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NephroTalk: Communication Tools to Enhance Patient-Centered Care

Authors

  • Jane O. Schell,

    1. Section of Palliative Care and Medical Ethics, Renal-Electrolyte Division, University of Pittsburgh School of Medicine, UPMC, Pittsburgh, Pennsylvania
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  • Robert M. Arnold

    1. Section of Palliative Care and Medical Ethics, Renal-Electrolyte Division, University of Pittsburgh School of Medicine, UPMC, Pittsburgh, Pennsylvania
    2. Section of Palliative Care and Medical Ethics, Palliative and Supportive Institute, University of Pittsburgh School of Medicine, UPMC, Pittsburgh, Pennsylvania
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Address correspondence to: Jane O. Schell, Section of Palliative Care and Medical Ethics, Renal-Electrolyte Division, University of Pittsburgh School of Medicine, UPMC Montefiore, Suite 933 W, 200 Lothrop Street, Pittsburgh, PA 15213, or e-mail: schelljo@upmc.edu.

Abstract

Nephrologists frequently must discuss serious news with patients, especially those with advanced comorbidities. These discussions include giving bad news, addressing prognosis, and assisting with treatment decision making. Few data exist about how nephrologists approach these difficult conversations. This article presents a framework for engaging in these discussions using a case example, and provides tools for assisting with treatment decision making for initiating or forgoing dialysis. Communication skills presented include Ask-Tell-Ask for discussing serious news, the N-U-R-S-E acronym for recognizing and responding to emotion; tools for naming uncertainty when addressing prognosis; and using big picture questions to elicit patient care preferences for treatment decision making. This article provides nephrologists with the framework and skills to better engage in patient-centered decision making.

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