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Effective TB Interviewing for Contact Investigation: Facilitator Led Training Guide 2006

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10. Course Activities

Facilitator

Activity 7: TB Interview Structure Exercise

Objective

To become familiar with components of TB interview

Time Allotted135 minutes total
  • 5 minutes for instructions
  • 60 minutes for interviews
  • 30 minutes for patient feedback
  • 30 minutes for observer feedback
  • 10 minutes for group discussion

Materials Needed

Copies of the “TB Interview Checklist” on pages 62-63, the “Observer’s Assessment Form” on page 64, and the three cases for all of the participants.

Pre-Course Procedure
  1. Photocopy the “TB Interview Checklist” and the “Observer’s Assessment Form” for each participant. Look at the case description sheets (pages 65-70). In each case description, there are three different roles for participants to play, including the patient, the interviewer, and the observer.
  2. Make photocopies of the whole set of case descriptions. The number of copies will be the total number of class participants divided by three, e.g., if there are 12 participants, you will have 4 copies of the entire set of cases. Paper clip each grouping of three slightly different pages together. Each grouping must have a description for Participant A, B, and C. Note that you may modify any of the cases to fit demographics of the local patient population.

Procedure
  1. During the course, divide the class into groups of three (triads). You can have people count off by the number of groups that you anticipate, e.g., if the course has 15 people, you will have 5 triads, so ask people to count off in groupings of 5. Then ask all of the 1s to go into one group, 2s in another group, etc. Designate locations in which each group should meet.
  2. Hand a set of the case descriptions and an interview checklist and observer assessment form to each person in each group.
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  3. Instruct each group that they are going to be involved in three brief role-plays representing three different patients. For each role-play, each group participant plays a different role. In one, a participant will be a patient, in one an interviewer, and in one an observer. The order in which participants play the role of patient, observer, and interviewer is pre-designated by the labels ‘Participants A, B, or C’ that participants will find printed on the tops of their handout sheets. Ask participants to choose letter A, B, or C and take the set of case descriptions which pertain to them. During the interview, they may use the “TB Interview Checklist” to assist them.
  4. The interviewer has 20 minutes to conduct the interview. After the interview is over, the patient has 10 minutes to provide the interviewer with feedback on how he or she felt and anything the interviewer may have missed. The observer then has 10 minutes to give his or her feedback to the interviewer, using the attached “Observer Assessment Form.”
  5. You should provide time reminders for each part of the interview as it occurs. You should also walk around the room to see how the exercise is progressing.
  6. When all groups are finished with their interviews, have them come back together and discuss how the process felt. For new interviewers, this activity is a good way to become familiar with question asking and the order in which to conduct an interview.

Participant

Activity 7: TB Interview Checklist

Checklist, p. 1

Introduction

  • Introduce self
  • Provide identification
  • Explain role in TB control
  • Build trust and rapport
  • Explain purpose of interview
  • Ensure confidentiality

Information and Education Exchange

  • Observe patient’s physical and mental state and evaluate communication skills
  • Collect and confirm the following information:
– Name
– Alias(es)/nickname(s)
– Date of birth
– Address
– Telephone number
– Next of kin
– Other locating information
– Physical description
– Known exposure to TB
– Recent hospitalization(s) for TB
– Medical provider for TB
– Transportation availability
– Other medical conditions
– Outpatient DOT plan
– Barriers to adherence

Assess disease comprehension/provide TB education

  • Obtain and confirm TB symptom history
  • Discuss basis of patient’s current diagnosis
  • Discuss disease intervention behaviors (treatment, infection control, and medical appointments)
  • Refine infectious period and review significance with patient

Contact Identification

  • Focus on infectious period
  • Explain priority and nonpriority contacts based on exposure
  • Stress importance of identification of all close contacts
  • Collect information on patient’s contacts in the household/residence, workplace, school, other congregate settings, and social/recreational environments during the infectious period including
– Name
– Alias(es)/nickname(s)
– Age, race, and sex
– Address and telephone number
– Other locating information
– Physical description
– Hours of exposure per week
– Dates of first and last exposures
 
