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Hit enter to return to the slide.Slide TextSUBMIT ALLsubmit allSUBMITsubmitvolumeyour child may have significant brain injury, so we’re going to do a ct scan. possibly. but i heard that this procedure can cause cancer. will my son get cancer? does radiation stay in my child’s body? possibilities are relatively high, i don’t know. and how do you do ct scans in children? i can’t say for sure. what are your thoughts about this conversation? do you think the doctor answered wisely? how do you think the child’s mother feels? welcome effective communication lack of confidence lack of confidence lack of confidence lack of confidence lack of information lack of information lack of information lack of information lack of engagement lack of engagement lack of engagement lack of engagement helped little in easing worries doctor’s answers reasonable what was the problem? best practices avoid evidence-based medicine healthcare provider and parents expectations healthcare provider experience + environment socioeconomic and cultural differences resources available why are best practices necessary? radiation “harm and alarm” voice is often the loudest harm and alarm voice understanding ct scan understanding ct scan understanding ct scan understanding ct scan dangers of ct scans dangers of ct scans dangers of ct scans dangers of ct scans potential consequences limited access what is said versus what is heard helplessness unfamiliarity making decisions for others parents’ environment and message delivery what you say how you say it effective communication: 3 principles information they need in a way that they can understand be informed be informed be informed be sensitive be sensitive be sensitive be engaging be engaging be engaging communication sensitive matters challenge constructing good communication there is 1 in 2000 chances that your child is going to die from a brain tumor from this ct scan 10 or 20 years from now, but don’t worry about it. is there anything else you would like to know? i understand that you’re concerned about this situation. this is a necessary examination from which we’re going to get excellent information about your child’s condition. i’m afraid it’s possible. i heard that this procedure can cause cancer. will my son get cancer? … be informed applying principles be sensitive be engaging this is a necessary examination from which we’re going to get excellent information about your child’s condition. i understand that you’re concerned about this situation. is there anything else you would like to know? back to the hospital does this procedure pose any risk to my baby? the ct perhaps doubles the risk that your child will develop cancer before age 19. the ct is an important exam that allows the physicians to rapidly evaluate and treat your baby’s injuries which otherwise could place the health of your baby at risk. the risk of adverse outcome is very small and the likelihood of normal development is still nearly the same as it is for any child. effectiveness of communication patient: baby symptoms: -unexplained cough -shortness of breath procedure: ct scan question 1 %act7% could you help this woman? message mapping keep it simple stakeholder: parents anticipated question or concern: how much radiation will my child receive? thoughts & ideas key message 1 this ct is recommended now to aid in diagnosis and guide the treatment of your child. clear concise transparent accessible broad audience various levels of education and understanding supporting information we have evaluated the clinical condition of your child and agreed that we need to confirm the diagnosis to make a decision about the treatment. will you discourage having the examination? misinformation risk information strong concerns informed discussion social media 59% unfavorable/ concerned 3% favorable 10% informative regarding ct dose reduction 29% neutral radiologists and physicists must engage in social media 59% unfavorable/ concerned should parents/caregivers sign a consent form for use of diagnostic medical radiation? consent group surveyed signed informed consent 80 70 60 50 40 30 20 10 yes no neither patient/parent advocates radiologists medical physicists pediatricians nurses regulators public policy experts improved messaging engage to improve message bring information radiation risks to people www.imagegentlyparents.org www.imagegentlyparents.org www.imagegentlyparents.org image gently alliance providing safe high quality pediatric imaging raise awareness in the imaging community of the need to adjust radiation dose when imaging children. conclusions cts are invaluable cts are invaluable cts are invaluable understand your audience understand your audience understand your audience content and delivery must be considered content and delivery must be considered content and delivery must be considered we are accountable as a team we are accountable as a team we are accountable as a team effective communication good content delivered poorly is a poor message. deliver your message wisely! <html><p align='left'><textformat leading='0' tabstops='[0, 48, 96, 144, 192, 240]' blockindent='0' indent='0'><font face='Open Sans' size='15pt' style='font-size:15pt' color='#ffffff'>-Your child may have significant brain injury , so we’re going to do a CT scan.