Vidyya Medical News Service
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Volume 6 Issue 12 Published - 14:00 UTC 08:00 EST 12-Jan-2004 Next Update - 14:00 UTC 08:00 EST 13-Jan-2004
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Information for practitioners: Using the 2-COM checklist

Introduction

Many patients with schizophrenia have trouble communicating their concerns and needs to the healthcare team. Often, the biggest concerns for patients relate to problems that arise in coping with the impact of the illness and its treatment on daily living these concerns can be among the most difficult to identify during the clinic appointment. The 2-COM checklist has been designed to help patients, caregivers and their care teams to:

  • Talk more openly about individual patients experiences of schizophrenia, treatment and their impact on daily living.
  • Find out what problems are bothering individual patients.
  • Take action to deal with problems identified.
  • Track the effects of action taken over time.

Purpose

2-COM is designed to help your patients better verbalise his or her concerns, and to help you and the care team find out what problems are causing most difficulties to each patient. Taking notice of these problems and doing something about them can help strengthen the relationship between patient and care team and improve patient satisfaction with care.

2-COM asks about common problems which might be related to the symptoms of the illness, to antipsychotic medications or to general problems which the patient might encounter on a day-to-day basis, such as housing or relationship difficulties. Again, bringing the problems to light, and discussing potential solutions as a team can strengthen the relationship between care team and patient.

The 2-COM Checklist

2-COM is a checklist of common problems that is designed to ensure that the patients concerns are identified and discussed during the clinical interview. 2-COM is to be filled in by the patient at the clinic before seeing the clinician. The process:

  • The patient will tick (√) yes to any problems listed on the checklist which relate to them
  • The patient will tick (√) no problems which are not a concern to them
  • The patient will tick (√) the third column would you like to talk about it, indicating that he/she would like to discuss this particular problem with the clinician or another member of the care team.

The second section of 2-COM is also to be completed by the patient, although some assistance may be required. This section allows information about an individuals experiences of illness, treatment and daily living to be captured at each appointment and tracked over time. The second section of the 2-COM checklist will allow you and your patient to monitor progress and the impact of action taken to address concerns raised.

A pilot study of 2-COM carried out with 126 patients with schizophrenia at 6 centres in Europe indicated that on over 80% of occasions the patients found the checklist to be useful in making their doctor aware of the problems they were experiencing. Indeed, in 23% of cases, 2-COM revealed problems that were previously unknown to the healthcare team. The final version of 2-COM was used in a fresh sample of 243 out-patients. The results were very encouraging, showing that 2-COM is a reliable and valuable instrument to bridge the gap in patient-professional discordance on patient needs. The results show that over half the patients found 2-COM helped the clinician know more about them, and in 63% of the cases, 2-COM revealed problems that had previously gone unnoticed by the healthcare team. 60% of the patients found 2-COM helped them discuss available treatment options and 40% of clinicians found 2-COM to be useful too. Overall, 2-COM appears particularly useful, among those who need it most patients with the highest number of needs.

Using 2-COM

2-COM was developed to be a flexible communication tool, so you should experiment to find out where the tool will work best in your own clinical setting. Some patients may not be able to fully understand the questions or how to respond to them. It may be better to have someone there who knows the patient and can help them answer the questions. You may want to go through the checklist with your patient during the clinical interview itself, or perhaps to encourage other members of the healthcare team to work through the checklist with the patient before the interview.

No matter how they are identified, a better understanding of any problems makes it easier to form a good relationship with your patient.

Before using 2-COM

You need to make sure that you know what to do with the information you get. If you work in a mental health service, you need to discuss it with the appropriate person, and find out which steps to take next. 2-COM works best when it is possible to schedule a follow-up assessment within a few weeks. Otherwise, the patient may feel as if his or her concerns are not being taken seriously.

Points to consider

Keep in mind that 2-COM is not foolproof. Some people will over-report problems, while others may actually have some of the problems covered in the checklist, but do not to report them.

Using 2-COM [Patient]

The 2-COM checklist has been put together to help you talk more openly with your doctor or your nurse about any problems you might be having. By knowing more about your problems, your doctor or nurse may be able to do more to help you. It can be difficult to remember to mention all the things that are bothering you when you go to see the doctor. The 2-COM list will help you to remember the things that you want to talk about with the doctor at your appointment.

STEP 1:

Complete the checklist while you are waiting for your appointment. Go down the list of questions and tick (v) all of the boxes that apply to you. Completing the form shouldnt take more than a few minutes. If you do not want to give answers to some of the questions then they should be left blank, but you should answer questions the as honestly as you can. There are no right or wrong answers. Only you and your doctor or nurse will know what answers you have given.

STEP 2:

On the back of the form are three scales for you to mark with a cross (X). The scales help tell the doctor how you are managing with your treatment, how you think you are coping with everyday life and how you are feeling generally. Putting a cross nearer the bottom of the scale means you think you are not doing very well. Putting a cross nearer the top of the scale means you think you are doing well.

STEP 3:

Give your form to your doctor at the beginning of your clinic appointment so that you can work through the list together and discuss the problems you have ticked.


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