ESPS SP Checklists

Extended Standardized Patient Scenario

ELAINE STUART
Standardized Patient Checklist - Visit #6: 5/15/98
(Detailed Discussion of Options & Treatment of Symptoms)

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 allowed to "tell my story" without interruption.

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 told about the range of survival rates with this kind of cancer.
5. I was told that less than a 6 month survival expectancy is required to enter Hospice.
6.The resident/student talked about my life expectancy.
7. I was told that I am a candidate for Hospice care.
8. I was asked about physical support.
9. I was asked about emotional support.
10. The benefits of chemotherapy were presented to me.
11. The benefits of Hospice were presented to me.
12.I was asked what my thoughts were regarding my options.
13. Our discussion was summarized.
14a. A detailed plan was agreed upon including: · Meds for pain and nausea
14b. A detailed plan was agreed upon including: · A follow-up visit in 2 weeks
14c. A detailed plan was agreed upon including: · To call if pain or symptoms are not relieved
14d. A detailed plan was agreed upon including: · To make a decision about chemo or Hospice
15. I was asked if I had any more questions.
16. I was reassured about my concerns.
17. An appropriate, polite closure ended the visit.