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Warren SE, Lopez LC, Anthony T, Coco L. Communication Public Health: An Integration of Audiology, Speech-Language Pathology, and Public Health. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:3022-3039. [PMID: 39083459 DOI: 10.1044/2024_jslhr-23-00491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
PURPOSE Health care is advancing toward a collaborative and integrative approach that promotes general health and wellness while addressing health inequities through the consideration of broader social and economic factors that influence the well-being of the entire population. Recently, there has been growing evidence of public health concept applications in fields related to speech, language, and hearing. However, there is an outstanding need to explicitly define the intersection of public health, including prevention and health promotion, and the discipline of communication sciences and disorders (CSD) across the areas of education, clinical practice, research, and policy. The authors propose a definition for this intersection using the new term communication public health. METHOD This tutorial provides guidance on how to conceptualize communication public health and invites refinement and expansion of the intersection between public health and CSD. Because readers are experts in CSD, this tutorial aims to supplement existing knowledge with information on public health to achieve three main objectives: (a) increase knowledge of the application of public health concepts among speech, language, hearing, and related professionals (SLHP+); (b) introduce the concept of communication public health; and (c) discuss the relevance of communication public health across domains within CSD. The authors utilize the socioecological model to provide examples of applications. RESULTS The concept of communication public health is proposed as the collaborative area of CSD and public health, which encompasses prevention and promotion of equity in communication health through individual-, community-, and population-level efforts. The goals of communication public health are achieved through applications of public health principles in CSD education, clinical practice, research, and policy. CONCLUSION Communication public health defines an area of collaboration between public health and CSD in which SLHP+ can apply public health concepts to both advance communication health and address health disparities.
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Affiliation(s)
- Sarah E Warren
- School of Communication Sciences and Disorders, The University of Memphis, TN
| | - Leslie C Lopez
- Department of Communication Disorders, School of Allied Health Professions, Louisiana State University Health Sciences Center, New Orleans
| | - Teresa Anthony
- College of Public Health, University of South Florida, Tampa
| | - Laura Coco
- School of Speech, Language, and Hearing Sciences, College of Health and Human Services, San Diego State University, CA
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Minga J, Fullwood SP, Rose D, Fannin DK. The Right ICD Code, Right Now: A Call to Action for Pragmatic Language Disorders After Right Hemisphere Stroke. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024:1-8. [PMID: 39173072 DOI: 10.1044/2024_ajslp-24-00090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
PURPOSE Diagnosis of language impairments after stroke is important to optimizing stroke outcomes. After right hemisphere brain damage (RHD), apragmatism can impact the comprehension and production of pragmatic language. However, despite decades of empirical evidence, there is no International Classification of Diseases (ICD) code for RHD pragmatic language impairments. The absence of an ICD code has far reaching ramifications that impact patient outcomes, including reduced clinical and public awareness, limited curricular content, and underdiagnosis. This viewpoint justifies the need to appropriately classify the pragmatic language symptomology after RHD with an ICD code. CONCLUSION An ICD code can positively influence health care practitioner knowledge, education, and practice while informing public health considerations vital to epidemiological analyses.
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Affiliation(s)
- Jamila Minga
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC
- Department of Neurology, Duke University School of Medicine, Durham, NC
| | - Shanika Phillips Fullwood
- Moses Cone Memorial Hospital, Greensboro, NC
- Department of Communication Arts, Sciences, and Disorders, Brooklyn College, The City University of New York, NY
- Cognitive Neuroscience Admitting Program, Duke University, Durham, NC
| | - Deborah Rose
- Department of Neurology, Duke University School of Medicine, Durham, NC
| | - Danai Kasambira Fannin
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC
- Department of Communication Sciences and Disorders, North Carolina Central University, Durham
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Marshall J, Wylie K, McLeod S, McAllister L, Barrett H, Owusu NA, Hettiarachchi S, Atherton M. Communication disability in low and middle-income countries: a call to action. BMJ Glob Health 2024; 9:e015289. [PMID: 38991579 PMCID: PMC11288154 DOI: 10.1136/bmjgh-2024-015289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 05/31/2024] [Indexed: 07/13/2024] Open
Affiliation(s)
- Julie Marshall
- Health Professions Department, Manchester Metropolitan University, Manchester, UK
| | - Karen Wylie
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
- School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
| | - Sharynne McLeod
- School of Education, Charles Sturt University, Bathurst, New South Wales, Australia
| | - Lindy McAllister
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Helen Barrett
- CBM Global Inclusion Advisory Group, Amstelveen, The Netherlands
| | - Nana Akua Owusu
- School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
- AwaaWaa2, Accra, Ghana
| | - Shyamani Hettiarachchi
- Department of Disability Studies, University of Kelaniya, Faculty of Medicine, Colombo, Sri Lanka
| | - Marie Atherton
- Australian Catholic University, Faculty of Health Sciences, Melbourne, Victoria, Australia
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Phongpunpisand P, Pumtong S, Sunantiwat M, Anuratphanich L. Designing Hospital and Pharmacy Services for Visually Impaired Persons in Bangkok, Thailand. Hosp Top 2024; 102:135-144. [PMID: 35998197 DOI: 10.1080/00185868.2022.2111288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This cross-sectional study aimed to develop a hospital and pharmacy services model from the patient's perspective, identifying the gap and domain for services improvement. The study was conducted on 140 persons aged ≥ 18 years with visual impairment or low vision in Bangkok, Thailand. The results demonstrated that patients' perceived services were not inclusively designed for visually impaired persons. The domains with the highest gap analysis score were navigation systems, followed by a detailed explanation, such as dose mismanagement, observed medication expiration dates, and pharmacy self-identification. The patient-centered service model empowered visually impaired persons to achieve medication outcomes and safety.
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Affiliation(s)
- P Phongpunpisand
- Social, Economic and Administrative Pharmacy (SEAP) Graduate Program, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
- Department of Pharmacy, Chulabhorn Royal Academy, Bangkok, Thailand
| | - S Pumtong
- Social and Administrative Pharmacy Excellence Research (SAPER) Unit, Department of Pharmacy, Mahidol University, Bangkok, Thailand
| | - M Sunantiwat
- Social and Administrative Pharmacy Excellence Research (SAPER) Unit, Department of Pharmacy, Mahidol University, Bangkok, Thailand
| | - L Anuratphanich
- Social and Administrative Pharmacy Excellence Research (SAPER) Unit, Department of Pharmacy, Mahidol University, Bangkok, Thailand
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Mellahn K, Kilkenny M, Siyambalapitiya S, Lakhani A, Purvis T, Reyneke M, Cadilhac DA, Rose ML. Comparing acute hospital outcomes for people with post-stroke aphasia who do and do not require an interpreter. Top Stroke Rehabil 2024; 31:527-536. [PMID: 38116813 DOI: 10.1080/10749357.2023.2295128] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/11/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND People with communication differences are known to have poorer hospital outcomes than their peers. However, the combined impact of aphasia and cultural/linguistic differences on care and outcomes after stroke remains unknown. OBJECTIVES To investigate the association between cultural/linguistic differences, defined as those requiring an interpreter, and the provision of acute evidence-based stroke care and in-hospital outcomes for people with aphasia. METHODS Cross-sectional, observational data collected in the Stroke Foundation National Audit of Acute Services (2017, 2019, 2021) were used. Multivariable regression models compared evidence-based care and in-hospital outcomes (e.g., length of stay) by interpreter status. Models were adjusted for sex, hospital location, stroke type and severity, with clustering by hospital. RESULTS Among 3122 people with aphasia (median age 78, 49% female) from 126 hospitals, 193 (6%) required an interpreter (median age 78, 55% female). Compared to people with aphasia not requiring an interpreter, those requiring an interpreter had similar care access but less often had their mood assessed (OR 0.50, 95% CI 0.32, 0.76), were more likely to have physiotherapy assessments (96% vs 90% p = 0.011) and carer training (OR 4.83, 95% CI 1.70, 13.70), had a 2 day longer median length of stay (8 days vs 6 days, p = 0.003), and were less likely to be independent on discharge (OR 0.54, 95% CI 0.33, 0.89). CONCLUSIONS Some differences exist in the management and outcomes for people with post-stroke aphasia who require an interpreter. Further research to explore their needs and the practical issues underpinning their clinical care pathways is required.
