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11/13/24, 8\:10 PM Guide | Ideas, concerns & expectations (ICE)

Ideas, concerns & expectations (ICE)

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Introduction

Establishing a patient's ideas, concerns and expectations, often called ICE, during consultations (both in real life and OSCEs) is
essential for understanding a patient’s viewpoint and is a cornerstone of patient-centred communication.
Using ICE helps establish a patient’s health beliefs, reach a shared understanding and results in a more e
Understanding patients’ perspectives leads to increased adherence to treatment, reduced unnecessary prescriptions,
improved shared decision-making and greater patient satisfaction.
Using ICE in consultations and OSCEs can be challenging. In this article, we will cover how to use ICE when communicating
with patients and include some example phrases you can use.

Ideas

Ideas should cover the patient's prior or baseline knowledge about the situation or their condition. This is an opportunity to
clarify misconceptions, improve understanding and build rapport. Ideas may include their thoughts about their condition's
nature, cause, or progression.
Be mindful of your wording, and use open-ended questions encouraging the patient to share their perspective freely\:
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“ W h a t t h o u g h t s h a v e y o u h a d a b o u t t h i s / w h a t a r e y o u r t h o u gh t s o n t h i s ?”
“ W h a t d o y o u t h i n k i s c a u s i n g t h i s ?”
“ W h a t d o y o u t h i n k m i g h t b e g o i n g o n ?”

Concerns

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Concerns will address the patient's fears and anxieties surrounding the situation. Concerns can relate to the seriousness of the
issue, potential implications for the future or unpleasant feelings and emotions.
“ W h a t w o r r i e s d o y o u h a v e a b o u t t h e s e s y m p t o m s ?”
“ I s t h e r e s o m e t h i n g s p e c i
“ W h a t i s y o u r b i g g e s t w o r r y a t t h e m o m e n t ?”

Expectations

Establishing the patient's expectations ensures you and the patient have the same agenda, ensuring that the consultation
addresses the patient's expectations, whether this is therapeutic options (e.g. prescribing a medication), advice or referral.
“ W h a t d o y o u h o p e t o g e t f r o m t h e c o n s u l t a t i o n ?”
“ W h a t w e r e y o u h o p i n g I m i g h t b e a b l e t o d o f o r y o u t o d a y ?”
“ Y o u’ v e c l e a r l y g i v e n t h i s s o m e t h o u g h t ; h o w w o u l d y o u l i k e t o go f o r w a r d w i t h t h i s ?”
“ W h a t d o y o u t h i n k m i g h t b e h e l p f u l f o r y o u ?”
Example of ICE in a consultation
A 52-year-old man, employed as a postman, presents to the GP with progressively worsening knee pain.
Ideas
“ I’ v e b e e n t h i n k i n g t h a t i t m i g h t b e s o m e k i n d o f a r t h r i t i s . M y m o t h e r , d u r i n g h e r l a t e r y e a r s , r e p l a c e m e n t d u e t o s e v e r e j o i n t p a i n a n d s h e r e a l l y l i m i t e d m o v e m e n t i n h e r h a n d s .
”
Concerns
h a d t o ge t a h i p
“ I’ v e b e e n w o r r y i n g a b o u t t h e i m p a c t o n m y w o r k . I s p e n d a l l d a y o n m y f e e t , a n d t h i s k n e e p a i n i s m a k i n g i t i n c r e d i b l y
d i
w a l k i n g a n d s t a n d i n g”
Expectations
“ I’ m h o p i n g t h a t y o u c o u l d a r r a n g e a n X -r a y o r s o m e o t h e r t e s t s ? H a v i n g a d i a g n o s i s w o u l d gi v e m e s o m e p e a c e o f
m i n d a n d h e l p m e p l a n f o r t h e f u t u r e .
”
Establishing ICE will help you address the patient's concerns (impact on work) and expectations (X-ray) during the
consultation.

Integrating ICE

ICE is not just a box-ticking exercise. Instead, it should
developing your ability to integrate ICE within the consultation requires practice. Actively listen and respond empathetically to
patients’ answers, ensuring their concerns are not brushed aside or skimmed over.
In real-life consultations, try not to see ICE as an isolated part of the consultation but as woven throughout the interaction by
e
For a structured approach, consider incorporating ICE during the ‘gathering information’ stage of the Calgary-Cambridge
model. Using open and closed questions, you can explore patients’ problems comprehensively. Using ICE at this point will lay
the foundation for a patient-centred consultation and provide a structured framework for the remainder of the consultation.
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OSCE examiner's tip
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It's important to cover ICE during communication skills OSCE stations (e.g. history taking and counselling stations). Most
patient scripts and examiner checklists include ICE, and you can lose marks if you do not cover this within your
consultation.

References

1. Tate, P. (2005). Ideas, concerns and expectations. M e d i c i n e , 3 3 (2), 26-27.
2. Murtagh, G. M. (2023). A critical look at ideas, concerns and expectations in clinical communication. M e d i c a l E d u c a t i o n , 5 7 (4),
331-336.
3. Whitaker, P. (2021). Ticking the ice box\: the future of doctor-patient communication in a post-covid world. B M J , 3 7 3 .
4. Denness, C. (2013). What are consultation models for?. I n n o v A i T , 6 (9), 592-599.
Source\: geekymedics.com
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