Best Practice in Communication

ISBN 978-616-91972-1-8

1 2557 1,000

Best Practice in Communication
1 : , 2557.
136
I. .

71/17 10700
. 0-2435-2345 197


Communication Skills
.. 2550

Communication Skills
.. ..
Medical Counseling Checklist (MCC) Communication
skills

2

2










..2550

. .
Communication Skills

2


1
2
5
1
1. . . 9
2. . . 17
3. . . 21
4. . 25
5. . 30
6. . 37

2
7. . . 43
8. . 46
9. . . 49
Sensitive issues
10. . . 56
11. . . 68

3
12. . 73

13. . 81
/
14. . 92

3


15. . 103
16. . . 113
17. . 123

4 Communication Skills
18. 127
19. 131
20. Feedback 133

4


.. .. .. .. .. ..
Cert. in Clinical Fellowship in Pediatric Hematology/ Diploma of Child and Adolescent Psychiatry
(London)
Oncology (U.S.A.)

.
(Siriraj Palliative Care Center)
.

.., .., .. .. .. ..
..
Certificate of Postdoctoral Fellowship Training MSc. Epidemiology MSc. Child and Adolescent
in Child Mental Health(with Merit) (London)
and Adolescent Psychiatry (U.S.A.) Certificate Health Professions Education (USA)

.
.

.. .. .. .. ..
Certificate in Clinical Fellowship in Certificate in Child and General Psychiatry(USA)
Adolescent Medicine (USA)


. .

.. .. .. .. ..
Diploma American Board of Medical Genetics ..
(Clinical Genetics, Clinical Molecular Genetics) Certificate in Deveolmental Pediatrics (USA)
11

. .

5

., .., .. .. ( 1) ..
.. .. ..
Diplomate of the American Board of Pediatrics Diplomate of the American Board of General
and American Sub-board of Pediatric Critical Care Psychiatry and Child and Adolescent Psychiatry
Medicine


.

.. .. .. ..
Certificate in Clinical Fellowship in ..
Adolescent Medicine(Canada)


.

.. ..
..

6
 1

 1

Principles of Medical Ethics

. .

(.. )




(principles of medical
ethics)

9



Hippocratic Oath
Helsinki Declaration, World
Medical Code

I

code of conduct





..


.. 2451
.. 2471 ( 25 ..
2473)




.. 2495

10


I
2
2

( )

11







I

12


1. (Respect for autonomy)

13



2. (Non-maleficence)
Hippocratic Oath

I

3. (Beneficence)

4. (Justice)

5. (Veracity)

14


6. (Confidentiality)

15


1. (.. ). : . : . :
; 2544. 95.
2. . . 2506; 46: 725-64.
3. . . : ; 2543
4. . . :
: ; 2547 .. 2; ; 2547.
5. Dickenson D, Huxtable R, Parker M. The Cambridge Medical Ethics Workbook. 2nd ed. Cambridge: Cambridge University Press;
2010.
I

16
 2

. .

1.

2.

17


(family dynamics)
,


I

3.


3.1



3.2
verbal non verbal (active
listening)





(empathy)





(confron-
tation)

18


3.3 :

3.4

1.
1.1


1.2

2.
2.1

19


2.2

2.3
2.4
3.
I

1. http://www.directionservice.org/cadre/section4.cfm
2. http://www.helpguide.org/mental/effective_communication_skills.htm
3. http://www.amanet.org/training/seminars/The-7-Habits-of-Highly-Effective-People-for-Managers-2-Day-Workshop.aspx
4. http://cw.routledge.com/textbooks/9780415537902/data/learning/11_Communication%20Skills.pdf

20
 3

Interpersonal Relationships

. .

Interpersonal theory
1

1







1-2

21



Interpersonal Effectiveness1
Adolf Meyer ..1957
I

/

Interpersonal Theory Sullivan Mayer
Sullivan
interpersonal conflict
Interpersonal skills
connecting skills,
mindfulness skills, distress tolerance, emotional regulation, communication skills
interpersonal effectiveness

Interpersonal skills (communication
skills social skills)

1
Interpersonal skills







3
Interpersonal skills

22





4

I
verbal
nonverbal

2,4-5

1.

2.

23




3.