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Affiliation(s)
- Kathleen Mellahn
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia
- School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia
| | - Monique Kilkenny
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Australia
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | | | - Ali Lakhani
- School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia
| | - Tara Purvis
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Australia
| | - Megan Reyneke
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Australia
| | - Dominique A Cadilhac
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Australia
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | - Miranda L Rose
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia
- School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia
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Oshita JY, Gell NM, Reed NS, Stransky ML, MacLean CD. Older adults with communication disabilities and their use of communication support at doctor's visits: a nationally representative study. Disabil Rehabil 2024:1-8. [PMID: 38826064 DOI: 10.1080/09638288.2024.2351155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 04/30/2024] [Indexed: 06/04/2024]
Abstract
PURPOSE Older adults with communication disabilities (CDs) experience barriers to receiving care and face a paucity of accommodations for their disability. Utilizing someone that supports communication with healthcare providers (communication support persons) may be a way that this group self-supports their disability. We examined if this utilization was independently associated with CDs among older adults. We also sought to understand if socioeconomic factors were associated with utilization. METHODS We used the 2015 National Health and Aging Trends Survey (NHATS) to conduct a cross-sectional analysis of Medicare beneficiaries (n = 5954) with functional hearing, expressive, or cognitive difficulties. We calculated a weighted, population prevalence and an adjusted prevalence ratio (APR) controlling for sociodemographic, health and other disability factors. RESULTS Among community dwelling older adults, having CDs was associated with higher utilization of a communication support person at medical visits (APR: 1.41 [CI: 1.27 - 1.57]). Among adults with CDs, Black adults and women had lower levels of utilization as compared to White adults and men, respectively. CONCLUSION Communication support persons may be a way that older adults with CDs self-support their disability. However, not all older adults with CDs bring someone and variation by social factors could suggest that unmet support needs exist.
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Affiliation(s)
- Jennifer Y Oshita
- Center for Bioethics and Humanities, University of Colorado, Aurora, CO, USA
| | - Nancy M Gell
- Nursing and Health Sciences, University of VT, Burlington, VT, USA
| | - Nicholas S Reed
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michelle L Stransky
- Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Boson, MA, USA
| | - Charles D MacLean
- Department of Medicine, University of Vermont The Robert Larner MD College of Medicine, Burlington, VT, USA
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Burton L, Milad F, Janke R, Rush KL. The Landscape of Health Technology for Equity Deserving Groups in Rural Communities: A Systematic Review. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2024:2752535X241252208. [PMID: 38713914 DOI: 10.1177/2752535x241252208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2024]
Abstract
BACKGROUND Equity-deserving groups face well-known health disparities that are exacerbated by rural residence. Health technologies have shown promise in reducing disparities among these groups, but there has been no comprehensive evidence synthesis of outcomes. PURPOSE The purpose of this systematic review was to examine the patient, healthcare, and economic outcomes of health technology applications with rural living equity-deserving groups. RESEARCH DESIGN The databases searched included Medline and Embase. Articles were assessed for bias using the McGill mixed methods appraisal tool. ANALYSIS Data were synthesized narratively using a convergent integrated approach for qualitative and quantitative findings. RESULTS This evidence synthesis includes papers (n = 21) that reported on health technologies targeting rural equity-deserving groups. Overall, patient outcomes - knowledge, self-efficacy, weight loss, and clinical indicators - improved. Healthcare access improved with greater convenience, flexibility, time and travel savings, though travel was still occasionally necessary. All studies reported satisfaction with health technologies. Technology challenges reported related to connectivity and infrastructure issues influencing appointment quality and modality options. While some studies reported additional costs, overall, studies indicated cost savings for patients. CONCLUSIONS There is a paucity of research on health technologies targeting rural equity-deserving groups, and the available research has primarily focused on women. While current evidence was primarily of high quality, research is needed inclusive of equity-deserving groups and interventions co-designed with users that integrate culturally sensitive approaches. Review registered with Prospero ID = CRD42021285994.
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Affiliation(s)
- Lindsay Burton
- School of Nursing, University of British Columbia-Okanagan, Kelowna, BC, Canada
| | - Fathi Milad
- School of Nursing, University of British Columbia-Okanagan, Kelowna, BC, Canada
| | - Robert Janke
- Department Of Library, University of British Columbia - Okanagan, Kelowna, BC, Canada
| | - Kathy L Rush
- School of Nursing, University of British Columbia-Okanagan, Kelowna, BC, Canada
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Hickey E, Man B, Helm KVT, Lockhart S, Duffecy J, Morris MA. Preferred Communication Strategies for People with Communication Disabilities in Health Care Encounters: a Qualitative Study. J Gen Intern Med 2024; 39:790-797. [PMID: 38010462 PMCID: PMC11043277 DOI: 10.1007/s11606-023-08526-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/02/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND People with communication disabilities (CDs), which includes disabilities in speech, language, voice and/or hearing, experience health and healthcare disparities. A barrier to accessing high-quality, equitable care is the lack of effective communication between patients and their providers. OBJECTIVE In designing a patient-prompted tool to facilitate communication, we analyzed qualitative feedback on communication strategies and the experience of people with CDs, caregivers, and providers in healthcare encounters. We aimed to describe communication strategies that patients with CDs find most useful and optimize a tool for patients to share their communication strategy preferences during clinical encounters. While patient-provider communication is paramount in every interaction, we aimed to highlight the intricacies of optimizing communication for this population. DESIGN We performed a qualitative study utilizing focus groups and interviews with patients with CDs, their caregivers, and healthcare providers. PARTICIPANTS A total of 46 individuals participated in focus groups or interviews; 26 participants self-reported a CD, nine were caregivers, and 11 were providers. Participants represented diverse types of CDs, including stuttering, aphasia, hearing loss, and people with autism or cerebral palsy who use assistive technology to communicate. APPROACH Analysis of qualitative interview and focus group data was guided by a qualitative content analysis approach. KEY RESULTS We identified three themes: (1) While communication strategies should be individualized, participants agreed upon a consolidated list of best strategies and accommodations. We used this consolidated list to finalize tool development. (2) Patients and providers preferred disclosure of the CD and desired communication strategies before the appointment. (3) Providers often do not use communication strategies and accommodations during clinical encounters. CONCLUSIONS For patients with CDs, it is critical to acknowledge and document the CD and individualize communication strategies during healthcare visits to facilitate communication. Studies are needed to evaluate whether improved communication strategy usage leads to improved health outcomes for this population.
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Affiliation(s)
- Erin Hickey
- University of Illinois at Chicago, Chicago, IL, USA.
| | - Bernice Man
- University of Illinois at Chicago, Chicago, IL, USA
| | - Kaila V T Helm
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Steven Lockhart
- Adult and Child Center for Health Outcomes Research and Delivery Service, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | | | - Megan A Morris
- Adult and Child Center for Health Outcomes Research and Delivery Service, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
- Divisions of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- Center for Bioethics and Humanities, University of Colorado School of Medicine, Aurora, CO, USA
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O'Leary DP, O'Leary TJ. Communicating With Patients With Hearing Loss or Deafness-Can You Hear Me? JAMA Intern Med 2024; 184:345-346. [PMID: 38407879 DOI: 10.1001/jamainternmed.2023.8563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
This Viewpoint explores the ideal safeguards to improve communication with patients who are deaf or hearing impaired.
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Affiliation(s)
- Dianne P O'Leary
- Department of Computer Science and Institute for Advanced Computer Studies, University of Maryland, College Park
| | - Timothy J O'Leary
- Office of Research and Development, Veterans Health Administration, Washington, DC
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Brown C, Prusynski R, Baylor C, Humbert A, Mroz TM. Patient Characteristics and Treatment Patterns for Speech-Language Pathology Services in Skilled Nursing Facilities. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:912-936. [PMID: 38215225 DOI: 10.1044/2023_ajslp-23-00025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
PURPOSE Skilled nursing facility (SNF) care has historically been influenced by systemic issues that could impact speech-language pathology (SLP) service provision. However, there has been little study specifically on factors associated with SLP service provision in SNFs. Large administrative data sets are rarely analyzed in SLP research but can be used to understand real-world SLP services. This study investigated associations between patient and facility characteristics and SLP services. METHOD Mixed-effects logistic regression models were used to evaluate factors associated with SLP service provision in 2018 Medicare administrative data representing 833,653 beneficiaries. RESULTS Beneficiaries had higher odds of receiving SLP services when they had neurologic diagnosis (odds ratio [OR] = 3.32), had SLP-related functional impairments (ORs = 1.19-3.41), and received other rehabilitative services (ORs = 3.11-3.78). Beneficiaries had lower odds of receiving SLP services when they received care from SNFs located in hospitals versus freestanding (OR = 0.45), with need for interpreter services (OR = 0.76) and with thresholding (OR = 0.68), a financially motivated practice. Direction of association varied across racial and ethnic groups and measures of location. Odds of being provided SLP services decreased with increasing communication impairment severity. CONCLUSIONS The results suggest that clinicians are identifying patients with diagnoses most likely to warrant SLP services. However, association disparities and weakening association of service provision with increasing impairment severity have concerning clinical implications. Health services research methods can be used to further explore SLP practices in SNFs to support equitable service provision.
