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Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care
Published on: February 16, 2011
Avoidance: Exposure Therapy Informed Communication for Serious Illness Care.
Danielle Chammas1,2, Vicki Jackson3,4, Keri O Brenner5
1Department of Medicine, Division of Palliative Medicine, UCSF, San Francisco, California, USA.
Serious illness communication can be enhanced using exposure therapy principles to help patients manage anxiety and engage in decision-making. This approach reduces distress and improves resilience for patients facing difficult medical information.
Area of Science:
- Psychology
- Palliative Care
- Oncology
Background:
- Patients with serious illnesses may avoid distressing information, hindering values-based decisions.
- Death-related anxiety can lead to avoidance of crucial prognostic and end-of-life care discussions.
Purpose of the Study:
- To explore the application of exposure therapy principles in serious illness communication.
- To demonstrate how to adapt communication strategies for patients experiencing emotional avoidance.
Main Methods:
- Utilized core exposure therapy principles: safety, individualization, titration, and coping enhancement.
- Applied techniques like progressive disclosure and calibration of language potency.
- Used the "container" metaphor to match communication to patient readiness.
Main Results:
- Adapted communication strategies successfully supported patient engagement and reduced distress.
- Enhanced patient tolerance for difficult conversations over time.
- Strengthened psychological resilience in a patient with advanced cancer.
Conclusions:
- Integrating exposure-informed approaches into palliative care can improve communication for anxious patients.
- This strategy helps patients move from emotional avoidance toward values-concordant care.
- Clinicians can effectively manage patient distress and enhance decision-making capacity.

