Adapting Communication to Different Populations: Difference between revisions

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== Introduction ==
<div class="editorbox"> '''Original Editor '''- [[User:Robin Tacchetti|Robin Tacchetti]] based on the course by [https://members.physio-pedia.com/course_tutor/marissa-fourie/ Marissa Fourie]<br>
Patient-centred care is provided when communication is shared amongst provider, patients and their families.  This process encourages and invites patients and their families to actively participate in the healthcare decision-making process.  Through this open communication patient's dignities and rights are valued with subsequent positive care outcomes and perceptions of quality of care.<ref>Kwame A, Petrucka PM. [https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-021-00684-2 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.</ref>
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div>


Effective communication for providers begins with respect and building trust with their patients.  Having that mutual understanding and openness is important for building a relationship.  Successful communication is knowing how to adapt interactions to different groups such as children, seniors, people with disabilities, hearing impairments, cognitive impairments, mental health issues, people who speak another language etc.  Providers working with these populations will need to be patient and flexible as they might need to spend more time with these individuals.<ref>Iedema R, Greenhalgh T, Russell J, Alexander J, Amer-Sharif K, Gardner P, Juniper M, Lawton R, Mahajan RP, McGuire P, Roberts C. [https://bmjopenquality.bmj.com/content/bmjqir/8/3/e000742.full.pdf 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.</ref>


In order to be an effective communicator working with different populations and cultures, providers need to demonstrate culturally sensitive communication.  This type of communication demonstrates a mutual respect and understanding of each other's beliefs, values, preferences and culture to promote culturally sensitive care.  Clinicians will need to identify patient's needs through verbal and nonverbal communication.  Without culturally sensitive care, patients and their families feel less satisfied with their care and consequently there are risks of miscommuincation, poor adherence to treatment and poorer health outcomes.<ref name=":1">Brooks LA, Manias E, Bloomer MJ. [https://www.sciencedirect.com/science/article/pii/S1322769617303153 Culturally sensitive communication in healthcare: A concept analysis.] Collegian. 2019 Jun 1;26(3):383-91.</ref>


== Open ended questions ==
== Introduction ==
''or patient-centered communication, an open-ended question is strongly recommended as an opening question in the first visit of a medical consultation.5, 6 However, while the use of open-ended questions was beneficial for gathering medical information from standardized patients,7, 8 that was not necessarily the case in real first visits.9 Moreover, open-ended question.hey classified opening questions into five types: general inquiries (e.g., “How can I help you?”), gloss questions for confirmation (e.g., “Sounds like you're uncomfortable.”), confirming questions about symptoms (e.g., “You're having headache for a week.”), “How are you?” questions, and history-taking questions. They found that general inquiries were predominant and elicited long problem presentations as well as patients' satisfaction.14<ref>Abe T, Nishiyama J, Kushida S, Kawashima M, Oishi N, Ueda K. [https://onlinelibrary.wiley.com/doi/full/10.1002/jgf2.593 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.</ref>''
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.<ref>Kwame A, Petrucka PM. [https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-021-00684-2 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.</ref>
 
''Open-ended questions are used alone or in combination with other interviewing techniques to explore topics in depth, to understand processes, and to identify potential causes of observed correlations. Open-ended questions may produce lists, short answers, or lengthy narrativesAdapting questioning stategies- always start with open ended<ref>Weller SC, Vickers B, Bernard HR, Blackburn AM, Borgatti S, Gravlee CC, Johnson JC. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6010234/ Open-ended interview questions and saturation]. PloS one. 2018 Jun 20;13(6):e0198606.</ref>''
 
- open ended vs closed


- probing- either open or closed
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:


- leading question
* children
* older persons
* people with disabilities
* people with hearing impairments
* people with cognitive impairments
* people with mental health issues
* people who speak another language<ref>Iedema R, Greenhalgh T, Russell J, Alexander J, Amer-Sharif K, Gardner P, Juniper M, Lawton R, Mahajan RP, McGuire P, Roberts C. [https://bmjopenquality.bmj.com/content/bmjqir/8/3/e000742.full.pdf 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.</ref>


