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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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Pigott JS, Davies N, Chesterman E, Read J, Nimmons D, Walters K, Armstrong M, Schrag A. Delivering Optimal Care to People with Cognitive Impairment in Parkinson's Disease: A Qualitative Study of Patient, Caregiver, and Professional Perspectives. PARKINSON'S DISEASE 2023; 2023:9732217. [PMID: 37675146 PMCID: PMC10480026 DOI: 10.1155/2023/9732217] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/22/2023] [Accepted: 08/12/2023] [Indexed: 09/08/2023]
Abstract
Background Cognitive impairment is common in Parkinson's disease (PD) and associated with lower quality of life. Cognitive impairment in PD manifests differently to other dementia pathologies. Provision of optimal care requires knowledge about the support needs of this population. Methods Eleven people with PD and cognitive impairment (PwP), 10 family caregivers, and 27 healthcare professionals were purposively sampled from across the United Kingdom. Semistructured interviews were conducted in 2019-2021, audio-recorded, transcribed, and analysed using reflexive thematic analysis. Results Cognitive impairment in PD conveyed increased complexity for clinical management and healthcare interactions, the latter driven by multifactorial communication difficulties. Techniques that helped included slow, simple, and single messages, avoiding topic switching. Information and emotional support needs were often unmet, particularly for caregivers. Diagnostic pathways were inconsistent and awareness of cognitive impairment in PD was poor, both contributing to underdiagnosis. Many felt that PwP and cognitive impairment fell through service gaps, resulting from disjointed, nonspecific, and underresourced services. Personalised care was advocated through tailoring to individual needs of PwP and caregivers facilitated by flexibility, time and continuity within services, and supporting self-management. Conclusions This study highlights unmet need for people with this complex condition. Clinicians should adapt their approach and communication techniques for this population and provide tailored information and support to both PwP and caregivers. Services need to be more streamlined and collaborative, providing more time and flexibility. There is a need for wider awareness and deeper understanding of this condition and its differences from other types of dementia.
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Affiliation(s)
- Jennifer S. Pigott
- Queen Square Institute of Neurology, University College London, London, UK
| | - Nathan Davies
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| | | | - Joy Read
- Queen Square Institute of Neurology, University College London, London, UK
| | - Danielle Nimmons
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Kate Walters
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Megan Armstrong
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Anette Schrag
- Queen Square Institute of Neurology, University College London, London, UK
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Cook CV, Pompon RH. Lessons on Health Literacy and Communication in Post-Stroke Rehabilitation:: A Primer and Proposal. Dela J Public Health 2023; 9:44-49. [PMID: 37701478 PMCID: PMC10494792 DOI: 10.32481/djph.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
Health literacy, or the ability to find, understand, and use information to make well-informed health decisions, has been linked to post-stroke rehabilitation outcomes. Importantly, barriers to health literacy stem from stroke survivor characteristics, clinician practices, institutional norms, as well as systemic variables. These barriers impact recovery and rehabilitation outcomes. To address these obstacles, clinicians can learn from the evidence-based practices used by speech-language pathologists in their work with stroke survivors with aphasia, a language impairment that can follow stroke. These methods to overcome communication barriers are appropriate and recommended for patients and family members regardless of stroke impairment, and include a transdisciplinary care model, multimodal approaches to patient education, along with consistent engagement with patients and their care partners. These strategies may be adopted for both personal and organizational health literacy efforts and help optimize the rehabilitation and recovery outcomes of stroke survivors with and without aphasia.
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Zitelli L, Palmer C, Mamula E, Johnson J, Rauterkus G, Nilsen ML. Hearing screening and amplifier uptake results in a multidisciplinary head and neck cancer survivorship clinic. J Cancer Surviv 2023; 17:720-728. [PMID: 35348995 PMCID: PMC11186601 DOI: 10.1007/s11764-022-01198-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 12/28/2021] [Indexed: 10/18/2022]
Abstract
PURPOSE Hearing loss and tinnitus are prevalent among survivors of head and neck cancer (HNC), but auditory issues are under-addressed in the survivorship literature. The purpose of this study was to describe the hearing loss and management experience of a group of survivors provided with a hearing screening and amplifier assistance if needed during their visit. METHODS A retrospective chart review of 1176 individuals seen in the HNC Survivorship Clinic between December 2016 and October 2020 who interacted with audiology was performed. RESULTS Of these survivors, 72% failed the 30-dB HL hearing screening at one or more frequencies. Thirty-three percent of the sample reported tinnitus. Consistent with the general population, this group has a low prevalence of hearing aid use. In this clinic, individuals who fail the hearing screening at all frequencies are offered a simple, non-custom amplifier for use during their visit. Thirty-one percent of individuals offered the amplifier used it during their Survivorship Clinic visit to enhance communication and reduce listening effort. Only 54% of individuals who failed the hearing screening self-reported hearing loss. The poor sensitivity and specificity associated with the self-perception of hearing loss data support the need for hearing screening that consists of responding to tones. Of individuals who received a recommendation for a comprehensive hearing test, 21% received a hearing test with 68% of these individuals receiving the hearing test the same day of their Survivorship Clinic visit. CONCLUSIONS The data from 1176 survivors of HNC seen by audiology over the past few years as part of the UPMC HNC Survivorship Clinic support the need for hearing management in this population to improve communication during and after the Survivorship Clinic visit. IMPLICATIONS FOR CANCER SURVIVORS Survivors of HNC have a high prevalence of greater than mild hearing loss and tinnitus (both issues known to negatively impact health-related communication and quality of life). This manuscript describes a hearing screening program within a Survivorship Clinic that identifies individuals in need of non-custom amplification during their appointment to support effective communication. Survivors should be referred to audiologists for evaluation and management of treatment-related issues of hearing.
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Affiliation(s)
- Lori Zitelli
- UPMC, 203 Lothrop St., 4th Floor, Pittsburgh, PA, 15213, USA.
- University of Pittsburgh, Pittsburgh, PA, USA.
| | - Catherine Palmer
- UPMC, 203 Lothrop St., 4th Floor, Pittsburgh, PA, 15213, USA
- University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Jonas Johnson
- UPMC, 203 Lothrop St., 4th Floor, Pittsburgh, PA, 15213, USA
- University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Marci L Nilsen
- UPMC, 203 Lothrop St., 4th Floor, Pittsburgh, PA, 15213, USA
- University of Pittsburgh, Pittsburgh, PA, USA
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Mandal B, Pradhan KC, Mohanty P, Muhammad T. Migration status, physical limitations and associated self-rated health: a study of older Indian adults. BMC Geriatr 2023; 23:316. [PMID: 37217859 DOI: 10.1186/s12877-023-04002-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 04/25/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Migrant status with mobility impairment becomes a double burden for health and wellbeing of older adults. This study examined the independent relationships and multitude effects between migrant status, functional and mobility impairments and poor self-rated health (SRH) among older Indian adults. METHODS This study utilised nationally representative Longitudinal Ageing Study in India wave-1 (LASI) data, including a sample of 30,736 individuals aged 60 years and above. The main explanatory variables were migrant status, difficulty in activities of daily living (ADL), difficulty in instrumental activities of daily living (IADL) and mobility impairments; and the outcome variable was poor-SRH. Multivariable logistic regression and stratified analyses were used to fulfil the study objectives. RESULTS Overall, about 23% of older adults reported poor-SRH. Reporting poor-SRH was more prevalent (28.03%) among recent migrants (less than ten years). The prevalence of reporting poor-SRH was significantly higher among older adults who had mobility impairment (28.65%), difficulty in ADL or IADL (40.82% & 32.57%). Migrant older adults (regardless of duration) who had mobility impairment had significantly greater odds of reporting poor-SRH compared with non-migrant older adults who did not have mobility impairment. Similarly, older respondents who had problems in ADL and IADL with migration status had higher odds of reporting poor-SRH than their non-migrant counterparts with no such problems. CONCLUSIONS The study revealed the vulnerability of migrant older adults with functional and mobility disability, as well as those with limited socioeconomic resources and suffering from multimorbidity on rating their perceived health. The findings can be utilised to target outreach programmes and provision of services for migrating older individuals with mobility impairments and enhance their perceived health and ensure active ageing.
