The European Association for Communication in Healthcare

Video remote interpreting in clinical communication: A multimodal analysis

OBJECTIVE

Investigating how the spatial and audiovisual conditions in video remote interpreting (VRI) shape communicative interaction in a language-discordant clinical consultation.

METHODS

We conducted a multimodal analysis of an authentic VRI-mediated consultation with special reference to spatial arrangements, audiovisual conditions, and the healthcare professional's use of embodied communicative resources (body orientation, eye gaze, gestures).

RESULTS

The physician is found to pursue his communicative goals for the consultation by first creating an appropriate spatial and technical environment and then supporting his information-giving and relationship-building actions through the use of nonverbal (embodied) resources like body orientation, gaze and gestures as well as specific turn-management behaviour.

CONCLUSION

VRI allows healthcare professionals to access professional interpreters for language-discordant consultations but requires appropriate technical and spatial arrangements as well as users capable of adapting their communicative behaviour to spatial and audiovisual constraints.

PRACTICE IMPLICATIONS

Alongside telephone interpreting, VRI is the solution of choice for language-discordant clinical encounters in times of the Covid-19 pandemic. Its use requires appropriate technical and spatial arrangements as well as specific skills on the part of healthcare professionals to cope with inherent audiovisual constraints.

Efficacy of Short Message Service Text Messaging Interventions for Postoperative Pain Management: Systematic Review

Background

Addiction to opiates and synthetic opioids poses a major threat to public health worldwide, with pharmaceutical opioids prescribed to manage pain constituting the main problem. To counteract this threat, suitable pain management strategies should be implemented in health care. Monitoring pain management seems to be feasible using telemedicine with a certain degree of resource intensity and digitization. As a communication channel for this type of monitoring, SMS appears to be a valid alternative.

Objective

The aim of this systematic literature review was to (1) provide information on the state of research regarding postoperative pain management via SMS, (2) establish a basic understanding of SMS-based pain management, and (3) provide insight into the feasibility of these management strategies. The research question was as follows: Is postoperative pain management feasible and effective utilizing SMS?

Methods

A systematic literature review was performed mainly following the PRISMA guidelines and another guide on performing a systematic literature review for information systems–related research. A search string was developed based on the objectives and research question, and eight databases were searched.

Results

The initial search resulted in 2083 records, which could be narrowed down by applying various exclusion criteria. Thereby, 11 articles were identified as relevant, which were accordingly analyzed and evaluated by full-text screening. In all articles, pain management interventions were performed using SMS communication between health care professionals and patients or their legal guardians. A prospective approach was predominantly chosen as the study design (91%) with the leading research objective of determining the intervention’s feasibility (73%). The primary reason for sending SMS messages was to monitor patients (64%). Overall, the use of SMS improved adherence, acceptance, and satisfaction regarding postoperative pain management. With an average response rate of approximately 89.5% (SD 3.8%), the reliability of SMS as a communication and monitoring tool was further emphasized. This response rate is significantly higher than that for email interventions (66.63%, P<.001).

Conclusions

This study provides a comprehensive picture of the current status on postoperative pain management by SMS. Communication via SMS was beneficial in all interventions, even preoperative. Six SMS interventions could be certified by the respective institutional review board and three were Health Insurance Portability and Accountability Act–compliant. Therefore, the results of this study could be leveraged to address the opioid epidemic. Overall, the research question could be confirmed. Future research should extend this systematic literature review regarding preoperative pain management. Based on these findings, a pre- and postoperative communication model should be developed to address the opioid epidemic effectively.

Multilingual healthcare communication: Stumbling blocks, solutions, recommendations

OBJECTIVE

To provide guidance on multilingual and language discordant healthcare communication.

DISCUSSION

We provide a critical reflection on common stumbling blocks to securing (professional) language support, as well as on the currently available solutions to language discordance in healthcare. We discuss issues pertaining to i) the assessment of the patient and healthcare professional's language proficiency, ii) the decision making on whether to seek language support, iii) the currently available options of language support and the development of skills that ensure their effective use, iv) the inclusion of professional interpreters in the interprofessional healthcare team, and v) the transition from single- to integrated language support solutions that allow for a more comprehensive approach to multilingual healthcare communication. We present a set of recommendations for good practice.

CONCLUSION

Understanding the needs, capabilities and shortcoming of the available language- support solutions and the implications arising from them can enable decision makers to make informed decisions that ensure the quality of communication and care. The integrated use of language-support solutions at different stages of care can create the conditions for effective communication, while promoting patient and family participation in the decision making process. Evidence-based interventions that can inform the implementation of solutions are required.

