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Health Psychology > Communication in heath contexts > Flashcards

Communication in heath contexts Flashcards

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1
Q

What is the traditional model of communication?

A
  • Shannon and Weaver (1948)

- Source –> transmitter –> channel –> receiver –> destination

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2
Q

What are the three stages of communication?

A

Thought, encoding, decoding

  • Thought: A concept, idea, information, or feelings
  • Encoding: A message sent to a receiver (e.g. words)
  • Decoding: The receiver translates the words into a concept or information that he or she can understand
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3
Q

What are the common problems with traditional models of communication?

A
  • Oversimplified
  • Separation of roles
  • Direction (bidirectional exchange, not one directional – involves the speaker and receiver)
  • Model doesn’t allow the role of feedback
  • Doesn’t allow for the importance of content or meaning
  • Context
  • Relationship (speaker and listener – lecturer & student, doctor & student) (can have an issue with authority
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4
Q

What aspects of communication are just as important as the words used?

A
  • The tone of our voice when we speak
  • The attention we give to what the other person is saying
  • The messages we give out by the way we move and position our bodies
  • The accuracy and clarity of what we write are also key elements of good communication
  • Multiple communication aspects: listening and attending (including patient/family complaints), non – verbal, verbal, questioning, written
  • Questions and presentation of information (leaflets etc.)
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5
Q

What are the different types of communication?

A

Verbal and non-verbal

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6
Q

What is verbal communication?

A

Language

Paralinguistic

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7
Q

What is non-verbal communication?

A 
o Haptics (e.g. therapeutic touch)
o Gestures 
o Facial expressions 
o Eye-contact 
o Appearance
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8
Q

What is communication in healthcare?

A
  • A health professional may conduct as many as 150,000 patient interviews in an entire career
  • During a 4-day stay in hospital a patient may interact with 50 employees in the health care system
  • Lack of communication creates situations where medical errors can occur
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9
Q

Why is health professional-patient communication of importance?

A
  • Creating a good therapeutic relationship
    o Would like to have a good relationship with someone taking control of your care
  • Exchanging information
  • Making healthcare-related decisions
  • Most patient dissatisfaction and complaints are due to breakdown in the relationship
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10
Q

How has empathy been linked to health outcomes?

A
  • Patients who gave their clinician a perfect empathy score reported that their colds were less severe, were of shorter duration and they also had improved biomarkers of cold (Rakel et al, 2011)
  • Physician empathy was positively associated with improvement in patient-reported outcomes of depression and quality of life (Neumann et al, 2007)

o Suggests that psychology has a huge role in care and communication with patients

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11
Q

How has communication been linked to healthcare complaints?

A

Almost 1/5th of complaints by the public about doctors to the Medical council relate to poor communication

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12
Q

Why is good communication important?

A
  • GMC report (2012)
  • 23% increase in complaints regarding doctors (focusing primarily on how doctors interact with their patients)
  • 69% increase in complaints about communication
  • 45% rise in complaints regarding lack of respect
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13
Q

Case study of the consequences of poor communication –>

A

University of Missouri School of Medicine (2010)
o Continually voted as one of the bottom hospitals in the US in patient satisfaction
- Their medical center was consistently in the lowest quarter of hospitals in the country in patient-satisfaction scores
- Mixed messages:
o 18-45% of patients unable to recall major risks of treatment
o 44% of patient didn’t know the nature of their operation
o 60-68% of patients didn’t read or understand the consent form
o 80% of information told by doctor forgotten as soon as patient leaves consultation
o 50% of what is recalled by patients is incorrect
- As a result… Communication training
o The Missouri medical school now uses an online course that includes 17 videos illustrating different communication issues
o Physicians practice with actors specific to their medical specialties.
o Scenarios:
 A routine interaction in a clinic or hospital
 Delivering bad news
 Delivering a life-changing diagnosis
 Checking a patient’s understanding of a plan of care

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14
Q

What is the current drive in health psychology regarding communication?

A

Current drive in health psychology to implement communication training programs across healthcare professionals

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15
Q

What is being increasingly seen in the modern age and healthcare?

A

Changes in patient;
o Morbidity
 Increasingly seeing an ageing population and chronic pain issues/management
o Availability of information
 Internet, googling symptoms etc.
o Power balance (expert-patient)
 Patient can become more of an expert in their condition that the professional treating them

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16
Q

How has the epidemiological transition in morbidity influenced communication?

A
  • Refers to the shift from infectious pathologies to chronic and degenerative diseases
    o E.g. diabetes, recurring cancer
  • This signals a shift to the patient’s life rather than the patient’s body
  • For example, the reduction of pain or suffering can be more important than cure
    o More about management and managing the impact the illness has on their wider lives as well as their bodies
  • Burden of disease and quality of life increasingly important
    o Also, about whether there is a good QoL
17
Q

How has availability of information influenced communication in healthcare settings?

A
  • Patients used to be dependent on doctor for Information
    o Couldn’t google symptoms or use online GPs
  • Access to health information has improved
    o TV
    o Newspapers
    o Internet
  • Interactive-interface for self-selecting health information
    o We can choose how we obtain information about our health
18
Q

How has information and communication technology changes influenced communication in healthcare?

A
  • Facilitate informed decisions
  • Allow access to health information for disadvantaged groups
  • Flexibility to communicate more frequently and efficiently
  • Allow people with the same condition to talk
    o Having someone who understands your condition is helpful for coping
19
Q

How have modern changes in morbidity, availability of information and technology altered communication methods to be more difficult?

