Communication in heath contexts Flashcards
What is the traditional model of communication?
- Shannon and Weaver (1948)
- Source –> transmitter –> channel –> receiver –> destination
What are the three stages of communication?
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
What are the common problems with traditional models of communication?
- 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
What aspects of communication are just as important as the words used?
- 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.)
What are the different types of communication?
Verbal and non-verbal
What is verbal communication?
Language
Paralinguistic
What is non-verbal communication?
o Haptics (e.g. therapeutic touch) o Gestures o Facial expressions o Eye-contact o Appearance
What is communication in healthcare?
- 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
Why is health professional-patient communication of importance?
- 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
How has empathy been linked to health outcomes?
- 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
How has communication been linked to healthcare complaints?
Almost 1/5th of complaints by the public about doctors to the Medical council relate to poor communication
Why is good communication important?
- 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
Case study of the consequences of poor communication –>
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
What is the current drive in health psychology regarding communication?
Current drive in health psychology to implement communication training programs across healthcare professionals
What is being increasingly seen in the modern age and healthcare?
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
How has the epidemiological transition in morbidity influenced communication?
- 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
How has availability of information influenced communication in healthcare settings?
- 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
How has information and communication technology changes influenced communication in healthcare?
- 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
How have modern changes in morbidity, availability of information and technology altered communication methods to be more difficult?
- 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
How has a power balance change occurred within healthcare communication?
- 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
How have changes in healthcare communication been linked with health psychology?
- 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
What scenarios are there in which people seek and receive health services?
o Preventative o Routine care o Acute and chronic medical conditions o Conception to death - Communication difficulties run across this healthcare continuum
What parts are there within healthcare settings?
o Acute settings
o Primary Care
o Public Health
What acute healthcare settings are there?
- Secondary healthcare
- Active, short-term treatment for a severe injury or episode of illness, an urgent medical condition, or during recovery from surgery
What communication issues are professionals faced with in acute hospitalisation cases?
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
What challenges are there in acute healthcare with communication?
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
What is the MAGIC programme (the health foundation)?
- 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
What examples are there of the MAGIC programme?
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
What is primary care?
- 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
What aspects of communication are there within primary care?
- 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
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?
o Familiarity
o Cultural competency
o Bi-directional exchange
What is the importance of communication in public health?
- 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
What do intervention efforts which aim to change behaviours through communicative acts need to consider?
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
What are the main challenges of communication of public health interventions/programmes?
- 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
SUMMARY of this lecture
- 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