I

1.Mufson L, Dorta KP, Moreau D and Weissman MM. Interpersoal Psychotherapy for Depressed Adolescents,
2nd edition. New York : The Guilford Press. 2004 ; 19-29.
2. http://www.dbtselfhelp.com/html/connecting_skills.html
3. . . . . 2549
4. Bearman M, Bowes G, Jolly B. Looking for the Childs Perspective. Medical Education. 2005; 39:757-759
5. Brinkman WB, Geraghty SR, Lanphear BP, Khoury JC, et al. Effect of Multisource Feedback on Resident Communication Skills
and Professionalism: A randomized controlled trial. Arch Ped Adolesc Med. 2007 Jan; 161(1):44-9

24
 4

1.

25







I

2.

3.

( 0-1 )


6

( 1-3 )


2

26
 ( 3-5 )

I
( 6-10 )

1.

... ... ... .... ... ...


2.





3.

27


4.




I

5.




6.


7.


8.



9.


10.

28
 11.


12.

I
13.

1. Geldard K, Geldard D: Counselling Children A Practical Introduction, Third Edition. London: SAGE Publications; 2008.
2. McConaughy SH: Clinical Interviews for Children and Adolescents. New York: The Guilford press; 2005.
3. Faber A, Mazlish E: How to Talk so Kids can Learn. London: Piccadilly Press; 2003.
4. McLeod A: Listening to Children. London: Jessica Kingsley Publishers; 2008.
5. Engel JK: Pediatric assessment. USA: MOSBY ELSEVIER; 2006
6. Liu YH, Stein MT. In: Augustyn M, Zuckerman B, Caronna EB, editors. The Zuckerman Parker Handbook of Development and
Behavioral Pediatrics for Primary Care, 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2011.p. 7-11.

29

 5

.
I

10-21

1.

2.
3.
4.
5.

30

6.
1
7. one stop service
8.
9. (confidentiality)

31







I

1.







2.
(family dynamic)



3.

32

1.

2.
3.



4.

5.

6.

7.

8.

9.

10.

33



(HEEADSSS(S) Assessment)

I

HEEADSSS(S) assessment




()

HEEADSSS(S) assessment

Home:

Education/ Employment:


Eating:
(junk food)

Activities:
(screen time)

34
Drugs:


Sex:

I
Suicide:


/
Safety:

Strengths:

(Motivation interview)

()

35



1. Braverman PK, Strasburger VC. Office-based adolescent health care: issues and solutions. Adoles Med: State-of-the-Art Rev
1997;8:1
I

2. Elster A, Kuznets N. AMA guidelines for adolescent preventive services (GAPS); recommendations and rationale. Baltimore:
Williams & Wilkins, 1994
3. Ehrman WG, Matson SC. Approaches to assessing adolescents on serious or sensitive matters. Pediatr Clin North Am 1998;45:189
4. Ford CA, Millstein SG, Halpern-Felsher BL, et al. Influence of physician confidentiality assurances on adolescents willingness
to disclose information and seek future health care: a randomized controlled trial. JAMA 1997;278:1029
5. Goldenring JM, Rosen DS. Getting into adolescents heads. An essential update. Contemp Pediatr 2004;21(1):64
6. Berlan ED, Bravender T. Confidentiality, consent, and caring for the adolescent patient. Curr Opin Pediatr. 2009 Aug;21(4):450-6.
7. Klein JD, Slap GB, Elster AB, et al. Access to health care for adolescents: a position paper of the Society for Adolescent
Medicine. J Adolesc Health Care 1992;13:162
8. MacKenzie RG. Approach to the adolescent in the clinical setting. Med Clin North Am 1990;74:1085
9. Ozer EM, Adams SH, Lustig JL, et al. Increasing the screening and counseling of adolescents for risky health behaviors: a
primary care intervention. Pediatrics 2005:115(4):960

36
 6

1. 1-3

2. 3

37







I

1-2,4
1.



(sit face to face)

2.



3.



4.



5.


6.

38


7.

I
8.





9.

