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Athletic Trainer Tips: Communicating with Patients and Caregivers About an Injury

Posted October 2, 2019

By Sara Nuechterlein, MEd, ATC, LAT

As an Athletic Trainer (AT), one of the most important and sometimes precarious conversations you will find yourself in is speaking with a patient and caregivers about an injury. Prior to the conversation, the first and most important thing to remember is to ensure there is documented permission to discuss medical information to preserve the patient’s confidentiality. As always, document all conversations.

Although ATs are experts in prevention, assessment and management of medical conditions, you may be less than prepared in interpersonal communication. Communication is regarded as one of the foundational skills necessary to succeed as an AT, yet only one of the nearly 230 competencies in “National Athletic Trainers’ Association Athletic Training Education Competencies, 5th edition” published in 2011 pertains to mastering interpersonal communication.

Entry-level ATs are often found to be lacking in interpersonal communication skills, creating a gap between stakeholder communication expectations and an individual’s skillset, which can lead to turmoil, reports W. David Carr, and Jennifer Volberding, in “Employer and employee opinions of thematic deficiencies of new athletic training graduates” published in the Athletic Training Education Journal in 2012. Luckily, there are resources aimed at improving clinicians’ communication skills, particularly when it comes to delivering bad news. Drs. Robert Buckman and Walter Baile created a six-step protocol called “SPIKES—A Six-Step Protocol for Delivering Bad News: Application to the Patient with Cancer” published in The Oncologist in 2000 to increase a clinician’s confidence in sharing bad news specifically with patients and caregivers. Many of these steps are practical and completely relatable your athletic training practice and your patients.

1. Setting – If at all possible, try to meet with the patient and caregivers in person. It is best to share details with more than one set of ears, as details can get lost or muddled in high stress conversations.

2. Perception – When developing a rapport with patients, often ATs get a sense of family dynamics in addition to a solid understanding of a patient’s personality. A patient may be a sharer so you can surmise the patient’s details about the injury at home; conversely, the patient may be tight-lipped about issues so the caregivers may have no idea the patient has been managing a condition for some time.

3. Invitation – With experience, you will develop a perception to assess how much information to share with caregivers. Do they want to know all the acute risks as well as associated risks for 10 years down the road? Or can they only process the next step and prefer to focus on the immediate plan?

4. Knowledge – Don’t create a false sense of security or positive outlook if all assessment signs point to a serious injury. Be straightforward with assessment findings and review suspected and differential diagnoses to ensure the patient and caregivers understand the severity of the condition.

5. Empathy – Athletic training is a service profession centered on patient care. Share understanding to validate the family’s emotions – typically confusion, sadness and concern.

6. Summary and Strategy – Review the information and answer any questions. It’s okay to not have every answer. Make sure there is a well strategized and clearly communicated plan, preferably written, for the patient and caregiver to reference. Schedule a follow-up to decrease a sense of abandonment and give the patient and caregiver a way to contact you, preferably an office phone or email to protect personal boundaries.

Just like any skill, communication takes preparation, practice and repetition. Utilizing protocols during high-stress situations improves patient outcomes, so consider standardizing communication to advance results.

Resources

NATA (2011). National Athletic Trainers’ Association Athletic Training Education Competencies, 5th ed. https://www.nata.org/sites/default/files/competencies_5th_edition.pdf

Carr, W. D. & Volberding, J. (2012). Employer and employee opinions of thematic deficiencies of new athletic training graduates. Athletic Training Education Journal, 7(2), 53-59.

Baile, W., Buckman, R., Lenzi, R., Glober, G., Beale, E., & Kudelka, A. (2000). SPIKES--A Six-Step Protocol for Delivering Bad News: Application to the Patient with Cancer. The Oncologist,5(4), 302-311. doi:10.1634/theoncologist.5-4-302

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