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Affiliation(s)
- Cait Brown
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Rachel Prusynski
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Carolyn Baylor
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Andrew Humbert
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Tracy M Mroz
- Department of Rehabilitation Medicine, University of Washington, Seattle
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Carragher M, Steel G, O'Halloran R, Lamborn E, Torabi T, Johnson H, Taylor NF, Rose ML. Aphasia disrupts usual care: "I'm not mad, I'm not deaf" - the experiences of individuals with aphasia and family members in hospital. Disabil Rehabil 2024:1-12. [PMID: 38444182 DOI: 10.1080/09638288.2024.2324115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 02/22/2024] [Indexed: 03/07/2024]
Abstract
PURPOSE Communication difficulties are highly prevalent in the stroke population, with implications for patient experience, safety and outcomes. This study explores the experiences of people with aphasia and family members regarding healthcare communication in acute and subacute stroke settings. METHODS AND MATERIALS A phenomenological approach was used to understand participants' experiences. Participants took part in a focus group and data were analysed using an inductive thematic approach. RESULTS For individuals with aphasia (n = 4) and family members (n = 2), five themes were generated: "aphasia makes it hard to communicate," "hospital staff focus on the patient's medical status only," "people with aphasia do not get the help they need to improve," "staff lack the skills to communicate with people with aphasia," and "staff are crucial to improving healthcare communication." CONCLUSIONS The stroke team has expertise in the medical management of stroke but struggle to communicate with patients with aphasia. Patients' experience of healthcare communication is often one-way and limited to following instructions, with missed opportunities to discuss core topics such as prognosis, rehabilitation, and person-specific needs. Patients and families assert that all members of the stroke healthcare team should be able to adapt communication to accommodate patients.
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Affiliation(s)
- Marcella Carragher
- Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - Gillian Steel
- Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - Robyn O'Halloran
- Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - Edwina Lamborn
- Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - Torab Torabi
- Computer Science and Information Technology, School of Engineering and Mathematical Sciences, La Trobe University, Melbourne, Australia
| | - Hilary Johnson
- Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- Scope Communication and Inclusion Resource Centre, Melbourne, Australia
| | - Nicholas F Taylor
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia and Allied Health Clinical Research Office, Australia
| | - Miranda L Rose
- Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
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Shand R, Foster A, Baker C, O'Halloran R. Identifying communication difficulty and context-specific communication supports for patient-provider communication in a sub-acute setting: A prospective mixed methods study. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024:1-20. [PMID: 38425157 DOI: 10.1080/17549507.2023.2289350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
PURPOSE To identify the sub-acute rehabilitation inpatients who have communication difficulty and the range of communication supports that can facilitate communicative success. METHOD A prospective cohort mixed methods study was conducted on two inpatient sub-acute rehabilitation wards. Nurses screened all new admissions for communication difficulty using the Inpatient Functional Communication Interview, Screening Questionnaire (IFCI-SQ). Patients identified as having communication difficulty were interviewed by a speech-language pathologist (SLP) using the Inpatient Functional Communication Interview (IFCI). During the interview, the SLP trialled different communication supports. The number of patients who had communication difficulty on the IFCI-SQ was calculated. The number and type of communication supports that improved communication within the patient-SLP interview were calculated. Deductive-dominant qualitative content analysis was conducted on the communication supports used during the IFCI. RESULT Seventy patients were screened. Nurses reported communication difficulty in 45/70 (64%) of patients. A total of 15/45 patients were interviewed by an SLP using the IFCI. The provision of communication supports improved communication for all patients within the context of the patient-SLP interview. CONCLUSION Many sub-acute rehabilitation inpatients have communication difficulty in the hospital setting. A range of communication supports facilitated communication. These insights could inform future communication partner training (CPT) programs.
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Affiliation(s)
- Rosalind Shand
- Monash Health, Melbourne, Australia
- Discipline of Speech Pathology, La Trobe University, Melbourne, Australia
| | - Abby Foster
- Monash Health, Melbourne, Australia
- Discipline of Speech Pathology, La Trobe University, Melbourne, Australia
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Caroline Baker
- Monash Health, Melbourne, Australia
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia
| | - Robyn O'Halloran
- Discipline of Speech Pathology, La Trobe University, Melbourne, Australia
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia
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Itai Bendavid I, Assi S, Sasson N, Statlender L, Hellerman M, Fishman G, Singer P, Kagan I. The EyeControl-Med device, an alternative tool for communication in ventilated critically ill patients: A pilot study examining communication capabilities and delirium. J Crit Care 2023; 78:154351. [PMID: 37348187 DOI: 10.1016/j.jcrc.2023.154351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 05/16/2023] [Accepted: 05/26/2023] [Indexed: 06/24/2023]
Abstract
INTRODUCTION Communication with ventilated patients in the Intensive care unit (ICU) is challenging. This may lead to anxiety and frustration, potentially contributing to the development of delirium. Various technologies, such as eye-tracking devices, have been employed to facilitate communication with varying grades of success. The EyeControl-Med device is a novel technology that delivers audio content and allows patients to interact by eye movements and could potentially allow for better communication in this setting. The aim of this exploratory concept study was to assess communication capabilities and delirium incidence using the EyeControl-Med device in critically ill patients unable to generate speech. MATERIAL AND METHODS A single-arm pilot study of patients in a mixed ICU. Patients were approached for consent if they were invasively ventilated and/or tracheotomized, hence unable to generate speech, but had no severe cognitive or sensory impairment that could prevent proper usage. Patients underwent at least 3 sessions with the EyeControl-Med device administered by a speech-language pathologist. Communication and consciousness were assessed using the Loewenstein Communication Scale (LCS) tool during the first and last sessions. Delirium was assessed using a computerized CAM-ICU questionnaire. RESULTS 15 patients were included, 40% of whom were diagnosed with COVID-19. All patients completed three to seven usage sessions. The mean LCS score improved by 19.3 points (p < 0.0001), with each of its five components showing significant improvements as well. The mean number of errors on the CAM-ICU questionnaire decreased from 6.5 to 2.5 (p = 0.0006), indicating a lower incidence of delirium. No adverse effects were observed. CONCLUSION The EyeControl-Med device may facilitate communication and reduce the manifestations and duration of delirium in ventilated critically ill patients. Controlled studies are required to establish this effect.
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Affiliation(s)
- I Itai Bendavid
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
| | - Saja Assi
- Department of speech, language, swallowing, hearing & communication disorders, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Noga Sasson
- Department of speech, language, swallowing, hearing & communication disorders, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Liran Statlender
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Moran Hellerman
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Guy Fishman
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Pierre Singer
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Ilya Kagan
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
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Kofi Opoku E, Peprah Opoku M, Frimpomaa L, Nketsia W, Kwadwo Wisdom M, Akoto Y, Safi M. Understanding adults with communication disorders in Ghana: Accessing rehabilitation and support systems. Soc Sci Med 2023; 336:116231. [PMID: 37774531 DOI: 10.1016/j.socscimed.2023.116231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/03/2023] [Accepted: 09/07/2023] [Indexed: 10/01/2023]
Abstract
Communication is pivotal to our societal experiences; therefore, the onset of a communication disorder will negatively affect an individual's social capabilities. However, in sub-Saharan African countries, there is limited public discourse on the development of individuals with communication disorders. From the perspective of critical disability theory, there have been few opportunities for adults with communication disorders to share stories about their experiences and their developmental progress. A semi-structured interview guide was designed to collect data from 23 adults with communication disorders recruited from 10 communities in three districts in a region in Ghana. The findings are thematized under the following criteria: diagnosis and rehabilitation, familial support and impact on development. The study concludes with an invitation to policymakers to prioritize the rehabilitation needs of individuals with communication disorders and a discussion on additional study implications.
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Affiliation(s)
| | - Maxwell Peprah Opoku
- Special Education Department, United Arab Emirates University, United Arab Emirates.
| | - Lilian Frimpomaa
- Department of Sociology and Social Work, Kwame Nkrumah University of Science and Technology, Ghana
| | - William Nketsia
- School of Education; University of Western Sydney, Australia
| | - Mprah Kwadwo Wisdom
- Department of Disability and Education, Kwame Nkrumah University of Science and Technology, Ghana
| | - Yaw Akoto
- Department of Educational Studies and Leadership, University of Canterbury, New Zealand
| | - Mohammed Safi
- Department of Speech Language Pathology, United Arab Emirates University, United Arab Emirates
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Hinckley J, Jayes M. Person-centered care for people with aphasia: tools for shared decision-making. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1236534. [PMID: 37928752 PMCID: PMC10623353 DOI: 10.3389/fresc.2023.1236534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/02/2023] [Indexed: 11/07/2023]
Abstract
Shared decision-making is a fundamental aspect of person-centered care, and can and should be part of many different aspects of the rehabilitation process. Communication disabilities like aphasia, which affects people's ability to use and understand spoken and written language, can make shared decision-making especially challenging to the resources and skills of rehabilitation practitioners. The purpose of this narrative review is to provide a comprehensive description of tools that can support successful shared decision-making with people with aphasia in the rehabilitation environment. These tools and strategies are appropriate for use by physicians, nurses, social workers, physical therapists (also referred to as physiotherapists), occupational therapists, and other service or care providers. The important role of speech-language pathologists as consultants is also described. Case scenarios throughout the paper illustrate the application of recommended tools and strategies along with best practices.