39







I

1. How to Communicate With Older Adults. [onlines]. Available from: URL: http://www.wikihow.com/Communicate-With-Old-
er-Adults
2. Robinson TE, White GL, Houchins JC. Improving Communication with Older Patients: Tips From the Literature. Fam Pract
Manag. 2006; 13(8): 73-8.
3. Halter JB. The Challenge of communicating health information to elderly patients: a view form geriatric medicine. In: Park
DC, Morrell RW, Shifren K, eds. Precessing of Medical information in Aging Patients: Cognitive and Human Factors Perspectives.
Mahwah, NJ: Lawrence Erlbaum Assoc;1999.
4. Dreher BB. Communication Skills for Working With Elders. New York: Springer; 1987

40
 2

 7

(Counseling technique)

. .

II



(counseling)
(client
center)

1


2-4

1-2
1. (opening)

2. (identification of problems)

43



3. (goal setting)



II

4. (problem solving)
1.
2.




3.
4.
5.

5. (closing)


1.

2.

3.

44


II

1. http://www.basic-counseling-skills.com/counseling-techniques.html
2. http://www.basic-counseling-skills.net/
3. Angold A. Diagnostic interviews with parents and children. In: Rutter M,Taylor E, eds. Child and Adolescent
Psychiatry. 4th ed. Bath : Blackwell Science, 2002:32-51.
4. Geldard D. Basic personal counselling: a training manual for counsellors. 3rd ed. Sydney : Prentice Hall, 1998:39-168.

45

 8

.
II

1.


2.

3.

46


1.

2.

II

3.

4.

5.

6.

47


1.

2.

3.


II

4.

.....
......
..()....
.....
/
5.

6.
7.

1. The telephone Helpline association. Guildelines for Good Practice in Telephone Work. London: Telephone Helplines Group/
Association; 1993
2. Rosenfield, M. Counselling by Telephone. London: SAGE Publications; 1997
3. . . : ; .. 2538

48
 9

Sensitive issues

. .

II

1-2

49



(patient confidentiality)





II

(active listening)





(wrap up)

50
 3 4
HEEADSSS interview (Home, Eating, Education/Employment, Activity and friends, Drugs,
Sexuality, Safety, Suicide and mood) 4



5

II

(small talk)
(patient confidentiality)

15-20

(clarification)

51



1.

II

? ?
?
?
.....
1-2

....

? ? ?
?

? ?
? ?
?
?
...
? ?
?....

52
 2.



(safe sex)

II
...... ?

?



..
..
..

.....

3.

2

......

53



....
.........
.........
...
.. ?
? ? ?
II

?
?

? ? .....
....
...
....

... 10-15 ...


....

54


1. . Practical aspects of adolescent sexuality. : , , ,

, , editors. . : ; 2551. p. 281-8.
2. Woods ER, Neinstein LS. Office visit, Interview Techniques and Recommendation to parents. In: Neinstein Lawrence S, Gordon
Catherine M, Katzman Debra K, Rosen David s, Woods Elizabeth R, editors. Adolescent Health Care; A practical guide. 5th ed.
Philadelphia: Lippincott Williams&Wilkins; 2008. p. 32-43.
3. . .. 2555 (Recom-
mended Guideline for Preventive Pediatric Health Care by The Royal College of Pediatricians of Thailand, 2012 ). 2555. Avail-

II
able on line at http://www.thaipediatrics.org/html/detail_news.php?nid=e46de7e1bcaaced9a54f1e9d0d2f800d [access on
March 24th, 2013]
4. Rosen DS, Neinstein LS. Preventive Health Care for Adolescents. In: Neinstein Lawrence S, Gordon Catherine M, Katzman
Debra K, Rosen David s, Woods Elizabeth R, editors. Adolescent Health Care;A Practical Guide. Philladelphia: Lippincott Wil-
liams&Wilkins; 2008. p. 44-80.
5. American Academy of Pediatrics. Sexuality education for children and adolescents. Pediatrics 2001;108(2):498-502.

55

 10

(Motivational Interviewing)

. .
II

1-2

3 (Stages of Change)

1. (Precontemplation)






2. (Contemplation)

56


3. (Preparation)

II



4. (Action)



(relapse pre-
vention)

5. (Maintenance)



( )
( )

57

 1
1.
2.
3.
1


II

2

1. (positive reinforcement or reward)
2. (acceptance)
3. (reasoning)

4. (self rewarding)

3 (inspiration)
1. (role model)

(identification)
2. (moral reasoning)


2 3

4-5
.