</font></textformat></p><p align='left'><textformat leading='0' tabstops='[0, 48, 96, 144, 192, 240]' blockindent='0' indent='0'></textformat></p><p align='left'><textformat leading='0' tabstops='[0, 48, 96, 144, 192, 240]' blockindent='0' indent='0'><font face='Open Sans' size='15pt' style='font-size:15pt' color='#ffffff'>-But I heard that this procedure can cause cancer. Will my son get cancer?</font></textformat></p><p align='left'><textformat leading='0' tabstops='[0, 48, 96, 144, 192, 240]' blockindent='0' indent='0'></textformat></p><p align='left'><textformat leading='0' tabstops='[0, 48, 96, 144, 192, 240]' blockindent='0' indent='0'><font face='Open Sans' size='15pt' style='font-size:15pt' color='#ffffff'>-Possibly.</font></textformat></p><p align='left'><textformat leading='0' tabstops='[0, 48, 96, 144, 192, 240]' blockindent='0' indent='0'></textformat></p><p align='left'><textformat leading='0' tabstops='[0, 48, 96, 144, 192, 240]' blockindent='0' indent='0'><font face='Open Sans' size='15pt' style='font-size:15pt' color='#ffffff'>-Does radiation stay in my child’s body?</font></textformat></p><p align='left'><textformat leading='0' tabstops='[0, 48, 96, 144, 192, 240]' blockindent='0' indent='0'></textformat></p><p align='left'><textformat leading='0' tabstops='[0, 48, 96, 144, 192, 240]' blockindent='0' indent='0'><font face='Open Sans' size='15pt' style='font-size:15pt' color='#ffffff'>-Possibilities are relatively high, </font></textformat></p><p align='left'><textformat leading='0' tabstops='[0, 48, 96, 144, 192, 240]' blockindent='0' indent='0'></textformat></p><p align='left'><textformat leading='0' tabstops='[0, 48, 96, 144, 192, 240]' blockindent='0' indent='0'><font face='Open Sans' size='15pt' style='font-size:15pt' color='#ffffff'>-I don’t know.</font></textformat></p><p align='left'><textformat leading='0' tabstops='[0, 48, 96, 144, 192, 240]' blockindent='0' indent='0'></textformat></p><p align='left'><textformat leading='0' tabstops='[0, 48, 96, 144, 192, 240]' blockindent='0' indent='0'><font face='Open Sans' size='15pt' style='font-size:15pt' color='#ffffff'>-And how do you do CT scans in children? </font></textformat></p><p align='left'><textformat leading='0' tabstops='[0, 48, 96, 144, 192, 240]' blockindent='0' indent='0'></textformat></p><p align='left'><textformat leading='0' tabstops='[0, 48, 96, 144, 192, 240]' blockindent='0' indent='0'><font face='Open Sans' size='15pt' style='font-size:15pt' color='#ffffff'>-I can’t say for sure.</font></textformat></p><p align='left'><textformat leading='0' tabstops='[0, 48, 96, 144, 192, 240]' blockindent='0' indent='0'></textformat></p><p align='left'><textformat leading='0' tabstops='[0, 48, 96, 144, 192, 240]' blockindent='0' indent='0'></textformat></p><p align='left'><textformat leading='0' tabstops='[0, 48, 96, 144, 192, 240]' blockindent='0' indent='0'><font face='Open Sans' size='15pt' style='font-size:15pt' color='#ffffff'>What are your thoughts about this conversation? Do you think the doctor answered wisely? How do you think the child’s mother feels?</font></textformat></p></html><html><p align='left'><textformat leading='0' tabstops='[0, 48, 96, 144, 192, 240]' blockindent='0' indent='0'><font face='Open Sans' size='15pt' style='font-size:15pt' color='#ffffff'>Have you ever been in a similar situation where communicating with your patient was a challenge? If so, let’s take this journey to effective communication!</font></textformat></p></html><html><p align='left'><textformat leading='0' tabstops='[0, 48, 96, 144, 192, 240]' blockindent='0' indent='0'><font face='Open Sans' size='15pt' style='font-size:15pt' color='#ffffff'>In the previous dialogue, you may have noticed that the doctor’s answers helped little in easing the mother’s worries. But at the same time, the doctor actually gave reasonable responses. So what do you think the problem was in this conversation? Think carefully and choose your answer.</font></textformat></p></html><html><p align='left'><textformat leading='0' tabstops='[0, 48, 96, 144, 192, 240]' blockindent='0' indent='0'><font face='Open Sans' size='14.5pt' style='font-size:14.5pt' color='#ffffff'>To avoid situations like the one described in the previous dialog, we need to develop best practices in pediatric imaging.