01Principles and purposeThe professional or clinical skill and the decisions it supports.
Clinical communication is a diagnostic, ethical and safety skill. The patient contributes lived experience, goals and acceptable trade-offs; the clinician contributes clinical interpretation and evidence. A good conversation makes both visible. Start with introductions, role, privacy and the patient’s agenda. Asking what they hoped would happen today prevents a technically accurate explanation from missing the actual decision.
Listening is active work. Use an open invitation, allow an uninterrupted initial account, reflect key words and emotion, then clarify chronology and discriminators. Summaries test your model and give the patient a chance to correct it. Signposting—“I’d like to ask about the breathlessness, then discuss what the tests may mean”—reduces surprise and helps people with cognitive load. Silence can be therapeutic when news is difficult.
Information should be tailored, layered and accessible. Ask what the patient already understands and how much detail they want. Give a headline, small chunks and pauses. Replace technical terms with plain language while preserving accuracy. When discussing risk, specify outcome, timeframe and denominator; distinguish relative from absolute change and acknowledge uncertainty. Teach-back asks the patient to explain the plan in their own words so the clinician can improve the explanation; it is not a test of the patient.
Decision making is a process rather than a signature. Describe reasonable options, benefits, harms, uncertainties, burdens and no treatment where relevant. Find out which consequences matter to the person and whether they need time or support. Capacity is decision- and time-specific. If capacity is impaired, maximise it and follow the applicable legal framework. Consent may be withdrawn and should be revisited when the plan or circumstances change.
Communication barriers require system action. Ask, record, flag, share, meet and review disability-related information needs under the Accessible Information Standard. Use professional interpretation for safety-critical discussions, speaking to the patient in the first person and pausing for accurate exchange. Preserve confidentiality and clarify the patient’s wishes about relatives. At closure, provide the agreed next step, safety net, access route and timeframe, then document material information and outstanding uncertainty.
Key points
- Begin by confirming identity, preferred name, role, privacy, communication needs and the patient’s agenda before supplying information.
- Use open questions to hear the account, then focused clarification; summarise and signpost so the patient can correct your understanding.
- Explore ideas, concerns, expectations, values and practical constraints because the same medical options can have different consequences for different people.
- Explain in short plain-language units, avoid unexplained jargon, use absolute risks with a common denominator where possible, and check understanding with teach-back.
- Shared decision making requires material benefits, harms, uncertainties, alternatives and the option of no intervention, linked to what matters to this patient.
- Use a trained interpreter when needed, address the patient directly and do not make a child or unverified relative responsible for safety-critical interpretation.
- Close with an agreed plan, uncertainty, safety-net symptoms, who to contact, timeframe and a record of the information and decision.
02Situations and prioritiesThe context, relevant information and actions that matter most.
Repeated questions, late-arising concerns or dissatisfaction may mean the patient’s main goal has not been elicited.
Pauses, changed tone, minimisation, anger or a repeated phrase can signal fear, grief, shame or loss of trust requiring acknowledgment.
Hearing, vision, language, literacy, learning disability, neurodivergence or cognitive impairment may require a different format or support.
Hesitation can reflect competing values, practical burden or misunderstood risk rather than refusal or lack of capacity.
Acquiescence, lack of questions or a relative answering everything may conceal coercion, dependency or inability to participate.
If the patient cannot explain the plan, warning signs or contact route, the communication task remains incomplete.
03Assessment and interpretationHow to gather information, assess the situation and recognise uncertainty.
Consider the information, its meaning and its limitations before deciding what follows.
- 01
Agenda mapping - Why
- Ask what the patient wants addressed and agree priorities for the available time.
- Interpretation and limitations
- Early agenda setting reduces late surprises and makes deferral explicit rather than silently ignoring concerns.
- 02
Understanding and preferences - Why
- Elicit current knowledge, desired detail, values and preferred role in decisions.
- Interpretation and limitations
- Tailor explanation without assuming that education, age or previous illness predicts what this individual understands or wants.
- 03
Accessible communication assessment - Why
- Identify, record and meet language, sensory and disability-related needs.
- Interpretation and limitations
- Arrange appropriate format, communication support or trained interpreter and verify that the adjustment worked.
- 04
Risk explanation - Why
- Use outcome-specific absolute frequencies over a stated timeframe and compare options on the same scale.
- Interpretation and limitations
- Natural frequencies and consistent denominators support comprehension; uncertainty and evidence limits remain explicit.
