about patient support systems, discusses other support available