58
 1. (Environmental Manipulation)

(square position)

(touch)

II
(support)

2. (Greeting)



(small talk)
....() .....()
....() ....()

3. (Good Attitudes)


(unconditioned positive regard) (neutral)
(understanding)
(two-way communication)
empathy
sympathy
sympathy :

59

 empathy :
( )



.

(Questioning)
II

(confi-
dentiality)

(Active listening)


(active listening)

60

1. (ordering, directing, commanding)
2. (warning, threatening)
3. (giving advice, making suggestions, providing solutions)
4. (persuading with logic, arguing, lecturing)
5. (moralizing, preaching, telling clients what they should do)
6. (disagreeing, judging, criticizing, blaming)
7. (agreeing, approving, praising)

II
8. (shaming, ridiculing, labeling)
9. (interpreting, analyzing)
10. (reassuring, sympathizing, consoling)
11. (questioning, probing)
12. (withdrawing, distracting,
humoring, changing the subject)

61









II

(Feedback)

(I-YOU Message)
You-message

I-message You
I-message
(I-message)
(You-message) (I-mes-
sage) (You-message)


..................
................
....................

62
 I-You message You
I-message You-message I-message

II


(emotional
support)
... ()
... ()
()
()
()

....
() (
)

(Facilitation)

....

63



(Body Language)


II

....

.... (

64
) ()
( ) (
) ....()

(Emotional Support)

1.1 (Ventilation)

II

1.2 (Positive Reinforcing)

1.3












.....

65

 .


1. (reduce resistance)

2. (promote collaboration)

3. (explore ambivalence)
II

4. (develop discrepancy)

66


II

1. Rollnick S, Miller WR. What is motivational interviewing? Behav Cogn Psychother 1995; 23: 325-34.
2. Miller WR, Rollnick S. Motivational interviewing: Preparing people to change. New York: Guilford Press, 2002.
3. Prochaska JO, DiClemente CC. Toward a comprehensive model of change. In: Miller WR, Heather N. eds. Treating addictive
behaviors: processes of change. New York: Plenum Press; 1986. p. 327.
4. Angold A. Diagnostic interviews with parents and children. In: Rutter M, Taylor E, eds. Child and adolescent psychiatry.4th ed.
Bath : Blackwell Science, 2002:32-51.
5. Geldard D. Basic personal counselling: a training manual for counsellors. 3rd ed. Sydney : Prentice Hall, 1998:39-168.

67

 11

Supportive Psychotherapy

. .
II

(supportive care)

Palliative care
Holistic care

supportive care palliative care Holistic care
(Supportive
Psychotherapy) Goldberg & Green
medical supportive care reassurance, suggestion manipulative1

Supportive Psychotherapy2-4



key activities critical negotiation



(resilience factors)

68

Supportive Psychotherapy
acute crisis

Therapeutic Alliance in Supportive Psychotherapy5

1. Trusting Relationship

II

empathy

Trusting Relationship

Trust-
ing Relationship
2. Parents capacity to perform therapeutic work

supportive

3. Safe environment

Techniques Supportive Psychotherapy 4

1. Relationship building
empathy

2. Ventilation

69




3. Esteem building reassurance & positive reassurance


(normalization) encouragement

4. Skills building
II

(advice) (teaching) anticipatory

guidance
5. Reducing and preventing anxiety
normalizing reframing
(rationalizing)
6. Expanding awareness
(clarification)
(confrontation) (interpretation)
7. Strengthening defenses (as opposed to challenging them)
defenses mechanism denial, projection,
regression defenses mechanism
repression
8. cognitive-behavioral therapy,
exposure therapy

1. Steinberg PI. Two techniques of supportive psychotherapy. Can.Fam.Psysician1989 ;35: 1139-43.
2. Wilston A, Rosenthal AR, Pinsker H. Tntroduction to Supportive Psychotherapy. Washington,D.C., American Psychiatric Pub-
lishing,2004.
3. Werman DS. The Practice of Supportive Psychotherapy. New York, New York Psychology Press,1984.
4. http://www.caps.utoronto.ca/Service-Offered/Individual-Psychotherapy/Supportive-Psychotherapy.htm
5. http://psychiatrist-blog.blogspot.com/2012/06/support-psychotherapy-101.html
6. http://www.wisegeek.com/what-is-supportive-psychotherapy.htm

70
 3

 12

..

