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Title: Preferred Communication Strategies for People with Communication Disabilities in Health Care Encounters: A Qualitative Study
Author: Julie Hughes
Source article: Hickey, E., Man, B., Helm, K. V. T., Lockhart, S., Duffecy, J., & Morris, M. A. (2024). Preferred Communication Strategies for People with Communication Disabilities in Health Care Encounters: a Qualitative Study. Journal of general internal medicine, 39(5), 790–797. https://doi.org/10.1007/s11606-023-08526-4.
Background: Given the population seen by palliative care (PC) specialists (often with multiple organ system dysfunction, progressive disability, advanced age, neurologic deficits), patients with communication disabilities (CD) are common. Since communication is the scaffold for palliative care evaluations, it’s imperative that we facilitate the best communication processes possible for our patients. The broad range of CDs precludes a universal simple strategy. An understanding of available modalities to improve communication would enhance the conversations between PC providers and their patients.
Design and Participants: The objective of this qualitative study was to develop a patient-prompted tool to facilitate communication by collecting qualitative feedback on communication strategies for CDs. Using qualitative content analysis, the semi-structured interviews collected data from people with CDs, caregivers, and healthcare providers to identify which communication strategies were most useful and their preferences about disclosure of the CD. Forty-six individuals participated, comprising focus groups of 26 patients with self-reported and diverse CDs, caregivers, and healthcare providers. The tool itself is not yet presented, but the article describes learnings from its development.
Results: Three themes were identified: (1) participants agreed on a consolidated list of best strategies and accommodations, (2) patients and providers preferred disclosure of the CD and desired communication strategies before the appointment, and concerningly (3) providers often don’t use communication strategies/accommodations during clinical encounters. An iterative team-based process was used to develop a draft of the tool, and this was introduced to participants via cognitive interviews for input on the tool’s design, layout and functionality as well as the communication strategies/accommodations listed.
Commentary: Patients within and across different types of CDs didn’t necessarily share the same preferences; therefore, communication strategies need to be individualized. While the tool itself is of interest (could it be used as part of our admission process in the hospital?), a study that collated the most useful ones according to those who have CDs themselves is enlightening. The idea of multiple modalities, warning patients when switching topics, asking permission to guess what the patient is saying, and voice-to-text apps that any provider could add to their phone were the most enlightening to me of the list of strategies and accommodations. Another recent article (Dias 2024) listed the most important communication strategies as defined by speech therapists. These included: patient position, appropriate speech pace, structured pauses, adjusting language level (even defaulting to “yes or no” questions, counter to many providers’ training), sticking to one topic at a time, and multiple modalities including tables with images/books with pictures (and using images of the patient’s interests or personal objects).
Bottom Line: Since palliative care’s relational foundation requires excellent communication with our patients/families, we are ideally positioned to employ and model these skills to other colleagues. There is constant tension at the nexus of what providers need to get their work done in limited time allotments versus the breadth of what patients need or would like. There are multiple inherent obstacles to communication in the healthcare setting, but investments into mitigating them pay substantial dividends.
References: Dias C, Rodrigues IT, Goncalves H, Duarte I. Communication strategies for adults in palliative care: the speech-language therapists’ perspective. BMC Palliative Care. 2024 23:49. https://doi.org/10.11.186/s12904-024-01382.
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