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Affiliation(s)
- Jacqueline Hinckley
- Department of Speech/Language Pathology, Nova Southeastern University, Ft. Lauderdale, FL, United States
| | - Mark Jayes
- Department of Health Professions, Manchester Metropolitan University, Manchester, United Kingdom
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16
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Adams EJ, Schroth S, Kaundinya T. Student-driven disability advocacy and education within the health professions: pilot survey results from a single-day virtual conference. JOURNAL OF COMMUNICATION IN HEALTHCARE 2023; 16:255-259. [PMID: 37140055 DOI: 10.1080/17538068.2023.2208836] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Health professional programs can promote equitable healthcare delivery but few programs include disability in these efforts. Limited opportunities exist for health professional students to engage with disability education within the classroom or beyond. The Disability Advocacy Coalition in Medicine (DAC Med) is a national interprofessional student-led organization which hosted a virtual conference for health professional students in October 2021. We describe the impact of this single-day virtual conference on learning and the current state of disability education across health professional programs. METHODS This cross-sectional study utilized a 17-item post-conference survey. A 5-point Likert scale-based survey was distributed to conference registrants. Survey parameters included background in disability advocacy, curricular exposure to disability, and impact of the conference. RESULTS Twenty-four conference attendees completed the survey. Participants were enrolled in audiology, genetic counseling, medical, medical scientist, nursing, prosthetics and orthotics, public health, and 'other' health programs. Most participants (58.3%) reported not having a strong background in disability advocacy before the conference, with 26.1% indicating they learned about ableism in their program's curriculum. Almost all students (91.6%) attended the conference to learn how to be a better advocate for patients and peers with disabilities, and 95.8% reported that the conference provided this knowledge. Eighty-eight percent of participants agreed that they acquired additional resources to better care for patients with disabilities. CONCLUSIONS Few health professional students learn about disability in their curriculum. Single-day virtual, interactive conferences are effective in providing advocacy resources and empowering students to employ them.
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Affiliation(s)
- Elizabeth J Adams
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Samantha Schroth
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Trisha Kaundinya
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Nikkels A, Berns P, Neijenhuis K. Communication partner training for SLT students: Changes in communication skills, knowledge and confidence. JOURNAL OF COMMUNICATION DISORDERS 2023; 105:106366. [PMID: 37541131 DOI: 10.1016/j.jcomdis.2023.106366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 08/06/2023]
Abstract
This paper describes the changes in communication skills, knowledge and confidence in Speech Language Therapy (SLT) students in conversations with People With Aphasia (PWA) after Training Con-tAct, a Dutch Communication Partner Training. METHODS On a voluntary basis, nine SLT students (2nd yr) completed Training Con-tAct, in which People With Aphasia (PWA) were involved as co-workers. A mixed method design with pre- and post-measures was used to analyze the students' communication skills, knowledge and confidence. A quantitative video analysis was used to measure changes in students' communication skills. Besides, a self-report questionnaire was used to measure the changes in students' knowledge and confidence regarding their communication with PWA. To evaluate the perspectives of the students on Training Con-tAct, additionally a focus group interview was held. RESULTS Regarding students' communication skills the outcomes revealed a significantly higher score on the 'supporting' competence in students who took part in Training Con-tAct. The mean scores for the 'acknowledging' and 'checking information' competences did not improve significantly. The outcomes of the questionnaire showed students gained more knowledge and confidence regarding communication with PWA. The focus group interview provided insights into: motivation for participating in Communication Partner Training, content and structure of the training, feedback in CPT, and learning experiences. CONCLUSION The present study suggests that SLT students may benefit from Training Con-tAct as the training leads to better skills, more knowledge about aphasia and more confidence in communicating with PWA. Training Con-tAct could be a valuable addition to the curricula of all healthcare disciplines, and eventually support interprofessional collaboration, resulting in improved access to health care, which is important for communication vulnerable people. Further research with a larger sample size and a control group is required.
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Affiliation(s)
- Alissa Nikkels
- Rotterdam University of Applied Sciences, Research Centre Innovations in Care, Postbus 25035, Rotterdam, the Netherlands.
| | - Philine Berns
- Rotterdam University of Applied Sciences, Research Centre Innovations in Care, Postbus 25035, Rotterdam, the Netherlands
| | - Karin Neijenhuis
- Rotterdam University of Applied Sciences, Research Centre Innovations in Care, Postbus 25035, Rotterdam, the Netherlands
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Dorsey Holliman B, Stransky M, Dieujuste N, Morris M. Disability doesn't discriminate: health inequities at the intersection of race and disability. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1075775. [PMID: 37484601 PMCID: PMC10357509 DOI: 10.3389/fresc.2023.1075775] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 06/02/2023] [Indexed: 07/25/2023]
Abstract
Objectives Given the prevalence of discrimination experienced by racial and ethnic minorities living with disabilities, it is likely that racism experienced by Black, Indigenous, and people of color (BIPOC) is compounded by the ableism experienced by people with disabilities, widening disparities in health and healthcare outcomes. To address this, we described unmet healthcare needs of a sample of Black, non-Hispanic, and Hispanic adults with and without disabilities. The following research question was examined exploratively: Are Black and Hispanic adults with disabilities at increased risk of unmet healthcare needs compared to Black and Hispanic adults without disabilities according to the 2018 National Health Interview Survey? Methods Survey data was examined from the 2018 National Health Interview Survey (NHIS), a nationally representative survey of community-dwelling adults in the United States. Results Black and non-Hispanic adults most commonly reported mobility only disabilities. People with disabilities were significantly more likely to delay or forego care than their peers without disabilities within each racial/ethnic group. Among non-Hispanic Black and Hispanic adults, nearly 30% of people with disabilities forewent services due to cost compared to persons without disabilities. Conclusions Black and Hispanic adults with disabilities experience greater disparities in access to healthcare than Black and Hispanic adults without disabilities. Therefore, health disparities experienced by racial and ethnic minorities living with disabilities is likely influenced by the dual systemic factors of racism and ableism.
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Affiliation(s)
- Brooke Dorsey Holliman
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, United States
- Adult and Child Center for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado, Aurora, CO, United States
| | - Michelle Stransky
- Department of Medicine, Boston Medical Center, Boston, MA, United States
| | - Nathalie Dieujuste
- Adult and Child Center for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado, Aurora, CO, United States
- Department of Psychology, University of Denver, Denver, CO, United States
| | - Megan Morris
- Adult and Child Center for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado, Aurora, CO, United States
- Department of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, United States
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Mellahn K, Larkman C, Lakhani A, Siyambalapitiya S, Rose ML. The nature of inpatient rehabilitation for people with aphasia from culturally and linguistically diverse backgrounds: a scoping review. Top Stroke Rehabil 2023; 30:146-156. [PMID: 34854368 DOI: 10.1080/10749357.2021.2008599] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Due to language and cultural barriers, people with aphasia from culturally and linguistically diverse (CALD) backgrounds are at risk of disadvantage in their access to comprehensive care. They are at higher risk of poorer inpatient outcomes in addition to challenges in receiving appropriate aphasia assessment and intervention. OBJECTIVES This study aims to examine the extent and nature of what is known about the inpatient phase of aphasia rehabilitation for CALD stroke survivors and identify potential research gaps in the literature for investigation. METHODS A scoping review with systematic search was conducted in September 2020 following the PRISMA Scoping Review checklist. Five electronic databases were searched using a combination of terms pertaining to "aphasia," "inpatient care" and "CALD." Key variables were extracted from studies that met the inclusion criteria for analysis. RESULTS Eighteen studies were yielded. Data regarding the inpatient phase of care indicate that CALD people with aphasia do not always receive comprehensive assessment or intervention in all their languages that may impact their discharge destination and access to community services. Speech-language pathologists (SLPs) report numerous barriers to service provision for this population. No studies investigated the degree and nature of differences in outcomes between CALD and non-CALD stroke survivors with aphasia. CONCLUSIONS CALD stroke survivors with aphasia inconsistently access SLP services in hospital. Assessment is unlikely to be conducted in patient primary languages and therapy is usually provided in the language of SLPs. Further research is required to determine whether this impacts functional outcomes and health services.
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Affiliation(s)
- Kathleen Mellahn
- School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia
| | - Chelsea Larkman
- School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia
| | - Ali Lakhani
- School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia
| | | | - Miranda L Rose
- School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia
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20
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McLeod S, Marshall J. Communication for all and the Sustainable Development Goals. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 25:1-8. [PMID: 36856150 DOI: 10.1080/17549507.2022.2160494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
PURPOSE Communication is central to the accomplishment of each of the United Nations' 17 Sustainable Development Goals (SDGs) and is a fundamental human right. METHOD This special issue of the International Journal of Speech-Language Pathology (IJSLP, vol. 25, no. 1) is dedicated to communication, swallowing and the SDGs; particularly focussing on people with communication and/or swallowing disability and those who support them. RESULT The papers in the special issue of IJSLP demonstrate that successful communication is necessary for realisation of all 17 SDGs at both a global and an individual level and advance the international call for SDG 18: Communication for All. The 36 papers address all 17 goals, focussing on poverty, hunger, health, education, work, innovation, climate, cities, land, oceans, justice, and partnerships. Authors worked and undertook their research in Australia, Austria, Benin, Cambodia, Cameroon, Canada, China, Columbia, Denmark, Egypt, Ethiopia, Ghana, Greece, Iceland, India, Iraq, Ireland, Italy, Jordan, Kenya, Lebanon, Maldives, Mozambique, Nepal, New Zealand, Nigeria, State of Palestine, Peru, Philippines, Rwanda, Serbia, South Africa, Uganda, UK, USA, Vietnam. CONCLUSION Communication for all is essential for the achievement of the SDGs, "peace and prosperity for people and the planet" (United Nations, 2015a). Achievement of the SDGs is the role of all; including communication specialists, people with communication/swallowing disability, their families and communities.