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Affiliation(s)
- Bittu Mandal
- School of Humanities and Social Sciences, Indian Institute of Technology Indore, Khandwa Road, Simrol, 453552, Indore, India.
| | - Kalandi Charan Pradhan
- School of Humanities and Social Sciences, Indian Institute of Technology Indore, Khandwa Road, Simrol, 453552, Indore, India
| | - Parimala Mohanty
- Institute of Medical Sciences & Sum Hospital, Siksha "O" Anusandhan, Bhubaneswar, 751030, Odisha, India
| | - T Muhammad
- Department of Family & Generations, International Institute for Population Sciences, Mumbai, 400088, Maharashtra, India
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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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Haring CT, Farlow JL, Leginza M, Vance K, Blakely A, Lyden T, Hoesli RC, Neal MEH, Brenner MJ, Hogikyan ND, Morrison RJ, Casper KA. Effect of Augmentative Technology on Communication and Quality of Life After Tracheostomy or Total Laryngectomy. Otolaryngol Head Neck Surg 2022; 167:985-990. [PMID: 34060949 DOI: 10.1177/01945998211013778] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Surgical procedures that render patients acutely aphonic can cause them to experience significant anxiety and distress. We queried patient perceptions after tracheostomy or laryngectomy and investigated whether introducing augmentative technology was associated with improvement in patient-reported outcomes. METHODS Participants included hospitalized patients who acutely lost the ability to speak due to tracheostomy or total laryngectomy from April 2018 to December 2019. We distributed questions regarding the patient communication experience and relevant questions from the validated V-RQOL questionnaire (Voice-Related Quality of Life). Patients were offered a tablet with the electronic communication application Verbally. Pre- and postintervention groups were compared with chi-square analyses. RESULTS Surveys were completed by 35 patients (n = 18, preintervention; n = 17, postintervention). Prior to using augmentative technology, 89% of patients who were aphonic reported difficulty communicating, specifically noting breathing or suctioning (56%), treatment and discharge plans (78%), or immediate needs, such as pain and using the bathroom (39%). Communication difficulties caused anxiety (55%), depression (44%), or frustration (62%), and 92% of patients were interested in using an electronic communication device. Patients reported less trouble communicating after the intervention versus before (53% vs 89%, P = .03), including less difficulty communicating about treatment or discharge plans (35% vs 78%, P < .01). V-RQOL scores were unchanged. DISCUSSION Acute loss of phonation arising from surgery can be highly distressing for patients, and use of augmentative technology may alleviate some of these challenges by improving communication. Further studies are needed to identify what additional strategies may improve overall well-being. IMPLICATIONS FOR PRACTICE Electronic communication devices may benefit patients with acute aphonia.
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Affiliation(s)
- Catherine T Haring
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Janice L Farlow
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Marie Leginza
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Kaitlin Vance
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Anna Blakely
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Teresa Lyden
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Molly E Heft Neal
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael J Brenner
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Norman D Hogikyan
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Robert J Morrison
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Keith A Casper
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
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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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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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Burshnic-Neal VL, Knollman-Porter K, Topper RH, McConnell ES, VanHaitsma K, Abbott KM. Examining Face Validity of Visual Stimuli Used in Preference Assessments for Older Adults With Communication Impairments. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:1297-1318. [PMID: 35344450 DOI: 10.1044/2022_ajslp-21-00303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Preference assessment is integral to person-centered treatment planning for older adults with communication impairments. There is a need to validate photographs used in preference assessment for this population. Therefore, this study aimed to establish preliminary face validity of photographs selected to enhance comprehension of questions from the Preferences for Everyday Living Inventory-Nursing Home (PELI-NH) and describe themes in older adults' recommendations for revising photographic stimuli. METHOD This qualitative, cognitive interviewing study included 21 participants with an average age of 75 years and no known cognitive or communication deficits. Photographic stimuli were randomized and evaluated across one to two interview sessions. Participants were asked to describe what the preference stimuli represented to them. Responses were scored to assess face validity. Participants were then shown the PELI-NH written prompt and asked to evaluate how well the photograph(s) represented the preference. A semideductive thematic analysis was conducted on interview transcripts to summarize themes in participant feedback. RESULTS Forty-six (64%) stimuli achieved face validity criteria without revisions. Six (8%) stimuli achieved face validity after one partial revision. Twenty (28%) stimuli required multiple revisions and reached feedback saturation, requiring team review for finalization. Thematic analysis revealed challenges interpreting stimuli (e.g., multiple meanings) and participant preferences for improving photographs (e.g., aesthetics). CONCLUSIONS Cognitive interviewing was useful for improving face validity of stimuli pertaining to personal care topics. Abstract and subjective preferences (e.g., cultural traditions) may be more challenging to represent. This study provides a framework for further testing with older adults with cognitive, communication, and hearing impairments.
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Affiliation(s)
- Vanessa L Burshnic-Neal
- Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center, NC
| | | | - Rachel H Topper
- Department of Speech Pathology and Audiology, Miami University, Oxford, OH
| | - Eleanor S McConnell
- Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center, NC
- Duke University School of Nursing, Durham, NC
| | - Kimberly VanHaitsma
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park
- Polisher Research Institute, Abramson Senior Care, Blue Bell, PA
| | - Katherine M Abbott
- Department of Sociology and Gerontology, Scripps Gerontology Center, Miami University, Oxford, OH
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Stojanovik V, Pagnamenta E, Seager E, Breen M, Jennings S, Joffe V, Harvey K, Pizzo E, Perry H. The ASCEND study: protocol for a feasibility study to evaluate an early social communication intervention for young children with Down syndrome. Pilot Feasibility Stud 2022; 8:8. [PMID: 35039084 PMCID: PMC8762187 DOI: 10.1186/s40814-022-00968-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 01/05/2022] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Down syndrome is the most common cause of learning disability, affecting approximately 1 in every 700 babies. Children with Down syndrome have particular difficulties with speech and language. This makes it challenging for them to participate fully in life, access healthcare services and educational opportunities. Improving the language skills of young children with Down syndrome is vital for their future social and emotional well-being and behaviour, and consequently contribution to society. As Down syndrome is detected before or at birth, we can provide support from early on. There are currently no standard interventions for improving the language skills of children with Down syndrome under the age of 36 months. Evidence suggests that early parent-based interventions may be effective in improving language outcomes. In partnership with parents and speech and language therapists, we have co-developed an intervention focusing on early social communication skills and our preliminary work shows that it can lead to better language in children with Down syndrome. Our aim is to carry out a feasibility study which will inform a future pilot/full trial to test whether the intervention is effective in improving language skills before children with Down syndrome start school. METHODS This is a two-arm feasibility randomised controlled trial (RCT), with 1:1 randomisation stratified by trial site comparing the intervention (plus standard NHS speech and language therapy) with no intervention (standard NHS speech and language therapy only). We aim to recruit between 25 and 30 children with Down syndrome aged between 11 and 36 months. Sites are defined by the geographical boundaries of three National Health Service (NHS) Trusts. Recruitment is from NHS Speech and Language Therapist caseloads within the 3 Trusts, and self-referral. In the intervention arm, parents/guardians will receive brief training on the parent-based intervention and a manual to follow with their child for 10 weeks. The children's language and early communication skills and family health outcomes will be assessed by a blinded assessor at baseline, post-intervention and 6 month follow-up. Questionnaire and semi-structured interviews will explore the acceptability of the intervention to parents and SLTs. DISCUSSION The feasibility study's outcomes will determine whether it would be viable to progress to a full-trial and whether adjustments need to made to the procedures, data collection methods, intervention delivery and the intensity of support needed. We want to assess whether our early intervention can be delivered and rolled out through NHS Speech and Language Therapy (SLT) Services. We anticipate that NHS SLT Services will need to make ongoing changes due to the COVID-19 pandemic, so it is likely that we will need to make adjustments for the definitive trial. We will also calculate descriptive statistics of the language outcome measure which we will use for any future sample size calculation. TRIAL REGISTRATION ISRCTN13902755. Registered on 25 August 2020. http://www.isrctn.com/ISRCTN13902755.
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Affiliation(s)
- Vesna Stojanovik
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, RG6 6AL, UK.
| | - Emma Pagnamenta
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, RG6 6AL, UK
| | - Emily Seager
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, RG6 6AL, UK
- King's College London, London, UK
| | - Maria Breen
- Thames Valley Clinical Trials Unit, University of Reading, Reading, UK
| | - Susie Jennings
- Thames Valley Clinical Trials Unit, University of Reading, Reading, UK
| | | | - Kate Harvey
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, RG6 6AL, UK
| | | | - Hayley Perry
- Thames Valley Clinical Trials Unit, University of Reading, Reading, UK
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13
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Morris MA, Hamer MK, Eberle K, Jensen KM, Wong AA. Implementation of Collection of Patients' Disability Status by Centralized Scheduling. Jt Comm J Qual Patient Saf 2021; 47:627-636. [PMID: 34144917 DOI: 10.1016/j.jcjq.2021.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/16/2021] [Accepted: 05/14/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Collection of disability status in electronic health records (EHRs) is critical to addressing the significant health care disparities experienced by patients with disabilities. Despite this, little evidence exists to inform implementation. METHODS This pilot trial evaluated the implementation of collection of patients' disability status during primary care new patient registration by centralized call center staff. The study took place over six weeks at an academic hospital system in Colorado. Staff received a 30-minute training on how to ask and document disability status in the EHR. Completion rate of collection, fidelity, and concordance were assessed through chart reviews and recordings of patient registration calls. Focus groups with staff and phone interviews with patients assessed the experience of including disability screeners in patient registration. RESULTS A total of 3,673 new patients were registered at one of the 53 primary care clinics during the study period. Completion of disability status in the EHR increased from 10% at baseline to > 50% by the last week of the trial, which was then maintained for eight weeks. Challenges were identified in the recorded calls with fidelity of if and how the questions were asked. No patient complaints were reported, and patients reported no concerns regarding collection of disability status during interviews. CONCLUSION Documenting disability status during patient registration was effective and was not concerning to patients. To make initial steps to providing equitable care, efforts should be made to implement this type of screening universally across the clinical encounter.
