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Carragher M, Steel G, O'Halloran R, Lamborn E, Torabi T, Johnson H, Taylor NF, Rose ML. Aphasia disrupts usual care: "I'm not mad, I'm not deaf" - the experiences of individuals with aphasia and family members in hospital. Disabil Rehabil 2024:1-12. [PMID: 38444182 DOI: 10.1080/09638288.2024.2324115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 02/22/2024] [Indexed: 03/07/2024]
Abstract
PURPOSE Communication difficulties are highly prevalent in the stroke population, with implications for patient experience, safety and outcomes. This study explores the experiences of people with aphasia and family members regarding healthcare communication in acute and subacute stroke settings. METHODS AND MATERIALS A phenomenological approach was used to understand participants' experiences. Participants took part in a focus group and data were analysed using an inductive thematic approach. RESULTS For individuals with aphasia (n = 4) and family members (n = 2), five themes were generated: "aphasia makes it hard to communicate," "hospital staff focus on the patient's medical status only," "people with aphasia do not get the help they need to improve," "staff lack the skills to communicate with people with aphasia," and "staff are crucial to improving healthcare communication." CONCLUSIONS The stroke team has expertise in the medical management of stroke but struggle to communicate with patients with aphasia. Patients' experience of healthcare communication is often one-way and limited to following instructions, with missed opportunities to discuss core topics such as prognosis, rehabilitation, and person-specific needs. Patients and families assert that all members of the stroke healthcare team should be able to adapt communication to accommodate patients.
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Affiliation(s)
- Marcella Carragher
- Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - Gillian Steel
- Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - Robyn O'Halloran
- Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - Edwina Lamborn
- Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - Torab Torabi
- Computer Science and Information Technology, School of Engineering and Mathematical Sciences, La Trobe University, Melbourne, Australia
| | - Hilary Johnson
- Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- Scope Communication and Inclusion Resource Centre, Melbourne, Australia
| | - Nicholas F Taylor
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia and Allied Health Clinical Research Office, Australia
| | - Miranda L Rose
- Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
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Sous W, Frank K, Cronkright P, Germain LJ. Use of a simulated patient case and structured debrief to explore trainee responses to a "non-compliant patient". BMC MEDICAL EDUCATION 2022; 22:842. [PMID: 36474211 PMCID: PMC9727840 DOI: 10.1186/s12909-022-03894-7] [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: 05/10/2022] [Accepted: 11/14/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Labeling a patient "non-compliant" is a form of dehumanization that can deprive the patient of positive human qualities and/or agency in the mind of a physician. The term "non-compliant" is frequently used in medical record documentation and has been shown to compromise care, particularly for marginalized communities. There is limited literature on the impact of the label on medical trainees. We aimed to explore how internal medicine residents and fellows (trainees) perceive the term "non-compliant patient" and its impact on their practice after interacting with a simulated refugee patient who has not followed a physician's recommendations. METHODS Kolb's experiential learning cycle guided the design of the educational session which was part of a required communication skills curriculum for trainees. A scenario was created to simulate a refugee patient who had not adhered to their treatment plan and could potentially be labeled as "non-compliant." Trainees participated in the 3-h session consisting of a remote simulated patient encounter immediately followed by a virtual structured debrief session that was recorded and transcribed. Thematic analysis of debrief transcripts was conducted starting with the use of provisional codes from the literature on the doctor-patient relationship and de/humanization. RESULTS In group debrief sessions, trainees reflected upon the standardized patient case and chose to also discuss similar cases they had experienced in clinical practice. Trainees indicated that the term "non-compliant patient" served as a biasing function and described how this bias negatively impacted the doctor-patient relationship. Trainees described how marginalized communities might be more susceptible to the negative connotation associated with the term "non-compliant patient." For some trainees, the term triggered further investigation of underlying barriers to care and exploration of the social determinants of health. CONCLUSIONS The use of the phrase "non-compliant patient," though common in medical practice, may lead to patient dehumanization among trainees. A simulated refugee patient encounter followed by a facilitated group debrief allowed participants to verbalize and reflect on the meaning and possible impact of the label.
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Affiliation(s)
- Waseem Sous
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY, USA.
- Department of Hospital Medicine, University of California, San Francisco, San Francisco, CA, USA.
- HEAL Initiative, University of California, San Francisco, San Francisco, CA, USA.
| | - Kay Frank
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Peter Cronkright
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Lauren J Germain
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
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Rethinking the Use of "Caucasian" in Clinical Language and Curricula: a Trainee's Call to Action. J Gen Intern Med 2022; 37:1780-1782. [PMID: 35212875 PMCID: PMC8876079 DOI: 10.1007/s11606-022-07431-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 01/20/2022] [Indexed: 11/05/2022]
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