Calgary-Cambridge Guide to Explanation and Planning

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'Original Editor - Mariam Hashem

Top Contributors - Mariam Hashem, Kim Jackson, Tarina van der Stockt, Ewa Jaraczewska, Shaimaa Eldib, Merinda Rodseth and Olajumoke Ogunleye

Introduction

Explanation of planning is considered to be the main reason behind the patient's visiting to see a healthcare clinician, they want to understand what is causing their aches and pains.

The aim of this stage in the healthcare consultation is to empower patients with knowledge regarding the nature of their condition, different treatment options, prognosis, and alternative options in the case of unsatisfactory outcomes.

Providing Feedback to the Patient

Explaining medical information should be communicated in an easy to understand language to facilitate recalling and comprehension of the received data in order to make a well-considered decision regarding further management.

There are three options for the content of explanation and planning in the Calgary-Cambridge model:

The focus could be on the pathology itself, discussing the significance of the problem.

The conversation can revolve around the negotiation of a plan of action which is mutually acceptable to both the patient/family unit and healthcare practitioner.

Possible further investigations and/or procedures can be the centre of the discussion.

In most cases, all three options will feature in the feedback and planning session, but depending on the specific patient scenario, the focus of conversation may incline more towards one of these options. In either case, it is important for the patient to have sufficient information regarding the presenting condition, including pathophysiology, course of disease and treatment options.

The health care professional should provide as much as possible specific and evidence-based information on probable outcomes, as well as risks and benefits of possible management strategies

Kaufman suggests a practical way in which to provide this feedback in a logical, easily remembered manner, by using the mnemonic DCEPT:

• D – Diagnosis
• C – Cause of condition
• E – Expected further course of the condition
• P – Prognosis
• T – Treatment options
• Shared Decision Making

Effective understanding and recall are often compromised by information overload during the medical interview, with subsequent errors in information retrieval and self-management.  The correct amount and type of information to be communicated to patients, as well as the selected method of transmission, can depend on certain patient-specific factors. Age, gender, education level, emotional status and any pre-existing health schemas can all influence the patient’s ability to absorb, process and recall information. The following is a summary of evidence-based methods to convey information to patients while enhancing optimal understanding and recall:

• Use written material with easily understandable terminology, flow diagrams and pictograms where applicable and possible.

• The use of audio recordings is helpful when patients experience high anxiety levels and may be receiving potentially distressing news or a lot of information. Practically, you may encourage the patient to record the conversation on his smartphone if available.

• Chunk and check: Deliver information in small quantities and then stop to ensure the patient understands, before continuing to the next bit of information.

• Use easily understandable and specific terminology when explaining diagnosis, prognosis, and treatment options. Information should be specific rather than vague (for example: “please contact me again if your cough is still present after 5 days” instead of “your symptoms should subside within a few days”). Repeat and summarise information where applicable.

• Ask the patient to repeat applicable instructions, advice, or summary of information. The use of acronyms and mind maps are also useful to aid in memorising and recalling of information.

• Personalise patient management plans rather than providing generic pre-modulated written protocols.

• In the management of older people, patients with relatively low literacy skills and anxious patients, the use of elderspeak have proven effective in enhancing understanding. Elderspeak entails a slower rate of speech, simple and short sentence construction, low speech complexity and varied intonation.  Care should be taken to not give the impression that a patient is being belittled.