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14
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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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15
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van der Kaap-Deeder J, Vermote B, Waterschoot J, Soenens B, Morbée S, Vansteenkiste M. The role of ego integrity and despair in older adults' well-being during the COVID-19 crisis: the mediating role of need-based experiences. Eur J Ageing 2021; 19:117-129. [PMID: 33679277 PMCID: PMC7914386 DOI: 10.1007/s10433-021-00610-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 01/21/2023] Open
Abstract
The COVID-19 pandemic has affected people across the world, with important heterogeneity among older adults in how they respond to the challenges associated with this crisis. Relying on a cross-fertilization between Erikson's personality theory and self-determination theory, this study aimed to examine possible sources of resilience (i.e., ego integrity and need satisfaction) and vulnerability (i.e., despair) in older adults' (mal) adjustment, thereby additionally considering the role of multiple risk and protective factors (e.g., gender and marital status). During the second month of the lockdown period in Belgium, 693 older adults (M age = 70.06, SD = 4.48, range: 65-89 years, 62.1% female) filled out online questionnaires concerning the study variables, while also completing assessments of several important sociodemographic factors. Structural equation modeling suggested that both ego integrity and despair related to indicators of well-being and psychological distress through experienced need satisfaction. Additionally, we found several factors to protect (e.g., higher perceived income) or diminish (e.g., being widowed) older adults' well-being during these challenging times, with little evidence for a moderating role of these factors in associations between the psychological variables. Theoretical and practical implications of these results are discussed.
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Affiliation(s)
- Jolene van der Kaap-Deeder
- Department of Psychology, Norwegian University of Science and Technology (NTNU), 7491 Dragvoll Trondheim, Norway
| | - Branko Vermote
- Department of Developmental, Social, and Personality Psychology, Ghent University, Ghent, Belgium
| | - Joachim Waterschoot
- Department of Developmental, Social, and Personality Psychology, Ghent University, Ghent, Belgium
| | - Bart Soenens
- Department of Developmental, Social, and Personality Psychology, Ghent University, Ghent, Belgium
| | - Sofie Morbée
- Department of Developmental, Social, and Personality Psychology, Ghent University, Ghent, Belgium
| | - Maarten Vansteenkiste
- Department of Developmental, Social, and Personality Psychology, Ghent University, Ghent, Belgium
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16
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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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17
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Hurtig RR, Alper R, Altschuler T, Gendreau S, Gormley J, Marshall S, Santiago R, Scibilia S. Improving Outcomes for Hospitalized Patients Pre- and Post-COVID-19. ACTA ACUST UNITED AC 2020. [DOI: 10.1044/2020_persp-20-00144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Purpose
Barriers to effective patient–provider communication increase the risk that a patient will experience a hospital-acquired condition (HAC) that will negatively impact the patient's health outcomes. Providing patients with communication tools can significantly reduce the risks of experiencing HACs. This article describes how barriers to effective patient–provider communication can impact patient outcomes and reports on the incidence of HACs in patients who received assistive technology to address barriers to patient–provider communication. This topic is of critical relevance, as the COVID-19 pandemic has dramatically increased the number of patients who face communication barriers and the accompanying challenges encountered by their health care providers.
Method/Approach
The researchers compared the number of expected HACs based on previously obtained data to the number of HACs reported among patients who received an assistive technology intervention. Additionally, the impact of COVID-19 on patient–provider communication was discussed through the provision of case descriptions from frontline speech-language pathologists who have worked in COVID-19 intensive care units.
Results
The patients who received the assistive technology intervention had a significantly lower incidence of HACs than what would be expected in hospital settings. Clinicians working directly with patients with COVID-19 identified suggestions on how both patients and providers can address the barriers to effective patient–provider communication.
Conclusion
A key to better patient outcomes and lower health care costs will require making the provision of communication tools part of the standard of care for all patients facing barriers to communication.
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Affiliation(s)
- Richard R. Hurtig
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City
| | - Rebecca Alper
- Department of Communication Sciences and Disorders, Temple University, Philadelphia, PA
| | - Tami Altschuler
- Department of Speech-Language Pathology, Rusk Rehabilitation, NYU Langone Medical Center, New York, NY
| | - Sarah Gendreau
- Department of Speech, Language and Swallowing Disorders, Massachusetts General Hospital, Boston
| | - Jessica Gormley
- Department of Speech-Language Pathology, Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha
| | - Sarah Marshall
- Communication Aids & Systems Clinic, Waisman Center, University of Wisconsin–Madison
| | - Rachel Santiago
- Inpatient Augmentative Communication Program, Boston Children's Hospital, MA
| | - Stephanie Scibilia
- Department of Speech, Language, and Swallowing Disorders, Massachusetts General Hospital, Boston
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18
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Reed NS, Assi L, Pedersen E, Alshabasy Y, Deemer A, Deal JA, Willink A, Swenor BK. Accompaniment to healthcare visits: the impact of sensory impairment. BMC Health Serv Res 2020; 20:990. [PMID: 33121483 PMCID: PMC7594990 DOI: 10.1186/s12913-020-05829-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 10/19/2020] [Indexed: 11/18/2022] Open
Abstract
Background Millions of older adults in the United States experience hearing, vision, and dual sensory impairment (concurring hearing and vision impairment) yet little research exists on their needs in interactions with the healthcare system. This piece aims to determine the use of accompaniment in healthcare interactions by persons with sensory impairment. Methods These cross-sectional analyses included data from the 2015 Medicare Current Beneficiaries Survey and survey weighting provided by Centers for Medicare and Medicaid Services. Adjusted odds of reporting accompaniment to healthcare visits and given reasons for accompaniment among United States Medicare beneficiaries with self-reported sensory impairment (hearing, vision, and dual sensory impairment) were examined. Results After excluding observations with missing data, 10,748 Medicare beneficiaries remained representing a 46 million total weighted nationally representative sample, of which 88.9% reported no sensory impairment, 5.52% reported hearing impairment, 3.56% reported vision impairment, and 0.93% reported dual sensory impairment. Those with vision impairment and dual sensory impairment had 2.139 (95% confidence interval [CI] =1.605–2.850) and 2.703 (CI = 1.549–4.718) times the odds of reporting accompaniment to healthcare visits relative to those without sensory impairment. A secondary analysis suggests communication needs as the primary reason for accompaniment among persons with hearing loss, while those with vision impairment were more likely to indicate transportation needs. Conclusions Healthcare accompaniment is common for persons with sensory loss and healthcare systems should consider accommodations for and leveraging accompaniment to improve healthcare for persons with sensory impairments. In light of the current COVID-19 pandemic, as hospitals limit visitors to reduce the spread of infection, arrangements should be made to ensure that the communication and transportation needs of those with sensory impairment are not neglected.
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Affiliation(s)
- Nicholas S Reed
- Cochlear Center for Hearing and Public Health, Johns Hopkins University Bloomberg School of Public Health, 2024 E. Monument Street, Baltimore, MD, 21205, USA. .,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Lama Assi
- Cochlear Center for Hearing and Public Health, Johns Hopkins University Bloomberg School of Public Health, 2024 E. Monument Street, Baltimore, MD, 21205, USA.,Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Emily Pedersen
- Cochlear Center for Hearing and Public Health, Johns Hopkins University Bloomberg School of Public Health, 2024 E. Monument Street, Baltimore, MD, 21205, USA
| | - Yasmeen Alshabasy
- Cochlear Center for Hearing and Public Health, Johns Hopkins University Bloomberg School of Public Health, 2024 E. Monument Street, Baltimore, MD, 21205, USA
| | - Ashley Deemer
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jennifer A Deal
- Cochlear Center for Hearing and Public Health, Johns Hopkins University Bloomberg School of Public Health, 2024 E. Monument Street, Baltimore, MD, 21205, USA.,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amber Willink
- Cochlear Center for Hearing and Public Health, Johns Hopkins University Bloomberg School of Public Health, 2024 E. Monument Street, Baltimore, MD, 21205, USA.,Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bonnielin K Swenor
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.,Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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19
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Eby TL, Arteaga AA, Spankovich C. Otologic and Audiologic Considerations for COVID-19. Otolaryngol Head Neck Surg 2020; 163:110-111. [DOI: 10.1177/0194599820928989] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The COVID-19 pandemic has created a number of considerations for otolaryngology; anosmia and ageusia in particular have gained significant attention. Here we present considerations in regard to treatment with quinine-derived drugs and the influence of masks on communication.
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Affiliation(s)
- Thomas L. Eby
- Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Alberto A. Arteaga
- Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Christopher Spankovich
- Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, Mississippi, USA
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20
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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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21
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McAuliffe MJ, Schluter PJ, Jamieson HA. An epidemiological profile of communication disability among older adults with complex needs: A national cross-sectional study. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 21:537-546. [PMID: 30322277 DOI: 10.1080/17549507.2018.1495763] [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: 11/21/2017] [Revised: 06/10/2018] [Accepted: 06/20/2018] [Indexed: 06/08/2023]
Abstract
Purpose: Research on the prevalence of communication disability among community living older adults is scant, and often suffers from limitations. Using a national database, this study presents an epidemiological profile of communication disability in older community residents within New Zealand and examines whether ethnic populations are disproportionately represented.Method: Since 2012, all New Zealand community care recipients have undergone a standardised needs assessment, which includes questions directed at expressive and receptive language abilities. Those assessed between 1 September 2012 and 31 January 2016, aged ≥65 years, and who provided consent were included. Directly standardised prevalence estimates were calculated and logistic regression used to investigate age, sex and ethnic differences.Result: Overall, 71 859 people were eligible (mean age = 82.7 years, 61% female, 89.2% European/other), with 30.6% and 36.2% exhibiting at least some expression and comprehension communication disability, respectively. Māori, Pasifika and Asian people, males and those who were older were more likely to have at least some communication disability compared to their European/other, female and younger counterparts.Conclusion: Communication disability is common among older adults. With the increased provision of home-based integrated models of care, the impact of communication disability on service seeking and delivery must be recognised and accommodated.