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21
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Fannin DK, Elleby J, Tackett M, Minga J. Intersectionality of Race and Question-Asking in Women After Right Hemisphere Brain Damage. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:314-324. [PMID: 36626232 PMCID: PMC10023183 DOI: 10.1044/2022_jslhr-22-00327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/26/2022] [Accepted: 10/13/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE Atypical pragmatic language can impede quality health care access. Right hemisphere brain damage (RHD) results in changes in pragmatic language use; however, little is known about whether there are racial/ethnic influences. Recent research indicated differences in question-asking when RHD survivors were compared with healthy controls, prompting the current examination of question production in women by race/ethnicity and the presence of RHD. METHOD Participants were eight Black and eight White women who sustained a single right hemisphere stroke at least 6 months prior to data collection (2016-2020), and eight Black and eight White control participants from the Right Hemisphere Damage Bank (https://rhd.talkbank.org). Videos of informal, first-encounter conversational discourse tasks were transcribed and coded. Analyses were conducted for frequency of questions and question type. RESULTS Race/ethnicity had a statistically significant effect on the total number of questions and number of content and polar questions. The mean total of questions, number of content questions, and mean number of polar questions for Black participants was significantly less than White participants. There was less variability in question type for Black participants than White participants, and a tendency for Black participants to ask fewer questions regardless of RHD or control status. CONCLUSIONS Acquisition of health information and ensuing health care might be less fruitful for Black women communicating with someone who may not know to conduct comprehension checks and be proactive in provision of information. To be culturally responsive to Black patients with communication disorders, providers might apply this awareness of reduced question-asking to their strategies to improve patient-provider communication. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21809475.
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Affiliation(s)
- Danai Kasambira Fannin
- Department of Communication Sciences and Disorders, North Carolina Central University, Durham
| | - Jada Elleby
- Department of Communication Sciences and Disorders, North Carolina Central University, Durham
| | - Maria Tackett
- Department of Statistical Science, Duke University, Durham, NC
| | - Jamila Minga
- Department of Head and Neck Surgery & Communication Sciences and Department of Neurology, Vascular and Stroke Division, Duke University School of Medicine, Durham, NC
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22
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Morris MA. Striving Toward Equity in Health Care for People With Communication Disabilities. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:3623-3632. [PMID: 35858270 PMCID: PMC9802569 DOI: 10.1044/2022_jslhr-22-00057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/10/2022] [Accepted: 04/12/2022] [Indexed: 06/04/2023]
Abstract
PURPOSE Approximately 10% of the U.S. adult population has a speech, language, and/or voice disability, collectively referred to as communication disabilities. An increasing number of studies demonstrate that persons with communication disabilities have worse health and health care outcomes as compared to those without communication disabilities. Understanding the state of the science, including potential contributing factors is critical to begin to address the disparities. METHOD Applying a historical lens and integrating multiple models of disability provide a comprehensive perspective of the health and health care outcomes of persons with communication disabilities. RESULTS Three phases for addressing health care disparities exist: detecting, understanding, and reducing. Results from a 2012 National Health Interview Survey provide compelling population-level results of the health and health care disparities experienced by persons with communication disabilities. To understand the disparities, factors within the health care system, such as availability of communication aids and services, as well as provider and staff biases, assumptions, and lack of knowledge need to be considered. To date, few interventions exist to address disparities in care for persons with communication disabilities. Consequently, researchers need to engage with stakeholders in innovative study designs and methods to facilitate the rapid development, implementation, and dissemination of interventions that address the disparities. CONCLUSION To ensure equity for the large and growing population of persons with communication disabilities, researchers, policy makers, patients, and health care systems need to collaborate in identifying and addressing the factors contributing to health and health care disparities. Presentation Video: https://doi.org/10.23641/asha.21215804.
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Affiliation(s)
- Megan A. Morris
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora
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Mallipeddi NV, Aulov S, Perez HR. Associations between stuttering avoidance and perceived patient-centeredness of health care interactions. JOURNAL OF FLUENCY DISORDERS 2022; 73:105918. [PMID: 35797776 DOI: 10.1016/j.jfludis.2022.105918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 06/10/2022] [Accepted: 06/18/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To determine the relationships between (1) stuttering severity and (2) avoidance of speaking on patient centeredness of healthcare system interactions in a sample of persons who stutter. METHODS This quantitative study utilized cross-sectional electronic surveys to assess the experiences of one-hundred-twenty-two adults who stutter in the United States with primary care physicians. The surveys evaluated: (1) self-reported stuttering severity and avoidance of speaking; and (2) self-reported patient-centeredness of healthcare interactions. We used multivariate linear regression to model relationships between independent and dependent variables, controlling for age, gender, patient-provider relationship duration, race/ethnicity, the presence of comorbid conditions, and household income. RESULTS Patient self-reported avoidance of speaking was significantly negatively associated with self-reported patient-centeredness of healthcare interactions. Patient self-reported stuttering severity was not significantly associated with patient-centeredness. CONCLUSION Our findings present evidence that internal non-observable behaviors among persons who stutter, such as avoiding speaking, are associated with negative impact on healthcare interactions. Speech-language pathologists may want to discuss healthcare challenges with their clients and elicit communication barriers to inspire positive interactions within the healthcare system.
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Affiliation(s)
- Nathan V Mallipeddi
- Harvard Medical School, Harvard University, 25 Shattuck Street, Boston, MA 02115, USA.
| | - Sivan Aulov
- Fordham University, 113 West 60th St, New York, NY 10023.
| | - Hector R Perez
- Department of Medicine, Albert Einstein College of Medicine, 111 East 210 Street, Bronx, NY 10467, USA.
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Gaffney HJ, Hamiduzzaman M. Factors that influence older patients’ participation in clinical communication within developed country hospitals and GP clinics: A systematic review of current literature. PLoS One 2022; 17:e0269840. [PMID: 35759474 PMCID: PMC9236261 DOI: 10.1371/journal.pone.0269840] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 05/28/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Engaging older adults in clinical communication is an essential aspect of high-quality elder care, patient safety and satisfaction in hospitals and GP clinics. However, the factors that influence older adults’ participation during their appointments with health professionals from the older patient’s perspective remain under-investigated.
Objectives
We aimed to fill this knowledge gap by reviewing research articles that have examined older patients’ involvement in clinical communication. In doing so, we hope to assist healthcare professionals and institutions in developing new strategies to improve older patients’ participation and engagement in clinical communication.
Methods
A systematic review of nine databases was conducted for studies reporting identified influences on older patients’ participation in clinical communication published from 2010. These studies were then subjected to thematic analysis for stratification.
Results
Twenty-one articles with a total of 36,797 participants were included and highlighted three major themes that influenced older patients’ participation in the clinical communication. The first theme identified includes accessibility to appointments, support, health information and person-centred care, highlighting that access to appointments, person centred care and health information significantly influences clinical communication participation. Relevant and understandable healthcare information identified that communication factors [i.e. tailored health information, health literacy and patient language barriers, and communication impairments] influences older patients’ participation. Older Patient perceptions of HCP credibility and trustworthiness highlighted how patient’s perceptions of health professionals influence their willingness to participate in clinical communications.
Conclusions and implications
This review demonstrates that there are several factors that contribute to insufficient or no participation of older patients in clinical communication in hospitals and GP clinics. These include accessibility to relevant and understandable health information, and the perceived health professional credibility and trustworthiness. Identifying ways to address these factors may improve patient participation, doctor-patient collaboration and overall health outcomes for older patients.
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Affiliation(s)
- Harry James Gaffney
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- * E-mail:
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25
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Baylor C, Brown C, Mroz TM, Burns M. Understanding How Older Adults with Communication Difficulties Access Health Services: What We Can Learn from the National Health and Aging Trends Study (NHATS). Semin Speech Lang 2022; 43:176-197. [PMID: 35858604 DOI: 10.1055/s-0042-1749618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
People with communication disorders face barriers to accessing safe and respectful healthcare. These barriers result in increased healthcare complications and inefficiencies, both of which contribute to increased healthcare costs. One obstacle to advocating for accommodations that could improve healthcare for this population is the absence of cost effectiveness studies of such accommodations specifically, as well as a paucity of data defining the needs of this population in general. The purpose of this study was to explore how people with communication and swallowing difficulties are characterized in the National Health and Aging Trends Study (NHATS), a nationally representative survey of Medicare beneficiaries aged 65 and older, and how they manage their healthcare. Cross-sectional data from the NHATS rounds 5 to 9 (2015-2019) resulted in 8,038 unique respondents, 3,243 of who reported speech, memory, hearing, and/or swallowing difficulties. More than 90% of respondents with communication difficulties reported having a regular doctor. Less than 60% of respondents with communication difficulties had a family member or caregiver go to medical appointments with them, and around 70% of that subset of participants received help from that caregiver with communication during appointments. Fewer than 15% of respondents with communication difficulties used the internet for healthcare communication or information. Less than 5% of respondents across all communication difficulty categories had received rehabilitation services for communication in the year prior to their survey responses. While the information gleaned from NHATS points to likely gaps between the needs people with communication disorders may have for safe and accessible healthcare, and the support available, future research is needed to improve and clarify how communication disorders are defined and characterized in large-scale surveys to generate more interpretable data. These stronger empirical foundations are needed to support cost-effectiveness analyses to advocate for better communication accessibility of healthcare settings.