</font></textformat></p><p align='center'><textformat leading='0' tabstops='[0, 48, 96, 144, 192, 240]' blockindent='0' indent='0'> </textformat></p><p align='left'><textformat leading='0' tabstops='[0, 48, 96, 144, 192, 240]' blockindent='0' indent='0'><font face='Open Sans' size='14.5pt' style='font-size:14.5pt' color='#ffffff'>The best practices trilogy is made up of a combination of evidence-based medicine, healthcare provider and parents expectations, and healthcare provider experience. However, there’s a fourth element that is as important as the others: the environment. You should always remember that best practices may not be useful in different environments because of socioeconomic or cultural differences or the resources available.</font></textformat></p></html><html><p align='left'><textformat leading='0' tabstops='[0, 48, 96, 144, 192, 240]' blockindent='0' indent='0'><font face='Open Sans' size='14.5pt' style='font-size:14.5pt' color='#ffffff'>But, why are best practices necessary? Well, it is because radiation is usually related to fear. When people think of radiation, they think of fallout shelters and nuclear bombs, but they have also become afraid of CT scans and x-rays, and even microwaves and cellphones! And they do so because there is a lot of misinformation on the web and in both lay press and scientific journals that raises the “harm and alarm” voice. Headlines like the one you see on the screen pose questions such as “do you realize that this is happening when you get this kind of examination? Do you realize that these are the risks you are exposed to?”</font></textformat></p></html><html><p align='left'><textformat leading='0' tabstops='[0, 48, 96, 144, 192, 240]' blockindent='0' indent='0'><font face='Open Sans' size='14.5pt' style='font-size:14.5pt' color='#ffffff'>Look at the title of an article published in a scientific journal. What is meant by “Knowing the enemy”? How can you improve it? Choose one of the options on the screen.</font></textformat></p></html><html><p align='left'><textformat leading='0' tabstops='[0, 48, 96, 144, 192, 240]' blockindent='0' indent='0'><font face='Open Sans' size='14.5pt' style='font-size:14.5pt' color='#ffffff'>Taking into account that fear is the common denominator for radiation, you should try to see imaging from the point of view of parents. They feel helpless, they are unfamiliar with the equipment and feel the pressure of having to make a decision for somebody else, that is, their child. They also fear the potential consequences because they have limited access to information.</font></textformat></p><p align='left'><textformat leading='0' tabstops='[0, 48, 96, 144, 192, 240]' blockindent='0' indent='0'></textformat></p><p align='left'><textformat leading='0' tabstops='[0, 48, 96, 144, 192, 240]' blockindent='0' indent='0'><font face='Open Sans' size='14.5pt' style='font-size:14.5pt' color='#ffffff'>When giving information to parents you must be very careful because there is a difference between what you say and what they hear. To sum up, delivery is at least as important as content.</font></textformat></p></html><html><p align='left'><textformat leading='0' tabstops='[0, 48, 96, 144, 192, 240]' blockindent='0' indent='0'><font face='Open Sans' size='15pt' style='font-size:15pt' color='#ffffff'>Communication between healthcare professional and patient may present challenges when it comes to sensitive matters. Thus it is essential that patients receive the information they need in a way that they can understand. So to make communication effective, you need to apply three principles: be informed, be sensitive, and be engaging. Click on each to know more.</font></textformat></p></html><html><p align='left'><textformat leading='0' tabstops='[0, 48, 96, 144, 192, 240]' blockindent='0' indent='0'><font face='Open Sans' size='15pt' style='font-size:15pt' color='#ffffff'>Taking into account the three principles, how could the doctor improve the conversation with the patient’s mother? Select the most appropriate boxes to construct good communication and then submit your answer.</font></textformat></p></html><html><p align='left'><textformat leading='0' tabstops='[0, 48, 96, 144, 192, 240]' blockindent='0' indent='0'><font face='Open Sans' size='15pt' style='font-size:15pt' color='#ffffff'>Now can you identify which principle has been used for each message? Drag them to the appropriate columns and then submit your answer.</font></textformat></p></html><html><p align='left'><textformat leading='0' tabstops='[0, 48, 96, 144, 192, 240]' blockindent='0' indent='0'><font face='Open Sans' size='15pt' style='font-size:15pt' color='#ffffff'>We’re back to the hospital. A woman has been told that her baby needs a CT scan on the chest due to unexplained cough and shortness of breath. She has come to see you in order to know more about the procedure her baby is undergoing. Could you help this woman? Read her questions and choose your answers carefully. Pay attention to the way your answers impact on the effectiveness of the communication.