III

1-2

1-3
1. Non-directive
2. Non-judgmental
3. Confidentiality

(informative)
(au-
tonomy)



.... .... ..... ....

73


1,3
1.

2.
3. autosomal
dominant, autosomal recessive, X-linked recessive, X-linked dominant, multifactorial
inheritance

4.
III

5. (pedigree
or family tree)

-
- (consanguinity)
-



-

- ()

1,3
1. (medical fact)

2. (genetic fact)

74
 3. (psycholog-
ical support)

1,3
1. pedigree
(information gathering)
2. (verifying diagnosis)
3. (risk assessment)
4. (information giving)
5.

III
(psychological counseling)
6. (ongoing client support)

1,3
1.
2.
3.


4.
(two way communication)

75


(positive counseling)
(false hope)
1,3-4
()





III

5.

-
-

-

76
3-4


?
bonding
bonding

bonding
1-2

III

5-7
(guilt)

77

 (shame)

(subconscious)






X-linked recessive
III

5-6

5-6

78


III

5-6

79



1. . :
26 2549
2. Harper P.S. Practical genetic counseling 6th ed. London. Hodder Arnold 2004.
3. . . :
, . 2 . , 2553: 30-385.
III

4. . Down syndrome. :
. Ambulatory Pediatrics 3 2 . , 2553: 564-572
5. .
. ....
27 2554
6. , , , , , .
: (In Press 2556)
7. Weil J. Psychosocial genetic counseling. Oxford. Oxford University Press 2000

80
 13

. .

III
(UNAIDS) .. 2554
6,510 1


2

3

4

5

6

81

 .. 2548
Thailand MOPH-US CDC
Collaboration (TUC) pediatric disclosure model


7 1

1 :

1:

III

/ /

2:
/

3:

4:

82


1.




8

III
2.



9






10

83



11
3.



12

3.1

3.2

III

3.3

3.4

4 1)
2) 3)
4) 12 ( 1)

1:


7

84

() ()
.... ?

/



...

III




2:

1.

2.

85

 ?
?
3.

?

?


?
III

4.

?


?
?
5.

86
 3:

III
1.
2

?

?
2.

.3

()
?


3.

87

 ?
?
4.


?


.... ()
?
III

......
( )
5.


.....
() ?
?
()
?

?
6.


?


?

88
 ....
?
7.
?
()

8.

.... ?

III

...

4:

?

?
?

89

 ()

TUC13 4
1.


2.


3.
III

4.













( Sensitive Issues in Adolescents)

90

13

1. Thailand AIDS Response Progress Report 2012 Reporting period: 2010-20112012 [cited 2012 12 August 2012]: Available from:
http://www.unaids.org/en/dataanalysis/knowyourresponse/countryprogressreports/2012countries/ce_TH_Narrative_Report[1].
pdf.
2. Susan L. Diagnosis disclosure by family caregivers to children who have perinatally acquired HIV disease: when the time

III
comes. Nurse Res 1999;48:141-149.
3. Battles HB, Wiener LS. From adolescence through young adulthood: psychosocial adjustment associated with long-term
survival of HIV. J Adolesc Health 2002;30(3),161-168.
4. Instone SL. Perceptions of children with HIV infection when not told for so long: Implications for diagnosis disclosure. J
Pediatr Health Care 2000;14:235-43.
5. Boon-yasidhi V, Kottapat U, Durier Y, Plipat N, Phongsamart W, Chokephaibulkit K, et al. Diagnostic Disclosure status of status
of HIV-infected Thai Children. J Med Assoc Thai 2005; 88(Suppl 8): S100-5.
6. Lester P, Chesney M, Cooke M, Whalley P, Perez B, Petru A, et al. Diagnostic disclosure to HIV-infected children: How parents
decide when and what to tell. Clinical Child Psychology and Psychiatry 2002;7:85-89.
7. Boon-yasidhi V, Chokephaibulkit K, McConnell MS, Vanprapar N, Leowsrisook P, Prasitsurbsai W, et al. Development of a
diagnosis disclosure model for perinatally HIV-infected children in Thailand. AIDS care 2012, http://dx.doi.org/10.1080/095401
21.2012.749331.
8. . . : . /,
: , 2551: 289-316.
9. Nozyce ML, Lee SS, Wiznia A, Nachman S, Mofenson LM, Smith ME, et al. A behavioral and cognitive profile of clinically
stable HIV-infected children. Pediatrics 2006;117(3):763-70.
10. American Academy of Pediatrics. Committee on Pediatric AIDS. Disclosure of illness status to children and
adolescents with HIV infection. Pediatrics 1999;103:164-166.
11. Sawyer SM, Drew S, Yeo MS, Britto MT. Adolescents with a chronic condition: challenges living, challenges treating. Lancet.
2007;369(9571):1481-9.
12. . . : .
/, : , 2551: 265-288.
13. , , , , , . :
(). : ,