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Affiliation(s)
- Carolyn Baylor
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Cait Brown
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Tracy M Mroz
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Michael Burns
- Department of Speech and Hearing Sciences, University of Washington, Seattle, Washington
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Shady K, Phillips S, Newman S. Barriers and Facilitators to Healthcare Access in Adults with Intellectual and Developmental Disorders and Communication Difficulties: an Integrative Review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2022; 11:1-13. [PMID: 35669718 PMCID: PMC9148936 DOI: 10.1007/s40489-022-00324-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/11/2022] [Indexed: 11/26/2022]
Abstract
This integrative review explores the barriers to and facilitators of healthcare access in adults with intellectual and developmental disorders (IDD) and communication difficulties (CD) using Levesque et al.'s conceptual framework of access to health. IDDs are a group of disorders that occur early in childhood and often involve language dysfunction. CDs are prevalent in adults with IDD. Several themes emerged as barriers to access for adults with IDDs and CDs including health literacy, understanding health information, and screening; fear and negative patient expectations; impaired autonomy; time; accommodation needs; insurance coverage and financial hardship; communication; coordination and continuity of care; and supporter presence and inclusion. Communication between providers, patients, and supporters is a significant barrier for adults with IDD and CD. Supplementary Information The online version contains supplementary material available at 10.1007/s40489-022-00324-8.
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Affiliation(s)
- Kathryn Shady
- Medical University of South Carolina, 99 Jonathan Lucas St, Charleston, SC 29425 USA
| | - Shannon Phillips
- Medical University of South Carolina, 99 Jonathan Lucas St, Charleston, SC 29425 USA
| | - Susan Newman
- Medical University of South Carolina, 99 Jonathan Lucas St, Charleston, SC 29425 USA
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Varadaraj V, Guo X, Reed NS, Smith K, Boland MV, Nanayakkara AJ, Swenor BK. Identifying Accessibility Requests for Patients With Disabilities Through an Electronic Health Record-Based Questionnaire. JAMA Netw Open 2022; 5:e226555. [PMID: 35394512 PMCID: PMC8994132 DOI: 10.1001/jamanetworkopen.2022.6555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
IMPORTANCE People with disabilities experience disparities in health care access and outcomes, and inaccessible health care facilities are major barriers to health care access. Methods to collect accessibility request information are needed to improve health care outcomes for patients with disabilities. OBJECTIVE To evaluate an electronic health record (EHR)-based questionnaire designed to identify accessibility requests for patients with disabilities at an eye clinic. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional pilot study implemented an EHR questionnaire and prospectively collected data on accessibility requests at a university-based eye clinic. The study included 55 722 patients making appointments at the Johns Hopkins Wilmer Eye Institute from April 1, 2019, to March 31, 2020. MAIN OUTCOMES AND MEASURES The Wilmer Eye Institute staff were trained to assess accessibility requests of patients making appointments in-person or via telephone using a standardized script and entering patient responses into the EHR. Data were later extracted for analysis and used to determine the proportion of patients making eye appointments who reported a disability accessibility request (physical, sensory, or intellectual) during their clinic visit. RESULTS Accessibility request data were collected from 250 932 patient encounters. Patients had a mean (SD) age of 61.9 (20.6) years; most were women (146 846 [58.5%]) and were White individuals (162 720 [64.9%]). Of these, 23 510 (9.4%) encounters were associated with an accessibility request. The most reported accessibility request was mobility related (18 857 [7.5%]) (needing a cane, crutches, motorized scooter, walker, wheelchair, stretcher, assistance standing, or transport services), followed by sensory-related (2988 [1.2%]) (visual, hearing, or speech impairment), intellectual (353 [0.1%]), and other (1312 [0.5%]) (assistance with filling forms or service animal) requests. Patients with an accessibility request compared with those without, were older (72.6 vs 60.8 years), less likely to be White individuals (59.7% vs 65.4%), and more likely to be women (62.6% vs 58.1%), receiving Medicare (69.6% vs 41.5%), and have vision impairment (41.3% vs 13.6%) (P < .001 for all). CONCLUSIONS AND RELEVANCE In this cross-sectional study, a substantial proportion of patients making eye appointments reported having accessibility requests as captured using a new EHR-based questionnaire. Such standardization of data collection for disability-related accessibility requests in EHR is scalable, could be expanded to other clinical settings, and has the potential to improve accessibility of health care interactions for patients with disabilities.
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Affiliation(s)
- Varshini Varadaraj
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Johns Hopkins Disability Health Research Center, Baltimore, Maryland
| | - Xinxing Guo
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nicholas S. Reed
- Johns Hopkins Disability Health Research Center, Baltimore, Maryland
- Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kerry Smith
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | - Bonnielin K. Swenor
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Johns Hopkins Disability Health Research Center, Baltimore, Maryland
- Johns Hopkins University School of Nursing, Baltimore, Maryland
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Parey B, Sinanan L. Healthcare Barriers Among Working-Age Persons with Disabilities in Trinidad. QUALITATIVE HEALTH RESEARCH 2022; 32:479-490. [PMID: 34893008 DOI: 10.1177/10497323211059151] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Even though easily accessible and cost-effective healthcare is a fundamental human right, many persons with disabilities experience healthcare barriers and poor health outcomes. We explore the healthcare barriers among working-age persons with disabilities in Trinidad using a qualitative descriptive approach. Semi-structured interviews with 26 participants reveal barriers at the personal, healthcare facility, and societal levels. The findings indicate the need for a nation-wide integrated digitalized system and increased intersectoral collaborations to support adequate healthcare among persons with disabilities in Trinidad. Increased consultation with persons with disabilities and transformation of the disability discourses within the healthcare system and at the national level are also recommended as part of the humanisation of their care.
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Affiliation(s)
- Bephyer Parey
- Sir Arthur Lewis Institute of Social and Economic Studies, 37612The University of the West Indies, St. Augustine, Trinidad and Tobago
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29
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Beneteau E, Paradiso A, Pratt W. Telehealth experiences of providers and patients who use augmentative and alternative communication. J Am Med Inform Assoc 2022; 29:481-488. [PMID: 34897460 PMCID: PMC8800527 DOI: 10.1093/jamia/ocab273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 11/05/2021] [Accepted: 11/26/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE We explore the telehealth experiences of adults who use augmentative and alternative communication (AAC) and clinicians who work with people using AAC. MATERIALS AND METHODS We conducted semistructured, online interviews with 6 adults who use AAC and 8 clinicians who provide telehealth services to people who use AAC between July and September 2020. Participants were located in the United States and the United Kingdom. All participants had engaged in 2 or more telehealth visits in the past 6 months. We used an inductive, thematic approach to analyze the interview data. RESULTS Our findings reveal that (1) telehealth is an essential service, (2) technology causes barriers, (3) policies meant to protect actually inhibit, and (4) remote monitoring devices have the potential to mitigate risks. DISCUSSION Telehealth systems created for persons without disabilities do not provide equitable access to everyone. Telehealth should be flexible enough to allow patients to use the communication modality that best meets their needs. We suggest that healthcare systems think of the healthcare ecosystem as one which includes a variety of telehealth options in addition to traditional in-person clinical visits. CONCLUSIONS The benefits of telehealth for people who use AAC are substantial and should be an option for ongoing health care. However, the accessibility of telehealth technologies needs to be improved. Designers should view telehealth as part of a broad healthcare ecosystem, which includes in-person, telehealth, and remote health monitoring technologies. Designers should also include AAC users in the design and development process. Telehealth policies should encourage multimodality access to health care and address funding concerns.
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Affiliation(s)
- Erin Beneteau
- Information School, University of Washington, Seattle, Washington, USA
| | | | - Wanda Pratt
- Information School, University of Washington, Seattle, Washington, USA
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30
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William Go TW, Mok HT, Acharyya S, Suelo DC, Ho EC. Communication Vulnerability within Singapore’s Healthcare Environment. PROCEEDINGS OF SINGAPORE HEALTHCARE 2021. [DOI: 10.1177/20101058211068601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Communication difficulties can, and often do, create barriers between patients and healthcare workers (HCWs). We examined the perceptual differences between patients and caregivers; and HCWs with regards to their perceived communication vulnerabilities and identified communication needs in a tertiary hospital. A survey was conducted in selected outpatient settings among patients, their caregivers and HCWs, in a cross-sectional study. Respondents rated the reasons and frequency of encountering the communication difficulties during a hospital visit. Fifty-four percent of patients and caregivers cited poor hearing in the presence of noise, while HCWs cited patient’s poor vision (87%) as their primary communication barrier that requires improvement. Majority of HCWs (90%) had encountered patients who presented multiple communication barriers a quarter of the time. A third of HCWs felt that such encounters were especially challenging during communication, with very limited strategies available to deal with such communication vulnerable individuals. Patients, caregivers and HCWs universally experience communication challenges, even if their perceived barriers to communication happen to differ. Such perceptual difference between patients and HCWs may lead to inconsistent use of communication strategies by HCWs, potentially compromising patient’s healthcare needs. Nonetheless, the onus is on healthcare providers to bridge this communication gap to improve patient care.