</font></textformat></p></html><html><p align='left'><textformat leading='0' tabstops='[0, 48, 96, 144, 192, 240]' blockindent='0' indent='0'><font face='Open Sans' size='15pt' style='font-size:15pt' color='#ffffff'>We’re trying to communicate to a broad audience that may have various levels of education and understanding. So how can we keep it simple? Organizing the information is crucial, and one very useful strategy for that is the message map. Let’s see how to build one. First, think of a specific stakeholder and anticipate what questions or concerns they may have. Then organize thoughts and ideas to develop your answers, and classify them in key messages and supporting information. This tool helps you make communication clear, concise, transparent, and accessible.</font></textformat></p></html><html><p align='left'><textformat leading='0' tabstops='[0, 48, 96, 144, 192, 240]' blockindent='0' indent='0'><font face='Open Sans' size='14.5pt' style='font-size:14.5pt' color='#ffffff'>It is important to highlight that giving information to parents about risk does not discourage CT scans. It has been shown that although some parents may not know about the risks to which their child is exposed during a CT scan and information may make them feel strong concerns, they would still be willing to allow a CT scan.</font></textformat></p><p align='left'><textformat leading='0' tabstops='[0, 48, 96, 144, 192, 240]' blockindent='0' indent='0'></textformat></p><p align='left'><textformat leading='0' tabstops='[0, 48, 96, 144, 192, 240]' blockindent='0' indent='0'><font face='Open Sans' size='14.5pt' style='font-size:14.5pt' color='#ffffff'>Informed discussion is necessary and, as you can see, it does not have a negative effect. Moreover, it is useful to prove that a lot of information out there is wrong. Click on the next button to see some examples.</font></textformat></p></html><html><p align='left'><textformat leading='0' tabstops='[0, 48, 96, 144, 192, 240]' blockindent='0' indent='0'><font face='Open Sans' size='14.5pt' style='font-size:14.5pt' color='#ffffff'>In 2015, Vinay Prabhu and Andrew B. Rosenkrantz conducted a study which assessed perspectives and information relating to CT radiation risk on Twitter, a popular microblogging social network which became an important venue for the dissemination of information and sharing of ideas in medicine. The results showed that virtually 60% of user commentary in tweets were unfavorable or concerned about CT radiation risks. This heavy unfavorable view regarding CT on Twitter urges radiologists, physicists and radiologic technologists to actively engage in social networking sites to balance the social media dialogue.</font></textformat></p></html><html><p align='left'><textformat leading='0' tabstops='[0, 48, 96, 144, 192, 240]' blockindent='0' indent='0'><font face='Open Sans' size='14.5pt' style='font-size:14.5pt' color='#ffffff'>Another is example is that of an informal survey carried out at a WHO conference held in 2010. Patient/parent advocates, radiologists, medical physicist, pediatricians, nurses, regulators, public policy experts, among many other professionals are expected to be in a conference like that. Yet, 70% didn’t know that signed informed consent was not necessary for medical radiation delivery.</font></textformat></p></html><html><p align='left'><textformat leading='0' tabstops='[0, 48, 96, 144, 192, 240]' blockindent='0' indent='0'><font face='Open Sans' size='14.5pt' style='font-size:14.5pt' color='#ffffff'>You need to be more engaged to improve your message and develop strategies to bring information on CT scan radiation risks to people. Using social media is a good strategy but take a look at the microsite Image Gently created for parents. </font></textformat></p><p align='left'><textformat leading='0' tabstops='[0, 48, 96, 144, 192, 240]' blockindent='0' indent='0'><font face='Open Sans' size='14.5pt' style='font-size:14.5pt' color='#ffffff'>The Image Gently Alliance is a coalition of health care organizations dedicated to providing safe, high quality pediatric imaging worldwide. The primary objective of the Alliance is to raise awareness in the imaging community of the need to adjust radiation dose when imaging children. </font></textformat></p><p align='left'><textformat leading='0' tabstops='[0, 48, 96, 144, 192, 240]' blockindent='0' indent='0'><font face='Open Sans' size='14.5pt' style='font-size:14.5pt' color='#ffffff'>Click on the pictures below the link to see part of it.</font></textformat></p></html><html><p align='left'><textformat leading='0' tabstops='[0, 48, 96, 144, 192, 240]' blockindent='0' indent='0'><font face='Open Sans' size='14.5pt' style='font-size:14.5pt' color='#ffffff'>Now it’s time to highlight the main ideas discussed through this course. Click on each point to read more about it.</font></textformat></p></html><html><p align='left'><textformat leading='0' tabstops='[0, 48, 96, 144, 192, 240]' blockindent='0' indent='0'><font face='Open Sans' size='15pt' style='font-size:15pt' color='#ffffff'>We have reached the end of this journey to effective communication. Remember: good content delivered poorly is a poor message. So be careful and deliver your message wisely!</font></textformat></p></html>