- checking questions
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.<ref name=":1">Brooks LA, Manias E, Bloomer MJ. [https://www.sciencedirect.com/science/article/pii/S1322769617303153 Culturally sensitive communication in healthcare: A concept analysis.] Collegian. 2019 Jun 1;26(3):383-91.</ref>


== Comprehensible to patient ==
For providers to effectively communicate with patients from all backgrounds, they must be able to do the following:
- dont use jargon as it limits outcomes- patients wont ask questions


-inetellictualulasion- uncomfortable emotions so focus on facts; usually healthcare professional is uncomfortable
# Adapt their questioning strategy
# Make sense to the patient
# Treat patients in a dignified, respectful, and courteous manner, regardless of who and where they are in life<ref name=":3">Fourie, M. Adapting Communication to Different Populations.  Plus. 2023</ref>


-use pateints exerperiences to explain vs. anatomy
=== Questioning Strategy ===
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:<ref name=":3" />


-use of pictures
# open-ended: eliciting a sentence for the response
# close-ended: verifying a piece of information
# probing: can either be open or closed with the intent to find out more information about a topic
# checking: used to make sure the patient understands what has been said


-language barrier=negative outcome. 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. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7201401/
'''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.<ref>Weller SC, Vickers B, Bernard HR, Blackburn AM, Borgatti S, Gravlee CC, Johnson JC. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6010234/ Open-ended interview questions and saturation]. PloS one. 2018 Jun 20;13(6):e0198606.</ref> 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.<ref name=":3" />


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


# nonverbal cues
# General inquiries:  e.g. "What can I do for you today?", "What brings you in?"
# family member translate
#* these questions allow patients to describe their concerns using their own words and terms
# staff member to translate
# 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
# Confirming (or checking) questions about symptoms: e.g. "You have been having pain at night for a week?"
#* confirmation of concrete symptoms
# How are you inquiries: e.g. "How are you doing?"
#* general evaluations rather than questions on problem presentations
# History-taking questions: e.g. "What medicine do you take?"
#* close-ended; yes/no, fill-in-the-blank, multiple-choice questions questions<ref name=":2">Abe T, Nishiyama J, Kushida S, Kawashima M, Oishi N, Ueda K. [https://onlinelibrary.wiley.com/doi/full/10.1002/jgf2.593 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.</ref> <ref>Heritage J, Robinson JD. [https://www.sscnet.ucla.edu/soc/faculty/heritage/Site/Publications_files/OPENING_QUESTIONS.pdf The structure of patients' presenting concerns: physicians' opening questions.] Health communication. 2006 Mar 1;19(2):89-102.</ref>
<nowiki>**</nowiki> General inquiries are used most often in practice. These questions tend to elicit long problem presentations and improve patient satisfaction.<ref name=":2" />


more effecient:
== Comprehensibility ==
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:


# translator
# Do not use jargon or technical terms as they might stop a patient from asking questions, potentially resulting in poorer care outcomes
## ''Cultural interpreters are trained to help newcomer families navigate medical conversations. They can provide clear, precise translations that include nuances in meaning and nonverbal cues, while being careful not to ‘lead’ the conversation.'' ''Using a family member or friend (particularly a child) to translate, should be avoided. They are more likely to edit or reinterpret information to avoid conflict or protect family members (14). The patient and family may also be less forthcoming if community members are present to translate. It is recommended practice to use a cultural interpreter or language service by telephone.''  ''Translation applications, such as ‘Google Translate’ can help with simple questions but are unreliable aids for history-taking. They cannot communicate the nuances of language or culture that are essential for effective medical care. See Box 1 for useful tips on working with interpreters, and the CPS Caring for Kids New to Canada website (www.kidsnewtocanada.ca) for more information on this topic (1''4).<ref name=":0">Ladha T, Zubairi M, Hunter A, Audcent T, Johnstone J. Cross-cultural communication: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5815116/ Tools for working with families and children]. Paediatrics & Child Health. 2018 Feb 15;23(1):66-9.</ref>
# Explain clinical information with a focus on patient experience rather than on theoretical concepts.
## ''use of a professional interpreter, a best practice recommendation where language differences exist between clinicians, patients and families (Amouri and O’Neill, 2011; Cioffi, 2003; Douglas et al., 2011). The use of a professional interpreter, in person, is the preferred method for many health services, as it involves a trained professional directly participating in the conversation with the patient, family and clinician, helping to address language and cultural difficulties, and communication challenges (Matteliano & Street, 2012). The use of a professional interpreter is preferred over use of staff or family members, to ensure accurate, unbiased information is being communicate''<ref name=":1" />
# Use pictures and/or videos to help explain complex concepts<ref name=":3" />
# remote language interpreter
# apps
# learn the language yourself