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Affiliation(s)
- Teck W. William Go
- Clinical Research and Innovation Office, Tan Tock Seng Hospital, Singapore, Singapore
| | - Hoi T. Mok
- TTSH Pharmacy, Tan Tock Seng Hospital, Singapore, Singapore
| | - Sanchalika Acharyya
- Clinical Research and Innovation Office, Tan Tock Seng Hospital, Singapore, Singapore
| | - Darlin C. Suelo
- Centre for Geriatric Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Eu C. Ho
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, Singapore
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31
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Velez JA, Keene JR, Corwin M, Elko S, Potter RF. A Visual Interactive Narrative Intervention (VINI) for aphasia education: Can digital applications administer augmented input to educate stroke survivors with aphasia? PATIENT EDUCATION AND COUNSELING 2021; 104:2536-2543. [PMID: 33810913 DOI: 10.1016/j.pec.2021.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 03/11/2021] [Accepted: 03/13/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Persons with aphasia (PWA) face additional barriers to proper healthcare due to inadequate patient education by health professionals unequipped to use augmentative and alternative communication (AAC). The current study examines a digital application that evokes and sustains health information processing through AAC specifically aimed at increasing comprehension with augmented input (AI). METHODS A digital application designed to educate PWA about their health condition was compared to a video-recorded doctor providing oral-only education. Sixteen PWA received both education interventions in a crossover manner. Health information processing was assessed through heart rate (HR) and skin conductance levels (SCL), which were collected continually during each administration of education interventions. RESULTS PWA demonstrated greater cognitive processing of health information via HR and SCL indices during the digital application compared to the typical oral-only education intervention. The oral-only intervention led PWA to disengage with health information. CONCLUSION By combining visuographic materials and adapted language into a customizable narrative structure, digital applications can utilize AI to educate PWA about basic health information (i.e., diagnosis and prognosis). PRACTICE IMPLICATIONS The current study's AAC requires minimal training and can be used as an aided support in conjunction with other techniques that increase PWA's access to health information.
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Affiliation(s)
- John A Velez
- Communication Science Unit, The Media School, College of Arts + Sciences, Indiana University, Bloomington, USA.
| | - Justin Robert Keene
- Department of Journalism and Creative Media Industries, College of Media and Communication, Texas Tech University, Lubbock, USA
| | - Melinda Corwin
- Department of Speech, Language, and Hearing Sciences, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Stacy Elko
- School of Art, J.T. & Margaret Talkington College of Visual & Performing Arts, Texas Tech University, Lubbock, USA
| | - Robert F Potter
- Communication Science Unit, The Media School, College of Arts + Sciences, Indiana University, Bloomington, USA
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32
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Huang Y, Arnold SRC, Foley KR, Lawson LP, Richdale AL, Trollor JN. Factors associated with age at autism diagnosis in a community sample of Australian adults. Autism Res 2021; 14:2677-2687. [PMID: 34529351 DOI: 10.1002/aur.2610] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/25/2021] [Accepted: 09/02/2021] [Indexed: 01/20/2023]
Abstract
Autism diagnosis in adulthood has become increasingly common due to a range of factors including changes in awareness, diagnostic criteria, and professional practices. Past research identified a range of demographic and autism-related factors associated with autism diagnosis age in children. However, it is unclear whether these apply to autistic adults. This study aimed to examine predictors of autism diagnosis age in adults while controlling for current age and autistic traits. We used a cross-sectional sample of 657 adults aged 15-80 from three self and carer-report studies: the Australian Longitudinal Study of Autism in Adulthood (ALSAA), Study of Australian School-Leavers with Autism (SASLA) and Pathways, Predictors and Impact of Receiving an Autism Spectrum Diagnosis in Adulthood (Pathways). Using hierarchical multiplicative heteroscedastic regression, we found that older current age and higher self-reported autistic traits predicted older diagnosis age, and that female gender, lack of intellectual disability, language other than English, family history of autism, lifetime depression, and no obsessive-compulsive disorder predicted older diagnosis age beyond current age and autistic traits. The paradoxical relationship between high autistic traits and older diagnosis age requires further investigation. Based on these findings, we recommended strategies to improve autism recognition in women and people from non-English-speaking backgrounds. Future studies could extend the findings by examining the effects of childhood and adulthood socioeconomic status on adult diagnosis age.
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Affiliation(s)
- Yunhe Huang
- Department of Developmental Disability Neuropsychiatry (3DN), University of New South Wales, Sydney, New South Wales, Australia.,The Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
| | - Samuel R C Arnold
- Department of Developmental Disability Neuropsychiatry (3DN), University of New South Wales, Sydney, New South Wales, Australia.,The Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
| | - Kitty-Rose Foley
- Department of Developmental Disability Neuropsychiatry (3DN), University of New South Wales, Sydney, New South Wales, Australia.,Faculty of Health, Southern Cross University, Gold Coast, Queensland, Australia
| | - Lauren P Lawson
- The Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia.,Olga Tennison Autism Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Amanda L Richdale
- The Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia.,Olga Tennison Autism Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Julian N Trollor
- Department of Developmental Disability Neuropsychiatry (3DN), University of New South Wales, Sydney, New South Wales, Australia.,The Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
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33
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Morris MA, Wong AA, Dorsey Holliman B, Liesinger J, Griffin JM. Perspectives of Patients with Diverse Disabilities Regarding Healthcare Accommodations to Promote Healthcare Equity: a Qualitative Study. J Gen Intern Med 2021; 36:2370-2377. [PMID: 33564941 PMCID: PMC8342676 DOI: 10.1007/s11606-020-06582-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/29/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients with disabilities often require healthcare accommodations in order to access high-quality, equitable healthcare services. While attention has been paid to accommodation needs in specific disability populations, limited research to date has explored healthcare accommodations that cross-cut diverse disability populations. OBJECTIVE To identify a deeper understanding regarding accommodations in healthcare settings that could apply across disability populations and promote equitable healthcare. DESIGN We conducted qualitative focus groups with patients with disabilities and caregivers to understand their experiences and preferences for healthcare accommodations. PARTICIPANTS We recruited patients and caregivers across all major disability categories to participate in focus groups. Participants were recruited through advocacy organizations and healthcare settings in Southeastern Minnesota. APPROACH A total of eight focus groups were conducted with 56 participants. Participants described their healthcare experiences and desires for healthcare accommodations. The multidisciplinary research team recorded, transcribed verbatim, and coded all focus groups. The team thematically coded transcripts using content analysis within and across focus groups to identify major themes. KEY RESULTS Patients identified four challenges and corresponding steps healthcare team could take to promote equitable care: (1) consistent documentation of disabilities and needed accommodations in the medical record; (2) allowance for accommodations to the environment, including adapting physical space, physical structures, and scheduling and rooming processes; (3) provide accommodations for administrative tasks, such as completing paper or electronic forms; and (4) adapt communication during interactions, such as speaking slower or using terms that patients can easily understand. CONCLUSION These identified themes represent specific opportunities for healthcare teams to effectively provide accessible care to patients with disabilities. Many of the accommodations require minimal financial investment, but did require behavioral changes by the healthcare team to ensure equitable healthcare.
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Affiliation(s)
- Megan A Morris
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, School of Medicine, University of Colorado, Aurora, CO, USA.
