Adapting Communication to Different Populations

intro

The ideal environment for spoken communication is characterised in the first instance by ‘caring surroundings’. Such surroundings support communication among clinicians and with patients by contributing to care safety and patients’ feeling psychologically and physiologically safe, as noted by this patient: The literature associates effective communication with respect, commitment, positive regard, empathy, trust, receptivity, honesty and an ongoing and collaborative focus on care. Building relationships is paramount in circumstances where trust requires mutual understanding and openness

Greater care than normal needs to be taken when communicating with groups such as children and young people, people with problems understanding spoken English (eg, limited-English speakers, people with a hearing. impairment, learning disabilities or cognitive impairment) and people who are distressed or have mental health conditions.14 These groups need extra time, along with a flexible, personalised, context-sensitive and holistic approach: one size does not fit all. To optimise their communication with such unique groups, many hospitals have proposed the use of a ‘hosp

Open ended questions

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

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

- open ended vs closed

- probing- either open or closed

- leading question

- checking questions

Comprehensible to patient

- dont use jargon as it limits outcomes- patients wont ask questions

-inetellictualulasion- uncomfortable emotions so focus on facts; usually healthcare professional is uncomfortable

-use pateints exerperiences to explain vs. anatomy

-use of pictures

-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. 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.

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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