Adapting Communication to Different Populations

Introduction

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.

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.

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 miscommunication, poor adherence to treatment and poorer health outcomes.

For providers to effectively communicate to all types of individuals, three factors are important:

1. Adapting the questioning strategy
2. Be comprehensible to the patient
3. Treating patients in a dignified, respectful, and courteous manner, regardless of who and where they are in life

Question Strategy

When interacting with a patient for the first visit, open-ended questions are strongly recommended for gathering medical information. Open-ended questions can produce lengthy narratives, short answers or lists. They can be used alone or with close-ended questions that elicit a yes or no response. Clinicians working with patients can use a combination of question strategies to gain information. Questions can be classified into the five categories below:

1. general inquiries: "what can I do for you today", "what brings you in"
   • allows patients to describe their concerns in their own terms
2. gloss questions for confirmation: "sounds like you are uncomfortable"
   • formatted for a yes/no response however can have subsequent expansion of answer
3. confirming questions about symptoms: "you have been having pain at night for a week"
   • confirmation of concrete symptoms
4. how are you inquiries: "how are you doing"
   • general evaluations rather than problem presentations .
5. history-taking questions: "what medicine do you take"
   • close-ended; yes/no, fill in the blank, multiple choice

** General inquiries are used most often to elicit problem presentation and increased patients satisfaction

Comprehensible to patient

After gaining information from the patient through question strategies, the provider then needs to be able to communicate to the patient about the plan of care. In general provider should:

1. Not use jargon or technical terms as it might inhibit patients from asking questions and thus have a poorer outcome in care
2. Use patients experiences when describing medical terms versus anatomical terms
3. Use pictures and/or videos to help explain difficult concepts

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=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/

least effecient:

1. nonverbal cues
2. family member translate
3. staff member to translate

more effecient:

1. translator
   1. 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 (14).
   2. 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
2. remote language interpreter
3. apps
4. learn the language yourself

treating patients respectfully

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 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).

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.

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.

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.

Recommend: Develop and propose a treatment plan to the patient and their 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.

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

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https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-021-00684-2

1. talk directly to the patient
2. speak in normal tone
3. 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

1. relationship buidling
2. promote pateint engagement
3. address emotion
4. enhancing of info
5. management of uncertaintity
6. 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.

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Resources

• Using Communication to Enhance Therapeutic Interactions with People Living with Dementia
• Communication and Children with Cerebral Palsy