- 05
Teach-back - Why
- Ask the patient to describe the agreed plan and safety net in their own words.
- Interpretation and limitations
- Misunderstanding prompts a clearer explanation and repeat check, not blame or a declaration of incapacity.
- 06
Decision and documentation - Why
- Record material information, questions, preferences, consent and follow-up.
- Interpretation and limitations
- A form supports but never substitutes for dialogue; the record should allow continuity and later review.
04Worked approachesCases with ordered reasoning, an action and a check of the outcome.
01Worked caseExplaining an uncertain resultA patient is told a scan shows an indeterminate lung nodule. They hear the word cancer, become silent and ask whether they will die.+
- 1Pause the technical explanation, acknowledge the fear and ask what the patient understood; confirm whether they want a support person and what information they need now.
- 2Give a clear headline: the finding is real but indeterminate, so it neither diagnoses nor excludes cancer; explain the proposed next step, timeframe and what that test can resolve.
- 3Describe plausible outcomes using plain language and consistent absolute frequencies only if reliable data fit this patient, checking values and preferences rather than offering false reassurance.
- 4Use teach-back to confirm the plan and safety net, provide an accessible contact route, and document uncertainty, questions, agreed follow-up and responsibility for the result.
02Applied approachWorking with an interpreterA patient with limited English needs to discuss benefits and material risks of a procedure.+
- 1Arrange a trained interpreter matched to the clinical urgency and confirm identity, dialect, confidentiality and each participant’s role.
- 2Position the conversation toward the patient, speak directly in short first-person sentences and avoid side conversations.
- 3Pause for complete interpretation, observe non-verbal cues and invite the patient’s own questions and preferences.
- 4Check understanding through interpreted teach-back and document the support used and the resulting decision.
03Applied approachResponding to anger after delayA relative angrily says nobody has explained why treatment was delayed.+
- 1Ensure privacy and immediate safety, introduce yourself and invite their account without interrupting.
- 2Acknowledge the impact and emotion, clarify what information the patient permits you to share, and separate known facts from what requires checking.
- 3Explain the current clinical priority and concrete next steps, avoiding defensiveness or speculation about colleagues.
- 4Agree when and how you will update them, follow through, document the conversation and escalate any safety concern.
05Feedback, follow-up and evidenceReview outcomes, seek feedback and identify what to improve.
- Revisit understanding and preferences when the diagnosis, options or patient circumstances change; consent is ongoing.
- Record and share accessible-information needs so the patient does not need to re-establish them at every contact.
- Check that written information, appointment systems and safety-net routes are usable in the person’s required format.
- After difficult news, review emotional response and retention because distress reduces the amount of information processed.
- Document questions left unanswered and the named clinician responsible for the next conversation.
- Use complaints, feedback and observed communication failures as data for team improvement, while preserving confidentiality.
06Special situationsVariants, exceptions and circumstances that change the usual approach.
Teach-back tests the explanation
Frame it as checking how well you explained: a failed response means adapt the message, not label the patient difficult.
Risk needs a denominator
“Doubles risk” may describe a change from one to two in a thousand; provide absolute and relative forms when both aid the decision.
Empathy can be specific
Naming the observed emotion and its apparent reason is more credible than a generic expression that moves straight back to facts.
Interpreter choice affects safety
Family knowledge may help context, but a trained interpreter is needed for accurate, confidential safety-critical exchange.
Capacity is not agreement
An adult can understand, retain, weigh and communicate a choice that clinicians consider unwise; disagreement alone is not incapacity.
Station performance
CPSA, PACES and SCA communication is strongest when structure remains responsive: agenda, evidence, emotion, shared plan and safety net.
Questions need invitation
“What questions do you have?” signals that questions are expected more effectively than asking whether there are any.
Uncertainty can be bounded
State what is known, what remains possible, the next discriminating step and what would trigger earlier reassessment.
07Common pitfallsFrequent interpretation and management errors.
- 01
Delivering a long uninterrupted explanation before asking what the patient knows or wants.
- 02
Using jargon, inconsistent denominators or relative risk alone and assuming silence means understanding.
- 03
Ignoring an emotional cue to complete a checklist.
- 04
Speaking to the interpreter or relative rather than to the patient.
- 05
Treating a signed form as complete consent despite changed information or unresolved questions.
- 06
Ending without teach-back, warning signs, timeframe, contact route and documented ownership.