  • Discuss site visits and sharing information on a need-to-know basis and reinforce confidentiality
  • Discuss patient vs. health department referrals

Conclusion

  • Request, then answer patient’s questions
  • Review and reinforce adherence plan
  • Restate next appointment (if known)
  • Arrange reinterview and home visit (if not already completed)
  • Leave name and telephone number
  • Thank patient and close interview

Observer

Activity 7: Observer’s Assessment Form

Participant as Observer Handout

Complete this form when you are observing an interview. Circle the number indicating your opinion of the interviewer’s performance in the following activities.
ExcellentPoor
Established trust and rapport12345
Identified and addressed patient’s concerns12345
Exhibited confidence12345
Demonstrated professionalism12345
Used simple language and had clear explanations12345
Focused on an infectious period12345
Listened carefully12345
Exhibited nonjudgmental behavior12345
Made conversation flow easily12345

Comments:

Participant

Activity 7: Case Descriptions

Participant A

Participant A
Role Info. Form, p. 1

Instructions

The purpose of this exercise is to become familiar with the TB interview process and practice the questions you need to ask as an interviewer. As instructed by your course facilitator, read the information provided about each scenario as you come to each one. You will play a different role for each interview, as designated, for each of three rounds. Your other group members will also play roles as designated on their handouts. When you are in the role of the patient, do not give information away readily, but do not be an overly challenging patient either. Try to assist the interviewer through the process of the interview as part of the learning process. Your course facilitator will let you know when to move on to the different segments of this activity. You will have 20 minutes for each interview, 10 minutes for ‘Patient’ feedback, and 10 minutes for ‘Observer’ feedback.

Round 1 – Carl (Carla)

You are the patient in this interview. At the end of this interview, let the interviewer know how you think he or she did. Think about how you felt as a ‘patient.’

You are a patient named Carl (Carla), a 32-year-old who was admitted for same-day knee surgery at a local hospital 1 month ago. When the doctor did a routine physical exam and looked at your throat, he found a lump. He did a biopsy of the lump and it turned out to be TB. However, the diagnosis of TB was not made until a month later. You were then put on a lot of medications. The doctor told you that you could go back to work in a few weeks. You take your medications at home with the help of a person from the health department who comes to your home and watches you take the medications. You were tested for HIV 4 years ago and didn’t have it.

You live with nine relatives, volunteer in the city fire department, and serve as a minister of a neighborhood church. A health department worker has come to your home to interview you. You are alone at home.

Round 2 – Joseph (Josephine)

You are the interviewer in this interview.
Use the TB interview checklist to conduct your interview. You will have 20 minutes to complete the interview.

The patient you interview is Joseph (Josephine), a 21-year-old who has complained of productive cough, hemoptysis, night sweats, and loss of appetite for one month. Joseph (Josephine) was referred by a local college Student Health Center to a neighborhood medical clinic. CXR at clinic revealed an infiltrate, so the patient was referred to a TB clinic for follow-up. At the TB clinic, 6 sputum specimens were collected over a 7-day period – 5 smears negative and 1 positive. An appropriate 4-drug regimen was started with clinic-based daily DOT, and an interview is taking place in the clinic.

Round 3 – Paul (Paulette)

You are the observer in this scenario.
Use the Observer’s Assessment Form to make comments and provide feedback to the interviewer.

This is what the patient’s information says: You are a patient named Paul (Paulette), a 33-year-old who has had a cough and weight loss for 1 month and went to the hospital for fever, chills, and night sweats in the past few days. They admitted you into the hospital, did a lot of tests on you, and told you that you have TB. You have had TB before and have been in and out of different hospitals for the past 3 years for TB, but you never seem to be able to finish treatment. You don’t really care about the treatment since you also have HIV infection and think you will die from one illness or the other anyway. You live with your aunt and sister and have no job. You don’t use drugs or alcohol and most likely got HIV from a sexual encounter.

