Contextual Barriers to Discussing a Schizophrenia Diagnosis with Patients and Families: Need for Leadership and Teamwork Training in Psychiatry.

Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry

PubMedID: 25398264

Outram S, Harris G, Kelly B, Cohen M, Bylund CL, Landa Y, Levin TT, Sandhu H, Vamos M, Loughland C. Contextual Barriers to Discussing a Schizophrenia Diagnosis with Patients and Families: Need for Leadership and Teamwork Training in Psychiatry. Acad Psychiatry. 2014;.
OBJECTIVE
This research sought to gain insight into the processes used by clinicians to discuss a schizophrenia diagnosis with patients/families, with the aim of informing the development of a communications skills training program.

METHODS
A generic qualitative methodological approach was used. Sixteen mental health clinicians were recruited. Semi-structured individual interviews were used to explore their perceptions and experiences communicating a schizophrenia diagnosis. Interviews were recorded, transcribed, and thematic analysis undertaken.

RESULTS
There were five key themes relating to the process of communication about a diagnosis of schizophrenia: (1) orientation to patient care, (2) planning of communication, (3) the impact of team leadership and inter/intra-professional functioning on communication tasks, (4) the roles of different clinicians in communicating about diagnosis and treatment, and (5) time and resource deficiencies. Despite expressing care and concern for vulnerable patients and embracing the concept of multidisciplinary teams, communicating diagnostic information to patients and families was generally unplanned for, with little consistency regarding leadership approaches, or how the team communicated diagnostic information to the patient and family. This contributed to tensions between different team members.

CONCLUSION
The findings demonstrated a number of issues compromising good communication around a schizophrenia diagnosis, both in terms of clinician skill and clinical context, and support the importance of education and training for all members of the multidisciplinary team about their role in the communication process.