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Affiliation(s)
- Megan J McAuliffe
- Department of Communication Disorders, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, New Zealand
- New Zealand Institute of Language, Brain and Behaviour, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, New Zealand
| | - Philip J Schluter
- School of Health Sciences, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, New Zealand
- School of Clinical Medicine, Primary Care Clinical Unit, The University of Queensland, Brisbane, Australia
| | - Hamish A Jamieson
- Department of Medicine, University of Otago, Christchurch, New Zealand
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22
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O'Halloran R, Douglas J, Cruice M, Davidson B, McKinley K, Bigby C. Representation and reporting of communicatively vulnerable patients in patient experience research. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 21:524-535. [PMID: 30810412 DOI: 10.1080/17549507.2019.1567815] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 11/03/2018] [Accepted: 12/27/2018] [Indexed: 06/09/2023]
Abstract
Purpose: To apply a human rights lens to measuring patient experience. Specifically, to determine if the perspectives of communicatively vulnerable people have been included in the patient experience research used to inform the development of the Australian Hospital Patient Experience Question Set (AHPEQS). Method: Thirty-nine qualitative studies on patient experience that informed the development of AHPEQS were critically appraised in terms of reporting on: population of interest, eligibility criteria, communicative demands of the research and communicative supports provided. Result: Eleven of 39 studies included sufficient information about the population to determine that communicatively vulnerable people would have been approached to participate. Three of these studies explicitly excluded people who were communicatively vulnerable, and four did not report on the provision of any communication supports to enable communicatively vulnerable people to participate. Conclusion: Intentional exclusion and/or a lack of communication supports restrict the rights of people who are communicatively vulnerable to express their opinions about what matters to them in hospital. Inadequate reporting of qualitative research on patient experience also makes it difficult to determine if the perspectives of people who are communicatively vulnerable have informed the development of the AHPEQS.
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Affiliation(s)
- Robyn O'Halloran
- Living with Disability Research Centre, La Trobe University Bundoora , Victoria , Australia
- Speech Pathology Department, St Vincent's Hospital Melbourne , Victoria , Australia
| | - Jacinta Douglas
- Living with Disability Research Centre, La Trobe University Bundoora , Victoria , Australia
| | - Madeline Cruice
- Division of Language & Communication Science, School of Health Sciences City, University of London , London , UK , and
| | - Bronwyn Davidson
- Department of Speech Pathology, University of Melbourne Melbourne , Victoria , Australia
| | - Kathryn McKinley
- Speech Pathology Department, St Vincent's Hospital Melbourne , Victoria , Australia
| | - Christine Bigby
- Living with Disability Research Centre, La Trobe University Bundoora , Victoria , Australia
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23
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Morris MA, Lagu T, Maragh-Bass A, Liesinger J, Griffin JM. Development of Patient-Centered Disability Status Questions to Address Equity in Care. Jt Comm J Qual Patient Saf 2019; 43:642-650. [PMID: 29173284 DOI: 10.1016/j.jcjq.2017.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 06/25/2017] [Accepted: 06/29/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients with disabilities experience disparities in accessing and receiving high-quality health care services as compared to patients without disabilities. To address the disparities, health care organizations need to identify which of their patients have disabilities to track quality of care and provide appropriate health care accommodations. To date, no evidence-based sets of disability questions exist that serve these purposes. A study was conducted to identify patient-centered disability questions for health care organizations to determine which patients require health care accommodations and to track the quality of care experienced by patients with disabilities. METHODS In the first of three phases, a focus group with patients and caregivers (N = 54) and interviews with providers (N = 15) were conducted to explore the disability questions that they believed were important. In the second phase, nationally recognized experts (N = 17) participated in a modified Delphi panel to develop a set of disability questions. The third phase entailed cognitive interviews (N = 46) with patients with and without disabilities to refine the wording of the disability questions identified through the previous rounds. RESULTS Through the three phases, six essential questions and three additional recommended questions were identified. Questions addressed hearing, visual, motor, cognitive, communication, and learning disabilities, and the ability to conduct activities of daily living. An overall question for disabilities not included in the previous questions was also identified. CONCLUSION Through a rigorous, three-stage process that engaged multiple stakeholders, patient-centered disability questions were identified for health care organizations to use to identify disparities within their organizations and accommodations that address these disparities.
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24
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Morris MA, Oshita JY, Stransky M. Advancing the Delivery of Communication Sciences and Disorders Services Through Research: The Promise of Health Services Research. ACTA ACUST UNITED AC 2019. [DOI: 10.1044/2018_pers-st-2018-0002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Purpose
Traditional efficacy research, or research that studies interventions in controlled settings, can be difficult to translate to real-world clinical settings. In this article, we introduce the field of health services research (HSR) as 1 possible tool to aid this translation. HSR is a field of research that examines and intervenes in the use, cost, quality, delivery, organization, and outcomes of clinical interventions and services in the real-world setting. The complexity of the world outside the clinic walls is accounted for in HSR methods and data sources. As such, HSR often requires collaboration of stakeholders, including patients, caregivers, clinicians, and policy makers. These stakeholders are often engaged throughout the research process, from selecting research questions to disseminating results. HSR brings together researchers from multiple disciplines, including sociology, health economics, epidemiology, and implementation science, among others. The outcomes of HSR can inform policy changes both locally and nationally. To clarify the scope and impact of HSR, we present examples of HSR-based research on communication between patients with communication disorders and health care providers.
Conclusions
HSR is a critical tool for clinicians and researchers in the discipline of communication sciences and disorders who are committed to improving the lives and health of persons with communication disorders.
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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 Anschutz Medical Campus, Aurora, CO
| | - Jennifer Y. Oshita
- Department of Clinical and Translational Sciences, University of Vermont, Burlington, VT
- Department of Speech-Language Pathology and Audiology, University of Vermont Medical Center, Burlington, VT
| | - Michelle Stransky
- Department of Community Health, Tufts University, Medford, MA
- Social Science Applied Research Center, University of North Carolina Wilmington, Wilmington, NC
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Baylor C, Burns M, McDonough K, Mach H, Yorkston K. Teaching Medical Students Skills for Effective Communication With Patients Who Have Communication Disorders. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:155-164. [PMID: 31072161 PMCID: PMC6503863 DOI: 10.1044/2018_ajslp-18-0130] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Purpose Patients with communication impairments including speech, language, cognition, or hearing disorders face many barriers to communication in health care settings. These patients report loss of autonomy in health care decision making, are at increased risk for medical errors, and are less satisfied with health care than patients without communication disorders. Although medical students receive training in effective patient-provider communication, most of this training assumes patients have intact communication abilities. Medical students and other health care providers are often unprepared to meet the communication needs of patients with communication disorders in health care encounters. The purpose of this study was to assess the impact of a curriculum for training medical students to communicate effectively with patients who have a range of communication disorders. Method Twenty-six 2nd-year medical students volunteered for assessments before and after a required workshop in a class. This workshop included instruction about different types of communication disorders and communication strategies, followed by practice with standardized patients portraying different communication disorders. Outcome measures included a knowledge test, ratings of self-efficacy, and evaluation of students' skills when interviewing standardized patients portraying aphasia and dysarthria. Results Medical students demonstrated significant improvements in knowledge, self-efficacy, and use of recommended communication techniques. Conclusions The curriculum appeared effective in changing medical students' knowledge and skills for working with patients with communication disorders. Equipping medical students to meet the needs of patients with communication disorders is 1 key element for improving the quality of health care for this patient population.
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Affiliation(s)
- Carolyn Baylor
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Michael Burns
- Department of Speech and Hearing Sciences, University of Washington, Seattle
| | - Karen McDonough
- Division of General Internal Medicine, University of Washington, Seattle
| | - Helen Mach
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Kathryn Yorkston
- Department of Rehabilitation Medicine, University of Washington, Seattle
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Palmer AD, Carder PC, White DL, Saunders G, Woo H, Graville DJ, Newsom JT. The Impact of Communication Impairments on the Social Relationships of Older Adults: Pathways to Psychological Well-Being. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:1-21. [PMID: 30950760 DOI: 10.1044/2018_jslhr-s-17-0495] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose Social contact is known to be vital for older adults' mental and physical health but, because communication impairments often co-occur with other types of disability, it is difficult to generalize about the relative impact of a communication impairment on the social relationships of older adults. Specific aims of the study were to examine whether the severity of a communication impairment was associated with a range of social measures and to examine the association between these characteristics and psychological well-being. Method Community-dwelling older adults ranging in age from 65 to 94 were recruited for the study of Communication, Health, Aging, Relationship Types and Support. The sample included 240 participants with communication disorders arising from a variety of etiologies including hearing impairment, voice disorders, head and neck cancer, and neurologic disease, as well as older adults without a communication disorder. Results Communication impairment was a significant independent predictor for key characteristics of social relationships, including the number of friends in the social network, two types of social support, the frequency of social participation, and social self-efficacy. Communication impairment was also a significant predictor for higher levels of loneliness and depression. In addition, two distinct pathways between communication impairment and psychological well-being were identified, with social self-efficacy and reassurance of worth as mediators. Conclusions Even after controlling for age, gender, health, and disability, communication impairment is a significant independent predictor for key aspects of the social function of older adults and demonstrates two distinct pathways to loneliness and depression. Supplemental Material https://doi.org/10.23641/asha.7250282.
