ESPS SP Checklists

Extended Standardized Patient Scenario

ELAINE STUART
Standardized Patient Checklist - Visit #5: 5/8/98
(Cancer has Metastasized)

Communication Scale Responses	strongly agree	agree	do not agree or disagree	disagree	strongly disagree
1. The physician spoke to me in a direct manner concerning my condition.
2. The physician demonstrated sensitivity about my fears and anxiety at hearing this news.
3. The physician behaved warmly, but professionally throughout the encounter
4. Used words I could understand when discussing my problem.
5. Treated me like I was on the same level, did not talk down to me, or treated me like a child.
6. Encouraged me to ask questions.
7. The physician utilized space well (e.g., maintained a comfortable distance, shoulders at equal level, etc.).
8. The physician was sitting down or standing, attending appropriate distance when we talked.
9. The physician appeared comfortable conducting the interview.
10. The physician maintained appropriate eye contact throughout the interview.
11. The physician seemed genuinely interested as expressed by facial expressions and body posture.
12. I was offered reassurance.

Communication Responses	yes	no
1. I was asked about my pain.
2. I was asked about other difficulties that I was experiencing.
3. I was allowed to "tell my story" without interruption.
4. I was given the results of the CT scan.
5. I was informed about my prognosis.
6. I was asked about physical support.
7. I was asked about emotional support.
8. Hospice was suggested.
9. I was encouraged to pursue Hospice although I was resistant.
10. Continuation of chemotherapy was discussed.
11. I was told that resuscitatation would be attempted automatically, should I suffer a cardiac arrest.
12. I was told of survival rates related to resuscitation.
13. I was asked how I felt about resuscitation.
14. Our discussion was summarized.
15a. A detailed plan was agreed upon including: · Meds for pain and nausea
15b. A detailed plan was agreed upon including: · A follow-up visit in 2 weeks
15c. A detailed plan was agreed upon including: · To call if pain or symptoms are not relieved
15d. A detailed plan was agreed upon including: · To make a decision about chemo or Hospice
16. I was asked if I had any more questions.
17. I was reassured about my concerns.
18. An appropriate, polite closure ended the visit.