Contextual barriers to discussing a schizophrenia diagnosis with patients and families: need for leadership and teamwork training in psychiatry.
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.


CONCLUSIONS
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.
University of Newcastle, Callaghan, Australia, Sue.Outram@newcastle.edu.au.
Sue
S
Outram
Gillian
G
Harris
Brian
B
Kelly
Martin
M
Cohen
Carma L
CL
Bylund
Yulia
Y
Landa
Tomer T
TT
Levin
Harsimrat
H
Sandhu
Marina
M
Vamos
Carmel
C
Loughland
D000328:Adult; D002983:Clinical Competence / Q000592:standards; D003144:Communication Barriers; D004493:Education / Q000379:methods; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000379:methods / Q000592:standards; D007857:Leadership; D008297:Male; D020380:Needs Assessment; D010348:Patient Care Team / Q000458:organization & administration*; D010817:Physician-Patient Relations; D011368:Professional-Family Relations; D011379:Prognosis; D011570:Psychiatry / Q000193:education*; D036301:Qualitative Research; D012559:Schizophrenia / Q000175:diagnosis*