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Affiliation(s)
- Andrew D Palmer
- NW Center for Voice & Swallowing, Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland
| | - Paula C Carder
- Institute on Aging, College of Urban and Public Affairs, Portland State University, OR
| | - Diana L White
- Institute on Aging, College of Urban and Public Affairs, Portland State University, OR
| | - Gabrielle Saunders
- National Center for Rehabilitative Auditory Research, Portland VA Medical Center, OR
| | - Hyeyoung Woo
- Department of Sociology, Portland State University, OR
| | - Donna J Graville
- NW Center for Voice & Swallowing, Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland
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Stransky ML, Jensen KM, Morris MA. Adults with Communication Disabilities Experience Poorer Health and Healthcare Outcomes Compared to Persons Without Communication Disabilities. J Gen Intern Med 2018; 33:2147-2155. [PMID: 30143977 PMCID: PMC6258615 DOI: 10.1007/s11606-018-4625-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 07/02/2018] [Accepted: 08/01/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Persons with speech, language, and/or voice disabilities (collectively referred to as communication disabilities (CD)) represent 10% of the US population, yet their healthcare outcomes have not been described. Generally, research shows that persons with disabilities have poorer health and healthcare outcomes than their non-disabled peers. OBJECTIVES To examine the health and healthcare outcomes of persons with CD compared to persons without CD. DESIGN Retrospective cohort study of the 2012 National Health Interview Survey, which contained the first supplemental questions on CD. We compared proportional differences in outcomes; logistic and ordered logistic regression assessed the outcome measures across CD categories, controlling for demographics, non-communication disabilities, and chronic conditions. Findings are weighted to permit national inferences. PARTICIPANTS Adults (≥ 18 years old) were divided into 4 mutually exclusive groups: people with voice disabilities only; speech/language disabilities only; speech/language and voice disabilities; and people without CD. MAIN MEASURES Chronic health conditions; self-rated health; access to care; unmet needs for care; healthcare utilization. KEY RESULTS Adults with CD more frequently had ≥ 1 chronic condition (voice 67.9%, speech/language 68.6%, speech/language and voice 79.9%, no CD 50.1%, p < 0.001) and reported fair/poor health (voice 19.5%, speech/language 32.5%, speech/language and voice 48.3%, no CD 11.2%, p < 0.001) compared to those without CD. Adults with CD more frequently utilized healthcare compared to those without CD. However, persons with CD endorsed greater difficulties accessing care than those without CD, including identifying a usual source of care, trouble finding a physician, and delaying or foregoing care (e.g., delayed due to availability of care: voice 26.1%, speech/language 37.2%, speech/language and voice 30.8% no CD 16.1%, p < 0.001). CONCLUSIONS Persons with CD are medically complex and experience greater challenges accessing healthcare than persons without CD. Healthcare providers need support and tools to provide equitable care that addresses the medical needs of persons with CD.
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Affiliation(s)
- Michelle L Stransky
- Department of Community Health, Tufts University, 574 Boston Ave., Suite 208, Medford, MA, 02155, USA. .,Affiliated Research Faculty, Social Science Applied Research Center, University of North Carolina, Wilmington, NC, USA.
| | - Kristin M Jensen
- Departments of Pediatrics and Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Megan A Morris
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Shumba TW, Moodley I. Implementation of disability policy framework in Namibia: A qualitative study. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2018; 74:400. [PMID: 30135916 PMCID: PMC6093090 DOI: 10.4102/sajp.v74i1.400] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 01/30/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study explores some of the experiences of national programme managers, heads of national organisations of persons with disabilities (OPDs) and persons with disabilities in the implementation of the disability policies and legal framework in Namibia. METHOD In-depth interviews were conducted with multiple key stakeholders mentioned above. Interviews were digitally recorded and transcribed verbatim. The Community Based Rehabilitation (CBR) matrix (health, education, livelihood, social and empowerment) was utilised to guide the development of themes and subthemes. RESULTS Twenty-one key informants participated in the study. Participants stated that while Namibia has made significant progress in addressing the medical and social needs of persons with disabilities, further progress can be achieved through better coordination, capacity building, review and updating of policies which allows for the inclusion of personal assistance, access to justice, improving supply chain management for a wide range of assistive devices, mainstreaming HIV prevention and treatment programmes, improved access to sexual reproduction and family planning, improved access to higher education, curricula reviews and effective monitoring and evaluating of the CBR programme. CONCLUSIONS The study revealed key issues that need to be addressed in reviewing the policy and legal framework so that it is responsive to the current needs of persons with disabilities. Further, the CBR programme needs an evaluation tool to assess its effectiveness and efficiency in meeting the needs of persons with disabilities and also to elicit their experiences and satisfaction.
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Affiliation(s)
- Tonderai W Shumba
- School of Nursing and Public Health, University of KwaZulu-Natal, South Africa
| | - Indres Moodley
- School of Nursing and Public Health, University of KwaZulu-Natal, South Africa
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Hurtig RR, Alper RM, Berkowitz B. The cost of not addressing the communication barriers faced by hospitalized patients. PERSPECTIVES OF THE ASHA SPECIAL INTEREST GROUPS 2018; 3:99-112. [PMID: 30854467 PMCID: PMC6402813 DOI: 10.1044/persp3.sig12.99] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Preventable adverse events (AEs) lead to poorer patient outcomes, added patient suffering and dissatisfaction, longer hospital stays, and billions in additional annual healthcare spending. Patients facing barriers to communication are three times more likely to experience a preventable adverse event than patients who faced no communication barriers. National data on hospital admissions, incidence and cost of preventable AEs, and the odds ratio regarding the risk of preventable AEs in people facing communication barriers were used to estimate potential benefits of improving patient communication. Reducing communication barriers could lead to an estimated reduction of 671,440 preventable AE cases and a cost savings of $6.8 billion annually. Facilitating patient-provider communication is an ethical and financial imperative. A multi-pronged approach, including increased awareness of and support for speech-language pathology services, is essential to creating a communication-friendly hospital culture, reducing patient suffering, and decreasing the financial cost of preventable AEs. Speech-language pathologists and allied healthcare professionals play a critical role in facilitating patient-provider communication and improving patient outcomes.
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Use of Accessible Examination Tables in the Primary Care Setting: A Survey of Physical Evaluations and Patient Attitudes. J Gen Intern Med 2017; 32:1342-1348. [PMID: 28924919 PMCID: PMC5698222 DOI: 10.1007/s11606-017-4155-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 03/02/2017] [Accepted: 08/02/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Accessible diagnostic equipment, including height-adjustable examination tables, is necessary to accommodate patients with disabilities. Studies demonstrate that only a minority of clinics provide accessible equipment. For clinics with this equipment, no studies have examined the use of such equipment in routine clinical care. OBJECTIVE In primary care clinics with and without height-adjustable examination tables, we compared the frequency and variation in physical evaluations on examination tables and patients' perceptions of quality care. DESIGN Survey administered to patients at two primary care clinics in Rochester, MN, in 2015. One clinic had height-adjustable examination tables in every exam room; the other clinic had none. PATIENTS A total of 399 English-speaking adult primary care patients (61% participation). MAIN MEASURES Participants were asked whether they were physically evaluated on a table during their clinical encounter. In addition, they completed two subscales of the Patient Perception of Quality of Care survey: Perceptions of Provider's Bedside Manner and Perceptions of Provider's Work. KEY RESULTS Overall, there were no differences between clinics in the likelihood of patients being examined on an exam table or in their perceptions of quality of care. Across both clinics, patients who reported a disability were 27% less likely to be examined on a table, were less likely to rate their provider's bedside manner favorably (74% vs. 59%) and to have positive perceptions of their provider's work (46% vs. 32%) than patients without disabilities. CONCLUSIONS The presence of accessible medical equipment was not associated with care delivered to patients. While this might not be meaningful for most patients, it could be problematic for patients with disabilities, who are less likely to be examined. Therefore, accessible equipment alone may not be sufficient to reduce disparities in the care experience. Provider- and organization-level factors must thus be considered in efforts to provide equitable care to patients with disabilities.
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Morris MA, Inselman J, Rogers JMG, Halverson C, Branda M, Griffin JM. How do patients describe their disabilities? A coding system for categorizing patients' descriptions. Disabil Health J 2017; 11:310-314. [PMID: 29110969 DOI: 10.1016/j.dhjo.2017.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 09/29/2017] [Accepted: 10/13/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND To provide care that meets the values and preferences of patients with disabilities, health care providers need to understand patients' perceptions and understanding of their disability. No studies have explored patients' definitions of disability within the healthcare setting. OBJECTIVE The aim of the study was to understand how patients' define their disability in the healthcare setting and to develop a coding system for categorizing how they describe their disability. METHODS In 2000 all new outpatients at Mayo Clinic, Rochester, MN completed a form that inquired if they had a disability and if so, to write in the disability. The research team categorized the responses by disability type (e.g.: visual or physical) and how the patient described his disability or "disability narrative" (e.g.: diagnosis or activity). RESULTS Within 128,636 patients, 14,908 reported a disability. For adults, lower limb (26%) and chronic conditions (24%) were the most frequent disability type and activity limitations (56%) were the most frequent disability narrative category. For pediatric patients, developmental disabilities (43%) were the most frequently reported disability type and diagnoses (83%) were the most frequent disability narrative category. Patients used different disability narrative categories to describe different disability types. For example, most adults reporting a mental health listed a diagnosis (97%), compared to only 13% of those with lower limb disabilities. CONCLUSIONS Patients had diverse descriptions of their disabilities. In order for providers and healthcare organizations to provide high-quality care, they should engage patients in developing a consistent, patient-centered language around disability.