91

 14

.. . .

III

-
-

-

-
-

Family dynamics

92


III

(repetition)

sudden cardiopulmonary arrest


()
( .......)
/

93



()

1.




III

2.



3.

()

94


()

III

sudden cardiopulmonary arrest

1. (Preventable ad-
verse event)

95

 ( )





2.
(Unpreventable
adverse event)

III

What?
(Known
facts)









()
When?

96

24

Who?


( Unpreventable adverse event)

III

()

How?

What & When?

97

 (extent of injury)


Who?

/
Preventable adverse event



III

/
(

98
)

()

III
(functional leaders)

()

-
()
(/ )
-
-
- (
)

(defensive)
(pause)

99







( )



III

..... ()
....


.....
()





()
( . ,
)





/

100

/

/

III

(
)

(Compas-
sionate palliative care)
(Withholding life-sustaining
treatment)
(Withdrawal life-sustaining
treatment)

1. Buckman R. How to Break Bad News: A Guide for Health Care Professionals. Baltimore, MD: The Johns Hopkins University
Press; 1992:65-97.
2. Prendergast TJ. Resolving conflicts surrounding end-of-life care. New Horiz 1997;5: 62-71
3. EPECs Participant Handbook. Module 2: Communicating bad news. In: Emanuel LL, von Gunten CF, Ferris FD. The education
for physicians on End-of-Life care (EPEC) curriculum. 1999
4. Truog RD, Cist AF, Brackett SE, et al. Recommendation for end-of-life care in the intensive care unit. The Ethics Committee
of the Society of Critical Care Medicine. Crit Care Med 2001;29:2332-48
5. Curtis JR, Patrick DL. How to discuss dying and death in the ICU. In: Curtis JR, Rubenfeld GD, eds. Managing death in the ICU.
The transition from cure to comfort. New York, NY: Oxford University Press; 2001:85-102
6. When Things Go Wrong: Responding to adverse event. A Consensus Statement of Harvard Hospitals. Massachusetts Coalition
for Prevention of Medical Errors. March 2006

101

 1

/
/
/ (
)


/
III

/

/


( )
/

/
/



/

102
 15

III





(1)

(the childs concept of death)3,4

Schonfel (1989) (concept of death)
4
1) Irreversibility
2) Finality (Non functionality)

3) Inevitability (Universality)

103

 4) Causality





( 0-3 )



III

(separation anxiety)



( 3-5 6-9 )
(causality)
5 (reversible)






5-9

(inevitability) 3-7 (Preoperational stage)
(magical thinking)

104

(guilt)
( 10-12 13-18 )
10


4

III







(abstract and hypothetical reasoning)

3-5


Elisabeth Kubler-Ross (1969)
5
(shock and denial)
(fear)

105

 (anger)

(guilt)


(despair)


(anxiety)

III

3,4,6-9




1.




- -
-

-

:

106
 :

:


2.

III

/
, /,

107











III

3.

4.

108


III

109











III

5.

