Adapting Communication to Different Populations

Introduction[edit | edit source]

Patient-centred care is provided when communication is shared openly 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 higher perceptions of quality care.[1]

Effective communication for providers begins with showing respect and building trust with their patients. Having that mutual understanding and openness is important for building a relationship. Communication styles will vary over the course of the day as providers interact with different populations. Some populations as listed below will require providers to be more flexibile and patience during their interaction time :

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

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.[3]

For providers to effectively communicate to all types of individuals, three components must occur:

  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[4]

Question Strategy[edit | edit source]

When interacting with a patient for the first visit, providers will ask many questions to attain the necessary information to provide the most optimal care. Open-ended questions are strongly recommended for gathering medical information. Open-ended as they 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] Clinicians 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 the 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[6] [7]

** General inquiries are used most often to elicit problem presentation and tend to increase patients' satisfaction[6]

Comprehensibility[edit | edit source]

After gaining information from the patient through question strategies, the provider needs to communicate the plan of care to the patient. When explaining intervention option, the provider should keep these three rules in mind:

  1. Do 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[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, decreased satisfaction with their healthcare and increased medication complications. [8]

Professional translators or language services are the recommended practice when language barriers present themselves. They can provide precise, clear translations without any interpretation or biases. Using apps like "google translate" can assist with simple questions however they are not reliable for history taking. 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 transpires through interactions that are respectful and flexible to the practices, beliefs and needs of the patient by demonstrating a willingness to help and learn. [3]As a provider it is important to consider the emotional, spiritual and cultural needs of the families and their influences on decision making. [10]Cross-cultural communication can be enhanced by the LEARN model as stated below:

  1. Listen: bring an attitude of humility and curiosity to promote understanding and trust
  2. Explain: communicate your perceptions of the health issues while realisiing the patient might understand it differently based on their culture or ethnic background
  3. Acknowledge: identify areas of agreement as well as differences and try to determine if their belief systems may lead to intervention dilemma
  4. Recommend: propose and develop an intervention plan to the patient and family
  5. Negotiate: partner with the patient and family for a treatment plan incorporating culturally relevant approaches that apply to their 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 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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