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Affiliation(s)
- Megan A Morris
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, 200 1st Street SW, Rochester, MN 55905, USA.
| | - Jonathan Inselman
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, 200 1st Street SW, Rochester, MN 55905, USA; Department of Health Sciences Research, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
| | - Julie M G Rogers
- Mayo Clinic, Department of Anesthesiology, 200 1st Street SW, Rochester, MN 55905, USA
| | - Colin Halverson
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, 200 1st Street SW, Rochester, MN 55905, USA; Center for Biomedical Ethics and Society, Vanderbilt University, 2525 West End Ave., Suite 400, Nashville, TN 37203, USA
| | - Megan Branda
- Department of Health Sciences Research, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
| | - Joan M Griffin
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, 200 1st Street SW, Rochester, MN 55905, USA; Department of Health Sciences Research, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
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O'Halloran R, Coyle J, Lamont S. Screening patients for communication difficulty: The diagnostic accuracy of the IFCI staff questionnaire. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2017; 19:430-440. [PMID: 27686874 DOI: 10.1080/17549507.2016.1209560] [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: 09/04/2015] [Revised: 03/17/2016] [Accepted: 05/22/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE Many patients have difficulty communicating about their healthcare. At present there is no tool to identify these patients. This research investigated whether the Inpatient Functional Communication Interview Staff Questionnaire (IFCI SQ) could detect patients who have difficulty communicating their healthcare needs by investigating the sensitivity, specificity and internal consistency of the IFCI SQ. METHOD Fifty patients and their nurses participated in this research. Every second consecutive admission on the general medical ward of a hospital was assessed for communication difficulty by a speech-language pathologist on the IFCI and screened for communication difficulty by a nurse using the IFCI SQ. RESULT At a cut off score of <2, the IFCI SQ had a sensitivity of 95% and a specificity of 77% compared with the IFCI. The IFCI SQ is a useful test in identifying patients who have communication difficulty and is an extremely good test at ruling out patients who do not have communication difficulty. The internal consistency of the IFCI SQ was also high at 0.954. CONCLUSION The IFCI SQ is a promising tool to detect patients in hospital with communication difficulty. Further research is required to explore the psychometric properties of the IFCI SQ in more detail.
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Affiliation(s)
- Robyn O'Halloran
- a Discipline of Human Communication Sciences , La Trobe University , Bundoora , Victoria , Australia and
| | - Julieanne Coyle
- b Department of Speech Pathology & Music Therapy, Monash Health , Melbourne , Australia
| | - Sue Lamont
- b Department of Speech Pathology & Music Therapy, Monash Health , Melbourne , Australia
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Palmer CV, Mulla R, Dervin E, Coyan KC. HearCARE: Hearing and Communication Assistance for Resident Engagement. Semin Hear 2017; 38:184-197. [PMID: 28522893 DOI: 10.1055/s-0037-1601574] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Impaired hearing is related to poor health outcomes, including compromised cognitive function, in aging individuals. Hearing loss is the third most common chronic health condition after arthritis and heart disease in older adults and the fourth most detrimental condition related to quality of life in older adults. Only 18% of aging adults who have impactful hearing loss actually use custom-fit amplification. Therefore, the majority of aging individuals entering senior living facilities will have untreated hearing loss. Older adults move to senior communities to maintain or increase their social engagement, to receive care from qualified staff, and to ultimately enhance their quality of life. We know that the majority of individuals over 65 years of age have significant hearing loss, which leaves them with complex listening needs due to low incidence of hearing aid use, group communication situations that are common for social activities, interactive dining environments, and the need for telephone use to connect with loved ones. Busy staff and family members may not be aware of the impact of decreased hearing on quality of life, as well as caregiver burden. HearCARE (Hearing and Communication Assistance for Resident Engagement) is an initiative to provide communication assistance on a day-to-day basis in senior living facilities in a cost-effective manner. This innovative model for delivering audiology services and communication assistance in senior living communities employing communication facilitators who are trained and supervised by an audiologist will be described. Data related to the communication facilitator training, daily activities, interactions with the audiologist, use of devices, and impact on residents, staff, and families will be described.
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Affiliation(s)
- Catherine V Palmer
- University of Pittsburgh, Pittsburgh, Pennsylvania.,University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania
| | - Reem Mulla
- University of Pittsburgh, Pittsburgh, Pennsylvania.,University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania
| | - Elizabeth Dervin
- University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania
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Zitelli L, Palmer CV. The Role of Audiology in an Outpatient Interdisciplinary Post-Trauma Clinic. Semin Hear 2017; 38:169-176. [PMID: 28522891 PMCID: PMC5435473 DOI: 10.1055/s-0037-1601572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Patients in the process of recovering from severe bodily injury will encounter several barriers to effective treatment. When present, untreated hearing loss can create additional obstacles in a process that is already difficult. This article describes an outpatient post-trauma clinic associated with a tertiary care hospital trauma unit that consolidates rehabilitation resources 2 weeks after inpatient discharge to help these patients on their path to recovery. The role of audiology in the interdisciplinary clinic is described and data related to services are presented. Some practical tips for implementation of audiologic services in this type of environment are provided.
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Affiliation(s)
- Lori Zitelli
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania;
- Department of Otolaryngology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
| | - Catherine V. Palmer
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania;
- Department of Otolaryngology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
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Moscoso-Porras MG, Alvarado GF. Association between perceived discrimination and healthcare-seeking behavior in people with a disability. Disabil Health J 2017; 11:93-98. [PMID: 28420592 DOI: 10.1016/j.dhjo.2017.04.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 01/27/2017] [Accepted: 04/03/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Experiences of discrimination lead people from vulnerable groups to avoid medical healthcare. It is yet to be known if such experiences affect people with disabilities (PWD) in the same manner. OBJECTIVES To determine the association between perceived discrimination and healthcare-seeking behavior in people with disabilities and to explore differences of this association across disability types. METHODS We performed a cross-sectional study with data from a national survey of people with disabilities. Perceived discrimination and care-seeking behavior were measured as self-reports from the survey. Dependence for daily life activities, possession of health insurance, and other disability-related variables were included and considered as confounders. We used Poisson regression models and techniques for multistage sampling in the analyses. A stratified analysis was used to explore effects of discrimination across types of disability. RESULTS Most of PWD were 65 years or older (67.1%). Prevalence of healthcare seeking was 78.8% in those who perceived discrimination, and 86.1% in those who did not. After adjusting for potential confounders, the probability of not seeking care was higher in people who reported perceived discrimination (adjusted PR = 1.15; 95%CI: 1.04-1.28). In a stratified analysis, significant effects of discrimination were found in people with communication disability (adjusted PR = 1.34, 95%CI: 1.07-1.67) and with physical disability (adjusted PR = 1.17, 95%CI: 1.03-1.34). CONCLUSIONS People with disabilities who perceive discrimination are less likely to seek healthcare. This association was higher for people with communication and physical disabilities. These results provide evidence to institutions who attempt to tackle discrimination.
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Affiliation(s)
| | - German F Alvarado
- School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru
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Saldert C, Forsgren E, Hartelius L. Teaching medical students about communication in speech-language disorders: Effects of a lecture and a workshop. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2016; 18:571-579. [PMID: 27063685 DOI: 10.3109/17549507.2016.1143975] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE This study aims to explore the effects of an interactive workshop involving speech-language pathology students on medical students' knowledge about communication in relation to speech-language disorders. METHOD Fifty-nine medical students received a lecture about speech-language disorders. Twenty-six of them also participated in a workshop on communication with patients with speech-language disorders. All students completed a 12-item questionnaire exploring knowledge and attitudes towards communication before and after the lecture or the workshop. The results from the two groups' self-ratings of confidence in knowledge were compared with expert-ratings of their ability to choose suitable communicative strategies. RESULT Both the lecture and the workshop increased the students' confidence in knowledge about speech-language disorders and how to support communication. Only the workshop group also displayed a statistically significant increase in expert-rated ability and changed their attitude regarding responsibility for the communication in cases of speech-language disorders. There were no statistically significant correlations between the student's own confidence ratings and the experts' ratings of ability. CONCLUSION Increased confidence in knowledge from learning is not always reflected in actual knowledge in how to communicate. However, an interactive workshop proved to increase medical students' expert-rated ability and attitudes related to communication in cases of speech-language disorders.