110
3,9,10
2
6

III

111


1. American Academy of Pediatrics. Committee on psychosocial aspects of child and family health. The pediatrician and child-
hood bereavement. Pediatrics 2000;105:445-7.
2. Beale EA, Baile WF, Aaron J. Silence is not golden: communicating with children dying from cancer. Journal of Clinical On-
cology 2005;23:3629-31.
3. Lewis M, Schonfeld DJ. Dying and death in childhood and adolescence. In: Lewis M, editor. A comprehensive textbook of
child and adolescent psychiatry. 3rd ed. Philadelphia: Lippincott William & Wilkins; 2002. p.1239-45.
4. Koocher GP, Gudas LJ. Death and dying. In: Alessi NE, editor. Handbook of child and adolescent psychiatry. volume II: Vari-
eties of development. New York: John Wiley & Sons; 1997. p.76-88.
5. Kubler-Ross E. On death and dying. London: Routledge; 1973.
6. Coleman WL, Richmond JB. After the death of a child: Helping bereaved parents and brothers and sisters. In: Carey WB,
Crocker AC, Coleman WL, Elias ER, Feldman HM, editors. Developmental-behavioral pediatrics. 4th ed. Philadelphia: Saunders
Elsevier; 2009. p.367-72.
7. Cook P. Long term follow-up and support. In: Linsay B, Elsegood J, editors. Working with children in grief and loss. London:
Bailliere Tindall; 1996.p.97-114.
8. Parkes CM, Kelf M, Couldrick A. Counseling in terminal care and bereavement. Leicester: St Andrews House; 1996.
III

9. Kang T, Hochn KS, Licht DJ, Mayer OH, Santucci G, Carroll JM, et al. Pediatric palliative, end-of-life, and bereavement care.
Pediatr Clin N Am 2005;52:1029-46.
10. Spender Q, Barnsley J, Davies A, Murphy J. Primary child and adolescent mental health: A practical guide. 2nd ed. London:
Radcliffe publishing; 2011.

112
 16

Communication In
Pediatric Palliative Care
. .

III

autonomy

(honesty)
(empathy) (hope)

113


Realists

Optimists

III

Avoiders

3 3

114




1.
2.
3.
4.

5.

III
1. (Breaking Bad News)



Palliative care
( )


?

2. (From
CURE to CARE)

115


(curative treatment) Palliative care
...
.....
( 1)

: ....
....
:
:
III

.?
: ()...
....
:
.....





?
..



( 1 2)

3. (Advance care plan)

116


III

4. (Advance
Directive)

advance directive


living will

117










4.1 Withhold/Withdraw treatment
III

(futile treatment)


4.2 DNAR (Do Not Attempt Resuscitation)
CPR (Cardio-Pulmonary Resuscitation)











progress note

118


III


...()...

....
(....)
()

..

5. (Bereavement Care)

119





(group support)



clip

III

System Management




palliative care ( 1)


( 2)

120
 1




opioid

III

(
)
Child life program
( 2)

palliative care

121

 2



physical therapy

24 .


( )

III

(home care) (hospice)

1. Field MJ and Behrman RE, editors. In: When children die: improving palliative and end-of-life care for children and their
families/ Institute of Medicine (U.S.), Committee on Palliative and End-of-Life Care for Children and Their Families, Board on
Health Science Policy. Washington, DC : The National Academies Press; 2003.
2. Back A, Arnold R, Tulsky J. Mastering communication with seriously ill patients: Balancing honesty with empathy and hope.
New York : Cambridge University Press; 2009.
3. Wolfe J, Hinds PS, and Sourkes BM. eds. Textbook of Interdisciplinary Pediatric palliative care. Philadelphia : Elsevier Saunders; 2011.
4. . . : ; 2555.
5. . . : ; 2549

122
 17

III

1.
2.


,
3.
/,
( )
/
Keywords

4.
/

123

 5.
/


Keywords


6.
/


III

7.
/ (
)

8.
/
/
24
/

9.
/ /
(
)
10. Inform consent

/

124
 4

Communication Skills

Medical Counseling Checklist (MCC)
 18

Communication Skills
.. 2557

1.

IV
2.
3. (participatory
Learning)

4.