This is what the interviewer’s information says: The patient you interview is Paul (Paulette), a 33-year-old who was admitted to a local hospital with complaints of cough, weight loss for 1 month, and fever, chills, and night sweats for about 3 days. TST result is 0 mm and patient is HIV infected. Chest X-ray reveals left pleural effusion and infiltrates. Sputum smear is negative and culture is pending. Hospital record indicates that patient acknowledges a 3-year history of six TB-related admissions to area hospitals with all sputa negative on smear but positive on culture.

Participant

Activity 7: Case Descriptions

Participant B

Participant B
Role Info. Form, p. 1

InstructionsThe purpose of this exercise is to become familiar with the TB interview process and practice the questions you need to ask as an interviewer. As instructed by your course facilitator, read the information provided about each scenario as you come to each one. You will play a different role for each interview, as designated, for each of three rounds. Your other group members will also play roles as designated on their handouts. When you are in the role of the patient, do not give information away readily, but do not be an overly challenging patient either. Try to assist the interviewer through the process of the interview as part of the learning process. Your course facilitator will let you know when to move on to the different segments of this activity. You will have 20 minutes for each interview, 10 minutes for ‘Patient’ feedback, and 10 minutes for ‘Observer’ feedback.

Round 1 – Carl (Carla)

You are the interviewer in this scenario.
Use the TB interview checklist to conduct your interview.
You will have 30 minutes to complete the interview.

The patient you interview is Carl (Carla), a 32-year-old who was admitted to the hospital for same-day knee surgery 1 month ago. A routine physical exam uncovered a cyst in the throat. A biopsy of the epiglottis cyst revealed M. tuberculosis on culture (smear negative). The patient is sensitive to first-line drugs and was just started on DOT at home after culture results came back. The patient is asymptomatic, tested HIV-negative 4 years ago, and has been ordered to stay at home for 2 weeks. You will conduct the interview in the patient’s home.

Round 2 – Joseph (Josephine)

You are the observer in this scenario.
Use the Observer’s Assessment Form to make comments and provide feedback to the interviewer.

This is what the patient’s information says: You are a patient named Joseph (Josephine), a 21-year-old who was referred by the Student Health Center of a local college to a neighborhood medical clinic. You had a bad cough and chills, were spitting up blood, and had no appetite for about 1 month. They took a chest X-ray and did some other tests and told you that you have TB. You were then referred to the TB clinic for medications and medical care. You go to the clinic to take your medication daily.

You live with a roommate in off-campus housing, are a psychology major attending 5 classes, and tutor other college students. You are worried about who may have gotten TB from you, but are also concerned about people finding out about your illness. Today you are also at the clinic to be interviewed by a health department worker.

This is what the interviewer’s information says: The patient you interview is Joseph (Josephine), a 21-year-old who has complained of productive cough, hemoptysis, night sweats, and loss of appetite for 1 month. Joseph (Josephine) was referred by a local college Student Health Center to a neighborhood medical clinic. CXR at clinic revealed an infiltrate, so the patient was referred to a TB clinic for follow-up. At the TB clinic, 6 sputum specimens were collected over a 7-day period - 5 smears negative and 1 positive. An appropriate 4-drug regimen was started with clinic-based daily DOT, and an interview is taking place in the clinic.

Round 3 – Paul (Paulette)

You are the patient in this scenario.
At the end of this interview, let the interviewer know how you think he or she did.
Think about how you felt as a ‘patient.’

