COUNSELLING AND

COMMUNICATION
SKILLS IN PEDIATRICS
Dr Khanisa Md Khalid
General Pediatrics & Child Health
HRPZ2, KB
What is communications skill?

• The ability to use language(receptive) and convey(express)

information
- Express ideas and feelings or giving information/instructions

• Critical element in our career and lives

Ways of communication
• Verbal
• Non verbal
• written
Communication strategies with
parents
• You notice that Madam Ana’s baby is dysmorphic. Following
further assesment, baby M has features of Down Syndrome.
What is the next step?
• Witholding concerns regarding dysmorphism can be bewildering and
frightening to parents
• A useful tactic: ask the parents whom the child resembles in the family
• Family can then disclose their concern regarding child’s appearance
and this can be a topic for careful discussion
• Geneticists often explain that the reason for examining the baby’s
appearance is to look for clues as to the cause of the prob;em(s) seen
in the baby
• Feedback from the family suggest that it is best to avoid terms such as
dysmorphic, and use terms such as “distintive facial features” instead
• Families report that the term abnormal or deformed can be offensive
and that abnormality is better described as problem/difficulty
• Parents need to be provided with good information about the
condition and informed about sources of further information and
support
SPIKES
- Six step Protocol in delivering
bad news

• Baile WF, Buckman R et al(2000): SPIKES- A Six-step protocol

for delivering bad news: application to a patient with cancer:
Oncologist 5: 302-311
STEP 1- SETTING UP THE
INTERVIEW
• Aim: get physical contact right, maximise privacy, avoid
interruption, help patient listen and understand, respect
confidentiality and provide support.
• What: make sure you have check all the available information
and have test results(including getting the right patient)
- Decide general terminology to be used(avoid jargons)
• Where: arrange for some privacy
• Who: decide who should break the news, presence of staff
• Starting off? Introduction and appropriate opening
STEP 2- Assessing the patient’s
PERCEPTION
• Find out how much the patinet know. How serious she/he
thinks and/or how much it will affect the future
• For eg: what do you know about your child’s illness so far?
What has DR XYZ tell you?
• The style and emotional content of the patient’s statement
provide you with information.
• Important to learn patient’s level of understanding and
articulation so that we can give information at the same level
• Observe bot verbal (words patient use to convey information)
and non-verbal(body posture, hand movements)
STEP 3- Obtaining the patient’s
INVITATION
• Find out how much the patients want to know
• Respect patient’s wish if he/she doesn’t want to know about
the disease- at the same time allow opportunities on
information regarding treatment and management
• “If the your child’s result (mention name) turns out to be
something serious, are you the kind of person who likes to
know exactly what’s going on”
• “ would you like me to tell you’re the details of (mention
name) diagnosis?”
STEP 4- Giving KNOWLEDGE
and information to the patient
• 4 crucial heading: Diagnosis, Treatment plan, Prgnosis,
Support
• Check whether your objectives are legitimate: we have to be
fully aware of patients right to
a) Accept or reject treatment offered
b) React to news and express their own feeling in any
way(legal) he/she chooses
• Aligning: reinforce what the patient already undersatnds using
his/her words-build up patients’ confidence that they have
been heard and taken to seriously. This helps the next stage of
modifying,correcting and educating patiet with new
information
• Educating: changing’s the patient’s understanding in small
steps, reinforce important information, use diagrams, written
message, try to simplify
• Listen to patients’ agenda: what are actually their main
concern for eg: patient is more worried about the side effects
of chemothaeraphy such as hair loss instead of side effects of
underlying disease
STEP 5-Adressing patient’s
EMOTION with empathic
response
• Acknowledge patients’s response
- The response to Bad News (the Grief Cycle)
- Shock
- denial
- Anger
- Bargain
- Depression
- Acceptance

- Provide empathy, avoid silence, do not argue

STEP 6- STRATEGY AND
SUMMARY
• Planning and follow through
• Demonstrate and undertand the patient’s problem list
• Make a plan/strategy and explain it
• Prepare for the worst but hope for the best
• Identify patient’s coping strategy and reinforce it
• Identify other sources of support and incorporate
• Invite questions
• Tell what happens next
SCENARIOS
• 1. You are meeting Pn Aina, to explain regarding her newborn
child with possible Down Syndrome
• 2. You are meeting Ms Lim, counsel regarding her premature
baby born 29 weeks, 1kg regarding possible complications
• 3. You are meeting Mr Raj. His newborn baby now 2 days old
has Neonatal jaundice secondary to G6PD. Unfortunately he
refuse admission, counsel him regarding the underlying
disease and benefits of phototheraphy
• 4. You are meeting Mrs Dawn, a mother to a premature baby
who is about to be discharge. Explain regarding the
importance of breast feeding/breast milk to baby