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Affiliation(s)
- Charlotta Saldert
- a Unit of Speech and Language Pathology, Institute of Neuroscience and Physiology , University of Gothenburg , Gothenburg , Sweden and
- b University of Gothenburg Centre for Person-Centred Care (GPCC) , Gothenburg , Sweden
| | - Emma Forsgren
- a Unit of Speech and Language Pathology, Institute of Neuroscience and Physiology , University of Gothenburg , Gothenburg , Sweden and
- b University of Gothenburg Centre for Person-Centred Care (GPCC) , Gothenburg , Sweden
| | - Lena Hartelius
- a Unit of Speech and Language Pathology, Institute of Neuroscience and Physiology , University of Gothenburg , Gothenburg , Sweden and
- b University of Gothenburg Centre for Person-Centred Care (GPCC) , Gothenburg , Sweden
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Palmer AD, Newsom JT, Rook KS. How does difficulty communicating affect the social relationships of older adults? An exploration using data from a national survey. JOURNAL OF COMMUNICATION DISORDERS 2016; 62:131-46. [PMID: 27420152 PMCID: PMC4968942 DOI: 10.1016/j.jcomdis.2016.06.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 06/21/2016] [Accepted: 06/21/2016] [Indexed: 06/04/2023]
Abstract
UNLABELLED Healthy social relationships are important for maintaining mental and physical health in later life. Less social support, smaller social networks, and more negative social interactions have been linked to depression, poorer immune functioning, lower self-rated health, increased incidence of disease, and higher mortality. Overwhelming evidence suggests that communication disorders adversely affect social relationships. Much less is known about whether some or all aspects of social relationships are negatively affected by a communication disorder. The relative impact of a communication disorder on social relationships, as compared to other kinds of disability, is also poorly understood. Data were analyzed from a representative national sample of community-dwelling adults aged 65 and older living in the continental United States (n=742). Results from multiple regressions indicated that difficulty communicating was significantly associated with several parameters of social relationships even after controlling for age, gender, partnership status, health, functional limitations, and visual impairment. Communication difficulty was a significant predictor of smaller social network size, fewer positive social exchanges, less frequent participation in social activities, and higher levels of loneliness, but was not a significant predictor of negative social exchanges. These findings suggest that communication disorders may place older adults at increased risk for mental and physical health problems because of social isolation, reduced social participation, and higher rates of loneliness. In addition, it appears that communication disorders may have a greater impact on positive, rather than negative, aspects of social relationships. LEARNING OUTCOMES As a result of this activity, the following learning outcomes will be realized: Readers will be able to (1) describe changes in the social relationships of older adults that occur as part of normal aging, (2) identify the aspects of social relationships that were significantly impacted by a communication difficulty, and (3) discuss possible reasons for these findings including potential clinical implications.
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Affiliation(s)
- Andrew D Palmer
- NW Clinic for Voice & Swallowing, Department of Otolaryngology-Head & Neck Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Rd., Mail Code: PV-01, Portland, OR 97239, USA.
| | - Jason T Newsom
- Institute on Aging, Portland State University, P.O. Box 751, Portland, OR 97207-0751, USA.
| | - Karen S Rook
- Department of Psychology and Social Behavior, School of Ecology, University of California, Irvine, CA 92697-7050, USA.
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Blackstone SW, Pressman H. Patient Communication in Health Care Settings: new Opportunities for Augmentative and Alternative Communication. Augment Altern Commun 2015; 32:69-79. [PMID: 26694249 DOI: 10.3109/07434618.2015.1125947] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Delivering quality health care requires effective communication between health care providers and their patients. In this article, we call on augmentative and alternative communication (AAC) practitioners to offer their knowledge and skills in support of a broader range of patients who confront communication challenges in health care settings. We also provide ideas and examples about ways to prepare people with complex communication needs for the inevitable medical encounters that they will face. We argue that AAC practitioners, educators, and researchers have a unique role to play, important expertise to share, and an extraordinary opportunity to advance the profession, while positively affecting patient outcomes across the health care continuum for a large number of people.
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Burns M, Baylor C, Dudgeon BJ, Starks H, Yorkston K. Asking the Stakeholders: Perspectives of Individuals With Aphasia, Their Family Members, and Physicians Regarding Communication in Medical Interactions. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2015; 24:341-57. [PMID: 25760479 DOI: 10.1044/2015_ajslp-14-0051] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 02/17/2015] [Indexed: 05/15/2023]
Abstract
PURPOSE The purpose of this study was to explore the experiences of patients with aphasia, their family members, and physicians related to communication during medical interactions. METHOD Face-to-face, semistructured interviews were conducted with 18 participants—6 patients with aphasia, 6 family members involved in patient care, and 6 practicing physicians. A qualitative description approach was used to collect and summarize narratives from participants' perspectives and experiences. Participants were asked about experiences with communication during medical interactions in which the family member accompanied the patient. Interviews were audio- and/or video-recorded, transcribed, and then coded to identify main themes. RESULTS Patients and family members generally described their communication experiences as positive, yet all participants discussed challenges and frustrations. Three themes emerged: (a) patients and family members work as a team, (b) patients and family members want physicians to "just try" to communicate with the patient, and (c) physicians want to interact with patients but may not know how. CONCLUSIONS Participants discussed the need for successful accommodation, or changing how one communicates, to help facilitate the patients' increased understanding and ability to express themselves. Over- and underaccommodation with communication were commonly reported as problems. Speech-language pathologists have a role to play in helping to improve communication during medical interactions. Implications for current speech-language pathologist practice and future directions of research are discussed.
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Morris MA, Meier SK, Griffin JM, Branda ME, Phelan SM. Prevalence and etiologies of adult communication disabilities in the United States: Results from the 2012 National Health Interview Survey. Disabil Health J 2015; 9:140-4. [PMID: 26303018 DOI: 10.1016/j.dhjo.2015.07.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 06/09/2015] [Accepted: 07/03/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND Communication disabilities, including speech, language and voice disabilities, can significantly impact a person's quality of life, employment and health status. Despite this, little is known about the prevalence and etiology of communication disabilities in the general adult population. OBJECTIVES To assess the prevalence and etiology of communication disabilities in a nationally representative adult sample. METHODS We conducted a cross-sectional study and analyzed the responses of non-institutionalized adults to the Sample Adult Core questionnaire within the 2012 National Health Interview Survey. We used respondents' self-report of having a speech, language or voice disability within the past year and receiving a diagnosis for one of these communication disabilities, as well as the etiology of their communication disability. We additionally examined the responses by subgroups, including sex, age, race and ethnicity, and geographical area. RESULTS In 2012 approximately 10% of the US adult population reported a communication disability, while only 2% of adults reported receiving a diagnosis. The rates of speech, language and voice disabilities and diagnoses varied across gender, race/ethnicity and geographic groups. The most common response for the etiology of a communication disability was "something else." CONCLUSIONS Improved understanding of population prevalence and etiologies of communication disabilities will assist in appropriately directing rehabilitation and medical services; potentially reducing the burden of communication disabilities.
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Affiliation(s)
- Megan A Morris
- Mayo Clinic, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA; Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
| | - Sarah K Meier
- Mayo Clinic, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA; Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Joan M Griffin
- Mayo Clinic, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA; Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Megan E Branda
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Sean M Phelan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
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Morris MA, Yorkston K, Clayman ML. Improving communication in the primary care setting: perspectives of patients with speech disabilities. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2015; 7:397-401. [PMID: 24939644 DOI: 10.1007/s40271-014-0067-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Patients with speech disabilities can present with challenges when communicating during primary-care clinical encounters. Little is known about the healthcare communication experiences of patients with severe speech disabilities. METHODS Twelve participants took part in open-ended, in-person interviews. All participants had either acquired or developmental, severe speech disabilities but were not limited by cognitive and language disabilities. A multi-disciplinary team conducted a thematic analysis that included reading the transcripts and then developing and applying a list of codes through consensus. RESULTS Participants discussed provider behaviors that affected communication during clinical encounters. They wanted providers to acknowledge their competence by speaking directly to them and using age-appropriate language. Additionally, participants appreciated when providers adapted to their communication style by maintaining eye contact, asking the patient how to best communicate with them, providing time for the patient to communicate, not interrupting the patient, and admitting when they do not understand the patient. CONCLUSION Primary-care providers need to be cognizant of the communication needs of patients with communication disabilities. While the needs might be similar to other patient populations, patients with communication disabilities present with unique challenges. With accommodations, patients with speech disabilities can potentially be more engaged in their healthcare conversations.
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Affiliation(s)
- Megan A Morris
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA,
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O'Halloran R, Lee YS, Rose M, Liamputtong P. Creating communicatively accessible healthcare environments: perceptions of speech-language pathologists. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2014; 16:603-614. [PMID: 24665913 DOI: 10.3109/17549507.2014.894125] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
There is a growing body of research that indicates that a person with a communication disability communicates and participates more effectively given a communicatively accessible environment. If this research is to be translated into practice then one needs to determine who will take on the role of creating communicatively accessible environments. This research adopted a qualitative methodology to explore the perceptions of speech-language pathologists about working to create communicatively accessible healthcare settings. Fifteen speech-language pathologists in three focus groups participated in this research. The focus group discussions were transcribed and analysed thematically. Thematic analysis indicated that speech-language pathologists believe there are four main benefits in creating communicatively accessible healthcare environments. These are Benefits for all people: Access for all, Benefits for healthcare administrators, Benefits for those wanting to improve communication with patients, and Benefits to the capacity to provide communicatively accessible environments. However, they believe these benefits can only be achieved if; The communication resources are available, Skilled, knowledgeable and supportive healthcare providers are available; and Systems are in place to support a whole-of-hospital approach. This research supports the development of a new role to improve the communicative accessibility of healthcare settings.