You are a patient named Paul (Paulette), a 33-year-old who has had a cough and weight loss for 1 month, and went to the hospital for fever, chills, and night sweats in the past few days. They admitted you into the hospital, did a lot of tests on you, and told you that you have TB. You have had TB before and have been in and out of different hospitals for the past 3 years for TB, but you never seem to be able to finish treatment. You don’t really care about the treatment since you also have HIV infection and think you will die from one illness or the other anyway. You live with your aunt and sister and have no job. You don’t use drugs or alcohol and most likely got HIV from a sexual encounter. An interviewer has come to talk to you in your hospital room.

Participant

Activity 7: Case Descriptions

Participant C

Participant C
Role Info. Form, p. 1

Instructions

The purpose of this exercise is to become familiar with the TB interview process and practice the questions you need to ask as an interviewer. As instructed by your course facilitator, read the information provided about each scenario as you come to each one. You will play a different role for each interview, as designated, for each of the three rounds. Your other group members will also play roles as designated on their handouts. When you are in the role of the patient, do not give information away readily, but do not be an overly challenging patient either. Try to assist the interviewer through the process of the interview as part of the learning process. Your course facilitator will let you know when to move on to the different segments of this activity. You will have 20 minutes for each interview, 10 minutes for ‘Patient’ feedback, and 10 minutes for ‘Observer’ feedback.

1 – Carl (Carla)

You are the observer in this scenario.
Use the Observer’s Assessment Form to make comments and provide feedback to the interview.

This is what the patient’s information says: You are a patient named Carl (Carla), a 32-year-old who was admitted for same-day knee surgery at a local hospital 1 month ago. When the doctor did a routine physical exam and looked at your throat, he found a lump. He did a biopsy of the lump and it turned out to be TB. However, the diagnosis of TB was not made until a month later. You were then put on a lot of medications. The doctor told you that you could go back to work in a few weeks. You take your medications at home with the help of a person from the health department who comes to your home and watches you take the medications. You were tested for HIV 4 years ago and didn’t have it.

You live with nine relatives, volunteer in the city fire department, and serve as a minister of a neighborhood church. A health department worker has come to your home to interview you. You are alone at home.

This is what the interviewer’s information says: The patient you interview is Carl (Carla), a 32-year-old who was admitted to the hospital for same-day surgery 1 month ago. A routine physical exam uncovered a cyst in the throat. A biopsy of the epiglottis cyst reveals M. tuberculosis on culture (smear negative). The patient is sensitive to first-line drugs and was just started on DOT at home after culture results came back. The patient is asymptomatic, tested HIV-negative 4 years ago, and has been ordered to stay at home for 2 weeks. You will conduct the interview in the patient’s home.

2 – Joseph (Josephine)

You are the patient in this scenario.
At the end of this interview, let the interviewer know how you think he or she did.
Think about how you felt as a ‘patient.’

You are a patient named Joseph (Josephine), a 21-year-old who was referred by the Student Health Center of a local college to a neighborhood medical clinic. You had a bad cough and chills, were spitting up blood, and had no appetite for about 1 month. They took a chest X-ray and did some other tests and told you that you have TB. You were then referred to the TB clinic for medications and medical care. You go to the clinic to take your medication daily.

You live with a roommate in off-campus housing, are a psychology major attending 5 classes, and tutor other college students. You are worried about who may have gotten TB from you, but are also concerned about people finding out about your illness. Today you are also at the clinic to be interviewed by a health department worker.

3 – Paul (Paulette)
You are the interviewer in this scenario.
Use the TB interview checklist to conduct your interview.
You will have 30 minutes to complete the interview.

The patient you interview is Paul (Paulette), a33-year-old who was admitted to a local hospital with complaints of cough, weight loss for 1 month, and fever, chills, and night sweats for about 3 days. The TST result is 0 mm and patient is HIV positive. CXR reveals left pleural effusion and infiltrates. The sputum smear is negative and culture is pending. The hospital record indicates that the patient acknowledges a 3-year history of six TB-related admissions to area hospitals, with all sputa negative on smear but positive on culture.


 
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