The REDE skills checklist The REDE skills checklist was created by The Cleveland Clinic and serves as a guide to effective and empathic communication between physicians and patients. Relationship Establishment ‒ Phase I Development ‒ Phase II Engagement ‒ Phase III Convey value & respect with the welcome Review chart in advance & comment on their history Knock & inquire before entering the room Greet patient & companions formally with smile & handshake Introduce self & team; clarify role(s) Position self at patient’s eye level Recognize & respond to signs of physical or emotional distress Attend to patient’s privacy Make a brief patient-focused social comment, if appropriate Engage in reflective listening Nonverbally, e.g., direct eye contact, forward lean, nodding Verbally, using continuers such as: “mm-hmm,” “I see” or “go on,” reflecting the underlying meaning or emotion of what is being said “What I hear you saying is…” or “Sounds like…” Avoid expressing judgment, getting distracted or redirecting the speaker Express appreciation for sharing Share diagnosis & information Orient patient to the education & planning portion of the visit Present a clear, concise diagnosis Pause if necessary Provide additional education, if desired & helpful to the patient Frame information in the context of the patient’s perspective Collaboratively set the agenda Orient patient to elicit a list of concerns Use an open-ended question to initiate survey Ask “What else?” all concerns are identified Summarize list of concerns to check accuracy; ask patient to prioritize Propose agenda incorporating patient & clinician priorities; obtain agreement Elicit the patient narrative Use transition statement to orient patient to the history of present illness Use open-ended question(s) to initiate patient narrative Maintain the narrative with verbal & nonverbal continuers: “Tell me more…” or “What next?” Summarize patient narrative to check accuracy Collaboratively develop the plan Describe the treatment goals & options including risks, benefits & alternatives Elicit patient’s preferences & integrate into a mutually agreeable plan Check for mutual understanding Confirm patient’s commitment to plan Identify potential treatment barriers & need for additional resources Introduce the computer, if applicable Orient patient to computer Explain benefit to the patient Include patient whenever possible (e.g., share labs or scans) Maintain eye contact when possible Provide closure Alert patient that the visit is ending Affirm patient’s contributions & collaboration during visit Arrange follow-up with patient & consultation with team members Provide handshake & a
Stop typing & attend to patient when emotion arises personal goodbye Demonstrate empathy using SAVE Recognize emotional cues & respond “in the moment” Allow space to be with the patient & their emotion without judgment Clarify the emotion if needed Recognize emotion evoked in you & refrain from trying to fix or reassure Demonstrate empathy verbally with SAVE: Support – “Let’s work together…” Acknowledge – “This has been hard on you.” Validate – “Most people would feel the way you do.” Emotion naming – “You seem sad.” Demonstrate empathy nonverbally – only that which feels natural & authentic to you Explore the patient’s perspective using VIEW activities “How does it disrupt your daily activity?” or “How does it impact your functioning?” Ideas “What do you is wrong?” Expectations “What are you hoping I can do for you today?” Worries “What worries you most about it?” Dialogue throughout ARIA Assess using open-ended questions What the patient knows about diagnosis & treatment How much & what type of education the patient desires/needs Patient treatment preferences Health literacy Reflect patient meaning & emotion Inform Tailor information to patient slowly & provide small chunks of information at a time Use understandable language & visual aids Assess patient understanding & emotional reaction to the information provided © 2013 The Cleveland Clinic Foundation. All Rights Reserved. Materials adapted from the by the American Medical Association with permission from The Cleveland Clinic Foundation. Source: AMA. Practice transformation series: building a patient experience program. 2017.