Developing the International Association for Communication in Healthcare (EACH) to address current challenges of health communication

In 2017, EACH celebrated its change of name from European Association for Communication in Healthcare to EACH: International Association for Communication in Healthcare. This paper aims to present the developments and achievements of EACH over the past five years with a focus on its mission in promoting and advancing the field of communication in healthcare. Specifically, the paper focuses on how EACH, first, promotes research in the field of health communication, second, provides support, resources and sharing for healthcare communication teachers and, third, aims at influencing policy through dissemination of evidence. This paper also explores future challenges and directions for EACH to further strengthen its impact by designing activities in knowledge transfer and knowledge dissemination, engaging with patients and truly benefitting from their expertise, fostering active participation and networking among its members, targeting interventions to the needs of different countries around the world and refining knowledge-sharing and cooperation both within the membership of EACH and outside the association to as wide an audience as possible. Scholars, educators and practitioners active in the field of healthcare communication are invited to comment on this paper and to actively contribute towards the goals of EACH.

Beyond "One Size Fits All": Physician Nonverbal Adaptability to Patients' Need for Paternalism and Its Positive Consultation Outcomes

In this study, we tested whether physicians' ability to adapt their nonverbal behavior to their patients' preferences for a paternalistic interaction style is related to positive consultation outcomes. We hypothesized that the more physicians adapt their nonverbal dominance behavior to match their patients' preferences for physician paternalism, the more positively the patients perceive the medical interaction. We assessed the actual nonverbal dominance behavior of 32 general practitioners when interacting with two of their patients and compared it with each of their patients' preferences for paternalism to obtain a measure of adaptability. Additionally, we measured patient outcomes with a questionnaire assessing patient satisfaction, trust in the physician, and evaluation of physician competence. Results show that the more nonverbal dominance the physician shows toward the patient who prefers a more paternalistic physician, as compared to toward the patient who prefers a less paternalistic physician (i.e., the more the physician shows nonverbal behavioral adaptability), the more positive the consultation outcomes are. This means that physicians' ability to adapt aspects of their nonverbal dominance behavior to their individual patients' preferences is related to better outcomes for patients. As this study shows, it is advantageous for patients when a physician behaves flexibly instead of showing the same behavior towards all patients. Physician training might want to focus more on teaching a diversity of different behavior repertoires instead of a given set of behaviors.

Five years of EACH (European Association for Communication in Healthcare)

Five years after launching EACH (European Association for Communication in Healthcare) we look back at what EACH achieved so far and announce new ideas and activities EACH plans to carry out in the near future. During the past five years several scientific, educational as well as societal changes have taken place in the area of communication in healthcare that all underline the need for continued international collaboration in line with the activities employed by EACH so far. Within communication research the focus has shifted from counting communication utterances to unraveling sequences of patient cues and provider responses. In the field of teaching it is becoming more and more common to attend to the training of trainers as well. Within these developments, new areas of interest arise and need attention. To comply with these increasing demands, EACH invites new persons to become a member of one of the recently launched committees in the area of research, teaching and publishing.

A quantitative analysis of anaesthetist-patient communication during the pre-operative visit

Previous communication research in general medical practice has shown that effective communication enhances patient compliance, satisfaction and medical outcome. It is expected that communication is equally important in anaesthesia, since patients often suffer from anxiety and lack of knowledge about anaesthetic procedures. However, little is known about the nature of communication during routine anaesthetic visits. The present study of 57 authentic anaesthetic visits provides the first results on the structure and content of communication in the pre-operative setting using the Roter Interaction Analysis System (RIAS). Patient-centred communication behaviours of anaesthetists and the extent of patient involvement were particularly investigated. From the 57 pre-operative visits, 18 267 utterances were coded. The mean (SD) [range] duration of the visit was 16.1 (7.8) [3.7-42.7] min. Anaesthetists provided 169 (68) and patients 153 (82) utterances per visit (53.5% vs. 46.5%). Physician and patient gender had no impact on the distribution of utterances and the duration of the visit. Conversation mainly focussed on biomedical issues with little psychosocial discussion (< 0.1% of all anaesthetist utterances). However, anaesthetists quite frequently used emotional comments toward patients (7%) and involved them in the conversation. The use of facilitators, open questions and emotional statements by the anaesthetist correlated with high patient involvement. The amount of patient participation in anaesthetic decisions was assessed with the Observing Patient Involvement Scale (OPTION). Compared with general practitioners, anaesthetists offered more opportunities to discuss treatment options (mean (SD) OPTION score 26.8 (16.8) vs. 16.8 (7.7)).