- Department of Family Medicine, School of Medicine, University of Colorado, Aurora, CO, USA.
| | - Alicia A Wong
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Brooke Dorsey Holliman
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, School of Medicine, University of Colorado, Aurora, CO, USA
- Department of Family Medicine, School of Medicine, University of Colorado, Aurora, CO, USA
| | | | - Joan M Griffin
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA
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34
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Moreland CJ, Ruffin CV, Morris MA, McKee M. Unmasked: How the COVID-19 Pandemic Exacerbates Disparities for People With Communication-Based Disabilities. J Hosp Med 2021; 16:185-188. [PMID: 33617440 DOI: 10.12788/jhm.3562] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/02/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Christopher J Moreland
- Department of Internal Medicine, Dell Medical School, University of Texas, Austin, Texas
| | - Chad V Ruffin
- Proliance South Seattle Otolaryngology, Burien, Washington
| | - Megan A Morris
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Michael McKee
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
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35
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Mach H, Baylor C, Burns M, Yorkston K. Training students from rehabilitation professions on communicating with patients with communication disorders. PM R 2021; 14:58-67. [PMID: 33611858 DOI: 10.1002/pmrj.12580] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 11/24/2020] [Accepted: 02/12/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND FRAME, a mnemonic referring to a program for helping health care providers adapt patient-provider communication when working with patients with communication disorders, improves the knowledge, confidence, and communication skills of medical students for working with this population. However, the impact of the FRAME program for preparing students from the rehabilitation disciplines to work with patients with communication disorders is unknown. OBJECTIVE To examine the effects of the FRAME program on the knowledge, confidence, and communication skills of students in physical therapy (PT), occupational therapy (OT), and prosthetics and orthotics (P&O) in terms of how to communicate effectively with patients with communication disorders. DESIGN An exploratory, quasi-experimental pretest-posttest design. SETTING PT, OT, and P&O clinical education programs at the University of Washington's Department of Rehabilitation Medicine. PARTICIPANTS Twenty rehabilitation students (PT = 12; OT = 7; and P&O = 1) participated in the FRAME training. INTERVENTIONS The FRAME program, delivered in a single, 2-hour session teaches students communication skills to use with patients with various types of communication disorders. MAIN OUTCOME MEASURES A quiz of students' knowledge about communication disorders and a self-rating of confidence for interacting with this patient population were used. Speech-language pathology graduate clinicians rated students' use of communication strategies from each area of the FRAME training during interactions with standardized patients portraying aphasia and dysarthria. Student qualitative feedback were also collected. RESULTS Students' knowledge, confidence, and use of communication strategies improved significantly following training. Greatest gains were observed in students' ability to familiarize themselves with how a patient communicates and establish a method of communication before proceeding with the interview. Qualitative feedback aligned with these findings. CONCLUSIONS The FRAME program increases the knowledge, confidence, and use of communication strategies in rehabilitation students in order to communicate more effectively with patients with communication disorders in their future careers.
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Affiliation(s)
- Helen Mach
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA.,College of Health Sciences, Newark, Delaware, USA
| | - Carolyn Baylor
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Michael Burns
- Department of Speech and Hearing Sciences, University of Washington, Seattle, Washington, USA
| | - Kathryn Yorkston
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
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Gormley J, Fager SK. Personalization of Patient-Provider Communication Across the Lifespan. TOPICS IN LANGUAGE DISORDERS 2021; 41:249-268. [PMID: 34421170 PMCID: PMC8375497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
People with disabilities are more likely to be hospitalized and use healthcare services relative to people without disabilities. They also report experiencing negative experiences interacting with health care providers during these encounters placing them at risk for preventable adverse medical events, poor quality of life, and dependence on others. Fortunately, providers and people with communication disabilities can take steps to improve these interactions by personalizing and implementing communication supports to empower people with communication disabilities to actively participate in these interactions and improve outcomes. The purpose of this article is to describe strategies that health care providers can use to develop and implement personalized communication supports for children and adults with communication disorders during health care interactions. Additional strategies are provided to guide people with disabilities as well as their community/school providers and families to prepare for health care interactions. Case examples are provided to illustrate use of these strategies in acute care, inpatient rehabilitation, and outpatient settings. The use of emerging training tools (e.g., video visual scene displays) and AAC partner training formats (e.g., just-in-time training) are also presented as future directions to expedite learning and implementation of communication supports in fast-paced and time-limited health care interactions.
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Affiliation(s)
- Jessica Gormley
- Department of Speech-Language Pathology Department, Munroe-Meyer Institute, University of Nebraska Medical Center, 985450 Nebraska Medical Center Omaha, NE, 68198-5450
| | - Susan Koch Fager
- Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, Lincoln, NE
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Sulaeman, Rijal M, Ridwan M. Self-Meaning of Oligodactyly: Health Communication Study of People with Oligodactyly in the Village of Ulutaue, South Sulawesi, Indonesia. Integr Psychol Behav Sci 2020; 55:497-526. [PMID: 32524417 DOI: 10.1007/s12124-020-09546-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A health communication of the people with oligodactyly aims at exploring the meanings associated with deformities of physical organs in fingers and/or toes from birth. This study discusses how fifteen people with oligodactyly in the village Ulutaue, South Sulawesi, Indonesia, construct themselves having physical abnormalities and physical organs different from those of other people through communicating with the surrounding environment. This research uses a subjective interpretive method with a health communication approach. The results explain that the people with oligodactyly are as the subjects and are considered to have their self-meaning, including the meaning of the physical abnormalities with the positive and negative self, the physical organ limitations with the self-meaning of feel ashamed, worthy to be pitied, will to work hard, patience and encouragement. The physical organ abnormalities provide a "scary, goose-bumpy, pity, and disgusting" image for the people who see them. To feel as "like anything" becomes the basis for the appearance of subjective meanings of every action in constructing oneself.
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Affiliation(s)
- Sulaeman
- State Islamic Institute, Ambon, Indonesia.
| | | | - M Ridwan
- State Islamic Institute, Ambon, Indonesia
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Major depressive disorder in Chinese persons with speech disability: High rates of prevalence and perceived need for mental health care but extremely low rate of use of mental health services. J Affect Disord 2020; 263:25-30. [PMID: 31818785 DOI: 10.1016/j.jad.2019.11.123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 10/21/2019] [Accepted: 11/29/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND In recent years, there has been increasing awareness on the importance of mental health services for persons with disability in China, but data on mental health of persons with speech disability (PwSD) are scarce. This study examined prevalence and correlates of major depressive disorder (MDD) among Chinese PwSD, as well as their perceived need for and utilization of mental health services. METHODS A total of 227 community-residing adult PwSD were successfully recruited by using multi-stage sampling approach, and interviewed with the Mini-international Neuropsychiatric Interview 5.0. Depressed PwSD's perceived need for and utilization of mental health services were also measured. RESULTS 29.5% of the PwSD suffered from MDD during the month before the interview and, of the depressed PwSD, 44.8% perceived a need for mental health care but only 1.5% had sought help from mental health specialists. Factors significantly associated with MDD included female gender (OR=2.42), marital status of "non-married" (OR=2.27), having the disability during childhood (OR=4.60) and adulthood (OR=10.99) (vs. at birth), co-occurring other types of disabilities (OR=2.29), major medical conditions (OR=2.62), and impaired ability of activities of daily living (OR=3.23). LIMITATIONS Findings can only be generalized to PwSD who register with the Disabled People's Federation (DPF) in China, because the sampling frame was based on the registration system of DPF. CONCLUSIONS There is a large unmet need for mental health services among Chinese PwSD. It is urgently needed to integrate the management of MDD and other common mental disorders into the services system for PwSD in China.
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Carragher M, Steel G, O'Halloran R, Torabi T, Johnson H, Taylor NF, Rose M. Aphasia disrupts usual care: the stroke team's perceptions of delivering healthcare to patients with aphasia. Disabil Rehabil 2020; 43:3003-3014. [PMID: 32045533 DOI: 10.1080/09638288.2020.1722264] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: Communication disability, including aphasia, is prevalent in the stroke population and impacts service delivery. This study explored the experiences of the multidisciplinary stroke team in delivering healthcare to patients with aphasia.Materials and methods: A phenomenological approach was used to understand the experiences of delivering healthcare services in the presence of aphasia. Healthcare professionals (n = 16) were recruited across acute and subacute stroke care, with a range of discipline backgrounds and experience. Participants took part in focus groups and data were analysed using an inductive thematic approach.Results: Five themes were evident: 1) aphasia is time consuming, 2) health professionals do not know how to help, 3) health professionals limit conversations with patients with aphasia, 4) health professionals want to know how to help, and 5) health professionals feel good after successful communication.Conclusions: Aphasia disrupts usual care. Health professionals want to help but are working in a non-optimal environment where communication and patient-centred care are not adequately resourced. A video abstract is available in Supplementary Material.IMPLICATIONS FOR REHABILITATIONCurrent hospital systems and ward culture make it difficult to offer patient-centred care to patients with aphasia.Health professionals want to help patients with aphasia but are working in an environment where patient-provider communication is not adequately resourced.As a result, health professionals dread, limit or avoid talking with patients with aphasia.Health professionals need support which may include ongoing education and on-the-job training, and a change in ward culture including key performance indicators focusing on patient-provider communication.
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Affiliation(s)
- Marcella Carragher
- Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.,NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Bundoora, Australia
| | - Gillian Steel
- Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.,NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Bundoora, Australia
| | - Robyn O'Halloran
- Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.,NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Bundoora, Australia
| | - Torab Torabi
- Computer Science and Information Technology, School of Engineering and Mathematical Sciences, La Trobe University, Bundoora, Australia
| | - Hilary Johnson
- Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.,Scope Communication and Inclusion Resource Centre, Melbourne, Australia
| | - Nicholas F Taylor
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.,Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
| | - Miranda Rose
- Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.,NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Bundoora, Australia
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Mastalerz K. Capsule Commentary on Agaronnik et al., Communicating with Patients with Disability: Perspectives of Practicing Physicians. J Gen Intern Med 2019; 34:1291. [PMID: 31011965 PMCID: PMC6614239 DOI: 10.1007/s11606-019-04987-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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