== treating patients respectfully ==
<nowiki>**</nowiki> As each patient is unique, providers will need to be able to adapt their communication style when explaining medical terminology and intervention techniques.
''stead consider the importance of spiritual, cultural, and emotional needs of families and their influence on decision making. We might also consider routinely assessing patient and family role preferences in decision making at the outset of difficult'' <ref>Bogetz J, Rosenberg A, Curtis JR, Creutzfeldt CJ. [https://www.jpsmjournal.com/article/S0885-3924(19)30571-8/pdf Applying an adaptive communication approach to medical decision making]. Journal of Pain and Symptom Management. 2020 Jan 1;59(1):e4-7.</ref>''conversations t''


''The LEARN (Listen, Explain, Acknowledge, Recommend, Negotiate) model is a framework for cross-cultural communication that helps build mutual understanding and enhance patient care (6).''
=== Language Barrier ===
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.<ref>Al Shamsi H, Almutairi AG, Al Mashrafi S, Al Kalbani T. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7201401/ Implications of language barriers for healthcare: a systematic review]. Oman medical journal. 2020 Mar;35(2):e122.</ref>


'''''Listen:''' Assess each patient’s understanding of their health condition, its causes and potential treatments. Elicit expectations for the encounter, and bring an attitude of curiosity and humility to promote trust and understanding.''
When there are language barriers, professional [[Working With Interpreters|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.<ref name=":0">Ladha T, Zubairi M, Hunter A, Audcent T, Johnstone J. Cross-cultural communication: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5815116/ Tools for working with families and children]. Paediatrics & Child Health. 2018 Feb 15;23(1):66-9.</ref><ref name=":1" />


'''''Explain:''' Convey your own perceptions of the health condition, keeping in mind that patients may understand health or illness differently, based on culture or ethnic background.''
== Respect ==
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.<ref name=":1" /> As a provider, it is important to consider the emotional, spiritual and cultural needs of the patient / family and their influence on decision-making.<ref>Bogetz J, Rosenberg A, Curtis JR, Creutzfeldt CJ. [https://www.jpsmjournal.com/article/S0885-3924(19)30571-8/pdf Applying an adaptive communication approach to medical decision making]. Journal of Pain and Symptom Management. 2020 Jan 1;59(1):e4-7.</ref> Cross-cultural communication can be enhanced by using the LEARN model:


'''''Acknowledge:''' Be respectful when discussing the differences between their views and your own. Point out areas of agreement as well as difference, and try to determine whether disparate belief systems may lead to a therapeutic dilemma.''
# Listen: bringing an attitude of humility and curiosity can promote understanding and trust
 
# Explain: communicate your perceptions of the health issues while realising the patient might understand it differently based on their culture or ethnic background
'''''Recommend:''' Develop and propose a treatment plan to the patient and their family.''
# Acknowledge: identify areas of agreement and disagreement, and try to determine if a patient's belief systems may lead to a therapeutic dilemma
 
# Recommend: design / suggest an intervention plan to the patient and family
'''''Negotiate:''' Reach an agreement on the treatment plan in partnership with the patient and family, incorporating culturally relevant approaches that fit with the patient’s perceptions of health and healing.''<ref name=":0" />
# 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<ref name=":0" />
 