5. 1 - 4
5.1
5.2 VDO
5.3 case scenario
5.4 (role play)
5.5 (Knowledge management)

127

Medical Error & Sudden Unexpected Death

///

communication skills ( .. 2554)
1 2 3 Faculty others
conf.
A. Basic communication with children and adolescents
Communication with children

B. History taking from children and adolescents

IV

C. Information giving for children (Management plan,

treatment)
D. Inform consent for procedures from children
E. Inform consent for research studies *
F. Involve children in decision making
A. Breaking bad news with surrogates and patients
B. Communicating palliative care
C. Understanding dying patients and family
D. Respect for different values and cultures
Palliative Care Issues

E. Advance directives with surrogates

F. Withhold/Withdraw life-sustaining treatment with
surrogates
G. Communicating as death approach
H. Notification of death
I. Request for organ donation *
J. Request for autopsy

128
 1 2 3 Faculty others
conf.
Communication with community Challenging Communications Communication with colleagues/teams Communication with parents/care givers A. History taking from parents
B. Information giving (Treatment, management plan)
C. Inform consent/refusal for procedures/procedures
D. Inform consent/refusal for research studies *
E. Counseling for chronic illness
F. Counseling for genetic diseases
G. HIV counseling
H. Negotiating goals of care
I. Counseling for second opinion
J. Advice by telephone
A. Consultation with specialists
B. Writing referral letters

IV
C. Information asking from other doctors
D.
E. Working within multidisciplinary teams
F. Conflict resolution with colleagues
G. Giving supervision for junior colleagues
A. Dealing with anger patients/parents
B. Violence (Child abuse, neglect) *
C. Specific needs patients/parents (Handicap, MR,CP LD)
D. Handling complaints
E. Managing unrealistic requests (Saying no)
F. Report mistakes to parents
A. Giving information
B. Program/disease campagne *
C. Child advocacy
D. School health
E. Communication via medias *
* = not necessary
Adapted from Khon Kaen Medical School portfolio checklist

129
 Medical Counseling Checklist (MCC)








( )


IV

checklist Portfolio

checklist

130

MedicalCounseling Checklist
.............................................................................................. .....................
............................................... HN..............................................................................................
.............................................................................................WARD...............................
........................................................................................................
N/A
A. (Opening)
1. /
2.
3.
4.
5.

IV
6.
7. (confidentiality)
B. (Identification of problem)
1. (Problem survey)
2.
3.
4.
5.
C. (Goal setting)
1. (Identification the problem)
1.1
1.2
2.
3.
D. (Problem solving)
1. (Medical facts)
1.1
1.2
1.3
1.4

131
 N/A
2.
3. (Let counselee make his/her own decision)
4.
5 (Segment Summary)
E. (Closing)
1.
2.
3.
F. (Counseling techniques)
1. (Facilitation skills)
1.1
1.2 (Posture, facial expression)
1.3
IV

1.4
1.5
1.6
1.7
1.8 (Questioning-open end)
1.9 (Active Listening)
2. (Relationship skills)
2.1 (Share of feeling)
2.2 (Acknowledges/ reflection : feeling)
2.3 (Share of thinking)
2.4 (Reflection of thinking)
2.5 (Support : positive)
2.6 (Empathy)
2.7 / (Nonjudgmental, neutral)
2.8 (Understanding)
2.9 (Unconditional positive regard, accept)

.......................................................................................................................................
......................................... from the Brown Interview Checklist Brown University 1991
By Dr. Panom Ketumarn MD. and Dr. Sirirat Kooptiwut MD. Faculty of Medicine
Siriraj Hospital Mahidol university 2001

132
 20
Feedback

2 Feedback

(positive feedback)

IV

1.
2.
3.
4.
5.
6.

1.
2.
3.

(Negative feedback)

1.

133
 2.
3.
4.
5. ()
6.
7.
8.
9.

Medical Counseling Checklist

(counseling process)
(Self Feedback) (Trainers Feedback)
IV

MCC



MCC

1.

2. Feedback Feedback

3. MCC Feedback

4. Feedback
MCC
5. Feedback

134
 5.1
-
-
-
-
-
5.2 2 3
5.3 / 5.1 Feedback
( Feedback Feedback )
5.4
/

IV
5.5

5.6

5.7
Feedback Feed-
back
5.8 MCC

135
 Communication Skills
.. 2556 - 2559

. .
..
. .
..
..
.
..
.
.
..
.
.


.
.
.
.
.

136
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