A
  • Questionable reliability and quality of information (Hodge et al., 2000)
    o People may be making important medical choices based on false information
  • Health professionals have to adjust to more informed patients
  • Demands not well received by all health professionals (Mechanic, 2001)
  • Health professionals have to learn to answer more questions, and deal with misinformation
    o E.g. their NHS may not provide the treatment being asked for
    o Tackle more misinformed patients
20
Q

How has a power balance change occurred within healthcare communication?

A
  • Shift from authoritarian to egalitarian relationship
  • Shift from supply to demand-style care
    o Shift from supplying people with what they need to what they ask for
  • Education gap between expert and patient closed
  • Induced power shift to greater patient participation
    o More active in their care
21
Q

How have changes in healthcare communication been linked with health psychology?

A
  • Patient centred medicine
    o Considered as a whole person rather than just a ‘broken leg’ for example
  • Patient illness representations
    o Understanding how patients understand their self-efficacy
  • Self-management
22
Q

What scenarios are there in which people seek and receive health services?

A 
o Preventative 
o Routine care
o Acute and chronic medical conditions
o Conception to death
- Communication difficulties run across this healthcare continuum
23
Q

What parts are there within healthcare settings?

A

o Acute settings
o Primary Care
o Public Health

24
Q

What acute healthcare settings are there?

A
  • Secondary healthcare
  • Active, short-term treatment for a severe injury or episode of illness, an urgent medical condition, or during recovery from surgery
25
Q

What communication issues are professionals faced with in acute hospitalisation cases?

A

o Ambient noise
 Busy settings
o Patient privacy
o Patients with special needs
 Communication issues, distressing patients
o Dealing/Communicating with relatives
 Don’t tend to go alone, so it’s an added aspect of communication

26
Q

What challenges are there in acute healthcare with communication?

A

Quality of the patient’s care as well as how patients experience acute care are negatively affected by:
o Complex and fragmented nature of health professional–patient interactions - loss of information and inadequate explanations to the patient
 E.g. shift changes and lack of communication between handovers and departments
o Failure to build rapport with patient - the patients’ understanding of management plans will be compromised
 Building a treatment plan without trust there

27
Q

What is the MAGIC programme (the health foundation)?

A
  • MAGIC – Making Good Decisions in Collaboration
  • Working with health care professionals in various settings on different ways of encouraging shared decision making
  • Helping patients feel listened to, engaged and involved
28
Q

What examples are there of the MAGIC programme?

A

o Helping men with enlarged prostate choose between taking drugs, surgery or making changes to their lifestyle
o Helping women with early breast cancer choose between mastectomy and breast conserving surgery
 Patients were involved in the process and decision-making, given clear information

29
Q

What is primary care?

A
  • The day-to-day care offered by health professionals
  • Many individual’s first point of contact in the healthcare system
    o General practitioner
    o Nurse practitioner
    o Pharmacist
    o Occupational therapist
  • Barrier in knowing who to go to for what
    o Need to identify the correct channel to enter the primary care system
30
Q

What aspects of communication are there within primary care?

A
  • One of the aims of primary care is care provided in the context of family and community: whole-person care
  • Providing whole-person care depends on the knowledge of a patient’s responsibilities at work, home, or school; medical history and principal health concerns; and their values and beliefs about care “contextual knowledge”
    o Contextual knowledge is especially true when with a family GP – may understand more about your situation
  • Communication is especially important in the management of chronic diseases, such as diabetes, hypertension etc.
  • Patients involved in decision making are more adherent to medical recommendations and are better at behaviour change (exercise, smoking cessation, and diet)
  • In joint decision making patients need to be informed about alternatives and risks of treatment
  • Primary care comes under fire due to the load of patients and management
31
Q

CASE STUDY: What were the three areas which came out when pps were asked to define quality care and a ideal visit to primary care?

A

o Familiarity
o Cultural competency
o Bi-directional exchange

32
Q

What is the importance of communication in public health?

A
  • It has relevance for virtually every area of health and well-being
    o Health promotion
    o Disease prevention
    o Quality of life
    o Influence of social, psychological and environmental influences on health behaviour
33
Q

What do intervention efforts which aim to change behaviours through communicative acts need to consider?

A

o Channels of intervention
 E.g. TV adverts, posters in the GP surgery
o How messages are disseminated
 Back of toilets etc.
o To whom the message is attributed
o How audience members respond
o Features of messages that have the greatest impact
 E.g. catching it early and eating too much sugar leading to Type 2 diabetes

34
Q

What are the main challenges of communication of public health interventions/programmes?

A
  • Evaluation of communication interventions e.g. those using national mass media is not easy to determine via RCT
    o How do you know who the intervention has reached?
  • Also, causes of human behaviour are multifaceted and this causes difficulties in designing and testing interventions
    o How do you know it was the campaign that facilitated this behaviour change?
  • Not every intervention will work for every individual
35
Q

SUMMARY of this lecture

A
  • Health professional-patient communication has changed considerably in the last decades and is still undergoing major changes
    o Patients who want and need to know more
    o Information technology increases amount and availability of health information for patients are increases challenges for health professionals
    o More egalitarian health professional-patient relationship
    o More diversity in patient needs
  • There are unique communication challenges in every healthcare setting
  • Shared decision-making is a key goal for health communication
  • Communication training, research and evaluation of health communication strategies should be specific to a given setting

Health Psychology (5 decks)

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