''The first attribute involves encouraging patients and families to participate in communication and decision making to the degree where they feel comfortable.  encouraging patient and family input, and by promoting effective interactions to overcome communication barriers.  prioritising cultural considerations in the planning and provision of care. This prioritisation can be achieved by demonstrating respect for the culture of the patient and their family by asking culturally sensitive questions about the patient’s and family’s values, beliefs and practices; obtaining information about the patient’s perceptions and beliefs associated with their presenting illness; and assessing the individual’s psychological, physiological and sociocultural needs, secondary languages, non-verbal communication techniques, religion and food preferences. developing a trusting relationship with the patient and family. This trust can be achieved through using open and non-threatening body language that demonstrates a willingness to help and learn. Establishing rapport and trust are critical to the communication process between clinicians, the patient and family. Trust can be created through active listening, using appropriate body language, using the patient’s actual words to communicate, and being flexible and respectful to the needs, beliefs and practices of the patient and their family''<ref name=":1" />
 
Go to:
 
https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-021-00684-2
 
# talk directly to the patient
# speak in normal tone
# include the patient
 
W/c: eye to eye
 
hearing loss: less ambient noise
 
speech impediment: be patient, shorter concrete questions
 
intellectual: simple direct sentences, more media and visual forms, no abstract ideas and be prepared to repeat
 
older adults:feel vulnerable and exposed
 
peds: need family member and kid- three way relatoinship, be patient, understandable language
 
# relationship buidling
# promote pateint engagement
# address emotion
# enhancing of info
# management of uncertaintity
# fostering of hope
 
poor health literacy: ask less questions, healthcare person might see as not engaged, communicate clearly and in laymans terms
 
* ''ry to identify influential cultural differences in yourself and your patients. Be self-aware of biases and values that you may be bringing to medical encounters.''
* ''Use a trained interpreter rather than a family member to translate, when needed.''
* ''Build awareness of differences in communication style (e.g., verbal and nonverbal) that may influence care.''
* ''Consider the role of silences in each patient encounter. They may represent discomfort with a topic or uncertainty about a question being asked. Paying attention to nonverbal cues can help determine whether a differential power relationship is hindering communication.''
* ''Building trust and understanding helps empower families and optimize patient care.''
* ''Booking longer and repeat visits with the same interpreter can forge trust and understanding around child and youth health issues and management plans.''
* ''Devise a tailored treatment plan that involves the patient’s immediate family, extended family or other community members, as appropriate.''
* ''Recognize that a ‘high-context’ communication style may be a family’s cultural norm and stay attuned to tone, body language and other nonverbal cues.''
* ''Recognize that diversity exists within ethnic and cultural groups as much as between groups, and avoid generalizing or stereotyping cross-cultural encounters.''
* ''Assess the literacy levels of patients or families and adjust the use of written materials accordingly.''<ref name=":0" />
 
Go to:


== Resources ==
== Resources ==
Line 108: Line 76:
* [https://www.physio-pedia.com/Using_Communication_to_Enhance_Therapeutic_Interactions_With_People_Living_With_Dementia Using Communication to Enhance Therapeutic Interactions with People Living with Dementia]
* [https://www.physio-pedia.com/Using_Communication_to_Enhance_Therapeutic_Interactions_With_People_Living_With_Dementia Using Communication to Enhance Therapeutic Interactions with People Living with Dementia]
* [https://www.physio-pedia.com/Communication_and_Children_with_Cerebral_Palsy Communication and Children with Cerebral Palsy]
* [https://www.physio-pedia.com/Communication_and_Children_with_Cerebral_Palsy Communication and Children with Cerebral Palsy]
== References ==
<references />
[[Category:Communication]]
[[Category:Professional Issues]]
[[Category:ReLAB-HS Course Page]]
[[Category:Course Pages]]

Latest revision as of 10:37, 10 March 2024

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:[4]

  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. checking: used to make sure the patient understands what has been said

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.
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