Adapting Communication to Different Populations

Original Editor - Robin Tacchetti based on the course by Marissa Fourie
Top Contributors - Robin Tacchetti and Jess Bell

Introduction[edit | edit source]

Patient-centred care can be achieved when there is open communication between providers, patients and their families. This process encourages and invites patients and their families to actively participate in healthcare decisions. Through open communication, a patient's dignity and rights are valued, which results in positive care outcomes and higher perceptions of care quality.[1]

Effective communication begins with providers showing respect and building the trust of their patients. Mutual understanding and openness are important for building a relationship. A provider may need to alter their communication style over the course of the day as they interact with many different patient populations. Some populations may require providers to be more flexible and patient during an interaction, such as:

  • children
  • older persons
  • people with disabilities
  • people with hearing impairments
  • people with cognitive impairments
  • people with mental health issues
  • people who speak another language[2]

Providers must demonstrate culturally sensitive communication when working with different populations and cultures. This helps to build mutual respect and an understanding of each other's beliefs, values, preferences and culture to promote culturally sensitive care. Clinicians need to identify a patient's needs through verbal and non-verbal communication. Without culturally sensitive care, patients and their families are likely to feel less satisfied with their care and there are risks of miscommunication, poor adherence to treatment and poorer health outcomes.[3]

For providers to effectively communicate with patients from all backgrounds, they must be able to do the following:

  1. Adapt their questioning strategy
  2. Make sense to the patient
  3. Treat patients in a dignified, respectful, and courteous manner, regardless of who and where they are in life[4]

Questioning Strategy[edit | edit source]

When interacting with a patient for the first time, providers must often ask many questions to attain the necessary information to provide optimal care. Types of questions might include:

  1. open-ended: eliciting a sentence for the response
  2. close-ended: verifying a piece of information
  3. probing: can either be open or closed with the intent to find out more information about a topic[4]

Open-ended questions are strongly recommended for gathering medical information. Open-ended questions produce lengthy narratives, short answers or lists. They can be used alone or with close-ended questions that elicit a yes or no response.[5] We should, however, be careful to avoid leading questions. Leading questions are formatted in a way that it encourages the answer we want or expect.[4]

Clinicians can use a combination of question strategies to gain information. Questions can be classified into five categories:

  1. General inquiries: e.g. "What can I do for you today?", "What brings you in?"
    • these questions allow patients to describe their concerns using their own words and terms
  2. Gloss questions for confirmation: e.g. "Sounds like you are uncomfortable?"
    • formatted for a yes/no response, but can lead to further expansion of the answer
  3. Confirming (or checking) questions about symptoms: e.g. "You have been having pain at night for a week?"
    • confirmation of concrete symptoms
  4. How are you inquiries: e.g. "How are you doing?"
    • general evaluations rather than questions on problem presentations
  5. History-taking questions: e.g. "What medicine do you take?"
    • close-ended; yes/no, fill-in-the-blank, multiple-choice questions questions[6] [7]

** General inquiries are used most often in practice. These questions tend to elicit long problem presentations and improve patient satisfaction.[6]

Comprehensibility[edit | edit source]

After gaining information from the patient through their questioning strategy, the provider needs to communicate the care plan to the patient. When explaining intervention options, the provider should keep these three rules in mind:

  1. Do not use jargon or technical terms as they might stop a patient from asking questions, potentially resulting in poorer care outcomes
  2. Explain clinical information with a focus on patient experience rather than on theoretical concepts.
  3. Use pictures and/or videos to help explain complex concepts[4]

** As each patient is unique, providers will need to be able to adapt their communication style when explaining medical terminology and intervention techniques.

Language Barrier[edit | edit source]

When there is a language barrier, it can be very difficult for the provider and patient to communicate effectively. Studies have shown that patients with language barriers have less access to healthcare and poorer health outcomes. If they are able to access healthcare, they tend to have decreased understanding of their diagnoses, reduced satisfaction with their healthcare and increased complications associated with medication use.[8]

When there are language barriers, professional interpreters / translators or language services are recommended. Using apps like "google translate" can assist with simple questions, but they are not reliable for history taking. It is best to avoid using a family member or friend to translate as they may reinterpret or edit information to avoid conflict or protect family members. In addition, the patient may be less forthcoming when their family members are translating.[9][3]

Respect[edit | edit source]

Establishing trust is essential to the communication process between providers, patients and their families. Trust develops through interactions that are respectful and flexible to the patient's practices, beliefs and needs. These qualities demonstrate a willingness by the provider to help and learn.[3] As a provider, it is important to consider the emotional, spiritual and cultural needs of the patient / family and their influence on decision-making.[10] Cross-cultural communication can be enhanced by using the LEARN model:

  1. Listen: bringing an attitude of humility and curiosity can promote understanding and trust
  2. Explain: communicate your perceptions of the health issues while realising the patient might understand it differently based on their culture or ethnic background
  3. Acknowledge: identify areas of agreement and disagreement, and try to determine if a patient's belief systems may lead to a therapeutic dilemma
  4. Recommend: design / suggest an intervention plan to the patient and family
  5. Negotiate: partner with the patient and family to create a treatment plan that incorporates culturally relevant approaches that consider the patient's and family's perceptions of health[9]

Resources[edit | edit source]

References[edit | edit source]

  1. Kwame A, Petrucka PM. A literature-based study of patient-centered care and communication in nurse-patient interactions: barriers, facilitators, and the way forward. BMC nursing. 2021 Dec;20(1):1-0.
  2. Iedema R, Greenhalgh T, Russell J, Alexander J, Amer-Sharif K, Gardner P, Juniper M, Lawton R, Mahajan RP, McGuire P, Roberts C. Spoken communication and patient safety: a new direction for healthcare communication policy, research, education and practice?. BMJ Open Quality. 2019 Sep 1;8(3):e000742.
  3. 3.0 3.1 3.2 Brooks LA, Manias E, Bloomer MJ. Culturally sensitive communication in healthcare: A concept analysis. Collegian. 2019 Jun 1;26(3):383-91.
  4. 4.0 4.1 4.2 4.3 Fourie, M. Adapting Communication to Different Populations. Plus. 2023
  5. Weller SC, Vickers B, Bernard HR, Blackburn AM, Borgatti S, Gravlee CC, Johnson JC. Open-ended interview questions and saturation. PloS one. 2018 Jun 20;13(6):e0198606.
  6. 6.0 6.1 Abe T, Nishiyama J, Kushida S, Kawashima M, Oishi N, Ueda K. Tailored opening questions to the context of using medical questionnaires: Qualitative analysis in first‐visit consultations. Journal of General and Family Medicine. 2023 Mar;24(2):79-86.
  7. Heritage J, Robinson JD. The structure of patients' presenting concerns: physicians' opening questions. Health communication. 2006 Mar 1;19(2):89-102.
  8. Al Shamsi H, Almutairi AG, Al Mashrafi S, Al Kalbani T. Implications of language barriers for healthcare: a systematic review. Oman medical journal. 2020 Mar;35(2):e122.
  9. 9.0 9.1 Ladha T, Zubairi M, Hunter A, Audcent T, Johnstone J. Cross-cultural communication: Tools for working with families and children. Paediatrics & Child Health. 2018 Feb 15;23(1):66-9.
  10. Bogetz J, Rosenberg A, Curtis JR, Creutzfeldt CJ. Applying an adaptive communication approach to medical decision making. Journal of Pain and Symptom Management. 2020 Jan 1;59(1):e4-7.