When healthcare professionals discuss making changes to opioids, this often meets defensiveness and resistance. Lecturing patients on the potential harms of opioids is unlikely to be effective in overcoming this resistance or in achieving sustained opioid reduction and a more collaborative approach is needed. At the heart of this is good communication. This is why we recommend that you begin the PROMPPT pain management review by you asking the patient tell you about their pain, how it affects them and what it’s important for you to know. Your first role as the patient tells their story is to listen.
True active listening only really occurs if the interviewer understands what the person is thinking, rather than just hearing the words. This is relatively easy if you have a confident, articulate patient who is open and explicitly expresses his thoughts. However, many people are anxious and inarticulate.
Some key skills for active listening:
- Allow the person time to gather her/his thoughts
- Appropriate use of silence
- Supportive atmosphere
- Encourage the person to speak about the topic
- Displaying interest (eye contact, posture, not fidgeting)
- Open questions
- Verbal prompts (“yes, go on…”)
- Non-verbal prompts (nodding)
- Refrain from interrupting, especially the opening statement
- Reflecting (repeating the last phrase)
- Concentrate on what the person says
- Eye contact
- Avoid distractions (e.g. bleep, excessive note-taking)
- Think about the person’s current answer, rather than formulating your next question
- Check understanding
- Clarifying questions
Empathy and validation
Empathy and, in particular, the level of validation experienced by patients is increasingly felt to be an important component of effective communication during pain consultations.
Empathy is the ability to understand and share the feelings of another. In other words, being able to put one’s self in another’s shoes and feel what that person is going through and share their emotions and feelings.
The most powerful words that any medical professional can say in response to pain is, “I believe you”From an anonymous Q-PROMPPT research participant
Validation means acknowledging and accepting another person’s internal experience as being valid without judgment. In pain consultations this means communicating to the patient that you understand their pain experience and accept it as real.
Validation does not mean that you necessarily agree with all the patient’s thoughts and feelings about their pain, it means that you accept them as valid and understandable rather than disputing or discounting their experience. People who experience validation may report feeling their experience has been accepted/ acknowledged and feeling believed and/or taken seriously.
Learn more about the role of active listening, empathy and validation in pain consultations by watching the following presentation by Prof. Tamar Pincus, a health psychologist and researcher with many years experience in chronic pain management.