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Affiliation(s)
- Robyn O'Halloran
- La Trobe University, Human Communication Sciences , Bundoora, Melbourne , Australia
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Silence in the EHR: infrequent documentation of aphonia in the electronic health record. BMC Health Serv Res 2014; 14:425. [PMID: 25248751 PMCID: PMC4181429 DOI: 10.1186/1472-6963-14-425] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 09/16/2014] [Indexed: 11/22/2022] Open
Abstract
Background To begin to deliver patient-centered care, providers need to be aware of when a patient has a communication disability and what communication methods to use with the patient. The aim of the study was to describe if and how patients’ communication disabilities are documented within electronic health records (EHR). Methods A retrospective manual chart review of all inpatient and outpatient clinical encounter notes within the EHR for patients who had undergone a laryngectomy at Northwestern Memorial Hospital (Chicago, IL) between 2000–2013. We selected patients who had undergone a laryngectomy as the patient population as we were able to easily identify the patients through Common Procedural Terminology (CPT) codes. Results We identified 81 patient charts with 7484 encounter notes. Of the 81 patient charts, 58 (72%) had at least one encounter note with a communication notation. Excluding speech-language pathology notes, 1164 (16%) of all encounter notes included some notation of the patients’ communication abilities. We coded the communication notations into four categories. 1) Descriptions of communication abilities appeared in 663 (9%) of all encounter notes, 2) descriptions of communication methods appeared in 590 (8%) of all encounter notes, and the last two categories 3) medical management and 4) referrals to speech-language pathology services each appeared in 148 (2%) of all encounter notes. While all patients had the same type of communication disability, aphonia, providers used 39 different terms and phrases to describe aphonia. Conclusions Patients’ communication abilities were infrequently documented in the EHR. When providers did document a patient’s communication disability or method, they used inconsistent descriptions, suggesting a lack of standardized language. Further work is needed to determine how to consistently and accurately document patients’ communication abilities so staff and providers can quickly recognize how best to communicate with patients with communication disabilities.
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Adib-Hajbaghery M, Rezaei-Shahsavarloo Z. Nursing students' knowledge of and performance in communicating with patients with hearing impairment. Jpn J Nurs Sci 2014; 12:135-44. [PMID: 25243617 DOI: 10.1111/jjns.12057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 06/14/2014] [Indexed: 12/01/2022]
Abstract
AIM The present study aimed to investigate nursing students' knowledge of and performance in communicating with patients with hearing impairment. METHODS A cross-sectional study was conducted on all senior nursing students (n = 71) in a nursing school in Iran in 2013. Data collection was performed with a demographics questionnaire, knowledge questionnaire, and performance assessment checklist. Two stages were designed to evaluate the students. In the first stage, students conducted an interview with a simulated patient with hearing impairment who experienced chest pain. In the second stage, students answered the knowledge questionnaire. Descriptive statistics, independent sample Student's t-test, and Pearson correlation coefficient were used to analyze the data. RESULTS In total, 11.3% of participants had a history of caring for a patient with hearing impairment. The majority of students evaluated their performance in communicating with such patients at a moderate level. A significant difference was observed between the mean score of knowledge in men and women (P = 0.05), and male students gained higher scores. In total, 61.5% of the students had low to very low levels of knowledge and 87.3% of them had weak to very weak performance in communicating with patients with hearing impairment. CONCLUSION Nursing students are lacking in knowledge and skills required for effective communication with patients with hearing impairment. Nurse educators should pay more attention to this issue as it is their responsibility to prepare nurses who are competent to deal with common issues they will face in practice.
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Affiliation(s)
- Mohsen Adib-Hajbaghery
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran
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Assessing the Nursing and Midwifery Students Competencies in Communication With Patients With Severe Communication Problems. Nurs Midwifery Stud 2014. [DOI: 10.5812/nms.18143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Adib Hajbaghery M, Rezaei Shahsavarloo Z. Assessing the Nursing and Midwifery Students Competencies in Communication With Patients With Severe Communication Problems. Nurs Midwifery Stud 2014. [DOI: 10.17795/nmsjournal18143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Adib Hajbaghery M, Rezaei Shahsavarloo Z. Assessing the nursing and midwifery students competencies in communication with patients with severe communication problems. Nurs Midwifery Stud 2014; 3:e18143. [PMID: 25414902 PMCID: PMC4228534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 02/20/2014] [Accepted: 03/03/2014] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Clients with communication impairment are at risk for health disparity. Hence, health care workers should be knowledgeable and skillful in communication. However, no studies are available on Iranian nursing and midwifery students' communication skills with patients with severe communication problems. OBJECTIVES The present study was conducted to investigate Iranian nursing and midwifery students' competencies in communication with patients with severe communication problems. MATERIALS AND METHODS This study was performed on all senior nursing and midwifery students of Kashan University of Medical Sciences in spring 2013. Data were collected through a knowledge questionnaire and two checklists for evaluation of skills needed for communication with patients with severe communication problems. Data analysis was performed through independent samples t test, and Fisher's exact test. RESULTS In total, 68.8% of the participants were female, 37.6% had a history of part-time job as a nurse or midwife. The mean score of knowledge were 4.41 ± 1.42 and 4.77 ± 1.77 for nursing and midwifery students, respectively and the difference was not significant (P = 0.312). In addition, the mean score of communication skills with deaf patients was 13.23 ± 4.68 and 11.86 ± 5.55 for nursing and midwifery students, respectively and the difference was not significant (P = 0.258). Also, the mean score of communication skills with stutter patients was 23.91 ± 4.17 and 21.25 ± 3.91 for nursing and midwifery students, respectively but the difference was not significant (P = 0.269). CONCLUSIONS Nursing and midwifery students did not significantly differ in terms of communication with patients with severe communication problems. Most of the students had low or very low knowledge and skills in communication with patients with hearing impairment. However, they had better skills in communication with patient with speech problem. Special workshops or training programs are recommended to empower nursing and midwifery students in communication with patients with communication problems.
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Affiliation(s)
- Mohsen Adib Hajbaghery
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, IR Iran,Corresponding author: Mohsen Adib Hajbaghery, Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-3615550021, Fax: +98-3615556633, E-mail:
| | - Zahra Rezaei Shahsavarloo
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, IR Iran
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Johnson M, Lin F. Communication Difficulty and Relevant Interventions in Mild Cognitive Impairment: Implications for Neuroplasticity. TOPICS IN GERIATRIC REHABILITATION 2014; 30:18-34. [PMID: 25356002 PMCID: PMC4209953 DOI: 10.1097/tgr.0000000000000001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Mild Cognitive Impairment (MCI) represents a critical point for controlling cognitive decline. Patterns of communication difficulty have been observed in patients with MCI and warrant examination and management. The present systematic review examined (1) characteristics of communication difficulty in MCI by focusing on two domains: expressive and receptive communication, and (2) cognitive interventions that addressed communication difficulties in individuals with MCI. Of the 28 observational studies we reviewed, expressive and receptive communications were generally impaired in individuals with MCI, compared to their healthy counterparts. However, only one of seven interventions effectively improved communication related outcomes. We finished the paper with a discussion about how neuroplasticity influences communication abilities in individuals with MCI to inform the future development of interventions for communication difficulty.
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Affiliation(s)
| | - Feng Lin
- School of Nursing, University of Rochester Medical Center
- AD-CARE Program, Department of Psychiatry, School of Medicine and Dentistry, University of Rochester Medical Center
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Ferreira KASL, de Andrade DC, Teixeira MJ. Development and Validation of a Brazilian Version of the Short-Form McGill Pain Questionnaire (SF-MPQ). Pain Manag Nurs 2013; 14:210-219. [DOI: 10.1016/j.pmn.2011.04.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 04/13/2011] [Accepted: 04/21/2011] [Indexed: 10/16/2022]
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Schalling E, Hartelius L. Speech in spinocerebellar ataxia. BRAIN AND LANGUAGE 2013; 127:317-322. [PMID: 24182841 DOI: 10.1016/j.bandl.2013.10.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 09/13/2013] [Accepted: 10/06/2013] [Indexed: 06/02/2023]
Abstract
Spinocerebellar ataxias (SCAs) are a heterogeneous group of autosomal dominant cerebellar ataxias clinically characterized by progressive ataxia, dysarthria and a range of other concomitant neurological symptoms. Only a few studies include detailed characterization of speech symptoms in SCA. Speech symptoms in SCA resemble ataxic dysarthria but symptoms related to phonation may be more prominent. One study to date has shown an association between differences in speech and voice symptoms related to genotype. More studies of speech and voice phenotypes are motivated, to possibly aid in clinical diagnosis. In addition, instrumental speech analysis has been demonstrated to be a reliable measure that may be used to monitor disease progression or therapy outcomes in possible future pharmacological treatments. Intervention by speech and language pathologists should go beyond assessment. Clinical guidelines for management of speech, communication and swallowing need to be developed for individuals with progressive cerebellar ataxia.
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Affiliation(s)
- Ellika Schalling
- Department of Clinical Science, Intervention and Technology, Division of Speech and Language Pathology, Karolinska Institutet, 141 86 Stockholm, Sweden; Department of Speech and Language Pathology, Karolinska University Hospital, 171 76 Stockholm, Sweden.
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