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PubMed2002

The role of health literacy in patient-physician communication.

BACKGROUND AND OBJECTIVES: Patients' health literacy is increasingly recognized as a critical factor affecting patient-physician communication and health outcomes. We reviewed research on health literacy, examined its impact on patient-physician communication, and offer recommendations to enhance communication with patients who have poor health literacy. METHODS: We conducted a literature review using the MEDLINE database for January 1966 through July 2001. The keywords "literacy" and "health literacy" were searched independently and in combination with the medical subject headings (MeSH) "physician-patient communication," "communication," and "reading." RESULTS: Poor health literacy is common, especially among elderly patients. More than 33% of patients ages 65 and older have inadequate or marginal health literacy, as do up to 80% of patients in public hospital settings. Patients with poor health literacy have a complex array of communication difficulties, which may affect health outcomes. Such patients report worse health status and have less understanding about their medical conditions and treatment; they may have increased hospitalization rates. Professional and public awareness of the health literacy issue must be increased, beginning with education of medical students and physicians and improved patient-physician communication skills. CONCLUSIONS: Future research needs to address identification of optimal methods for communicating with patients who have low literacy skills. This should focus on the effect of poor health literacy on patients' ability to communicate their history and physicians' ability to solicit information, as well as identifying the most-effective techniques to educate patients.

Audiovisual Aids↗
PubMed2000

Communication of the musculocutaneous nerve with the median nerve.

OBJECTIVE: To study the frequency of occurrence as well as the course and variations in the communicating branch of the musculocutaneous nerve and the relationship of the communicating branch to other structures in the upper arms of Zimbabwean subjects. DESIGN: Cross sectional anatomical dissections. SETTING: Department of Anatomy,University of Zimbabwe Medical School, Harare, Zimbabwe. SUBJECTS: Twenty four upper limbs from twelve preserved cadavers of both sexes. RESULTS: Eight instances of communication from musculocutaneous nerve to the median nerve were observed. Bilateral communication was observed in two cadavers. The communicating branch arose either before or after it pierced the coracobrachialis muscle. In one instance the whole musculocutaneous nerve joined the median nerve. In two instances, the musculocutaneous nerve did not pierce the coracobrachialis muscle. In two instances the communicating branch arose after the origin of the muscular branch to the biceps brachii. CONCLUSIONS: The communicating branch was present in 33% of the cases. The communicating branch when present varied considerably in respect of its origin and its union with the median nerve. In one extreme case, the whole musculocutaneous nerve joined the median nerve and the muscular branches to the biceps brachii and brachilis arose from the median nerve. The clinician or surgeon should be aware of the presence of communicating branch and its variations in origin, course and relationships in the upper arm.

Female↗
PubMed1992

Communication between the femoropatellar and medial and lateral femorotibial joints in horses.

Communications between the femoropatellar, medial femorotibial, and lateral femorotibial joints were studied, using fresh equine cadaver specimens. A total of 90 specimens from 45 horses were used. Horses were randomly assigned to 3 groups with 15 horses/group. Each group was assigned an injection site (femoropatellar joint, medial femorotibial joint, or lateral femorotibial joint), and red latex was injected into the respective location of each joint in each group. Immediately after injection, the joints were flexed and extended 100 times. The stifles were frozen in slight flexion, then cut into 1-cm sagittal sections. The communications between the femoropatellar and medial and lateral femorotibial joints were determined. None of the specimens in this study had communication between all 3 joint compartments. When the femoropatellar joint was injected, 18 of 30 joints (60%) communicated with the medial femorotibial joint, and 1 of 30 (3%) communicated with the lateral femorotibial joint. Injection of the medial femorotibial joint revealed 24 of 30 (80%) joints that communicated with the femoropatellar joint, and 1 of 30 (3%) that communicated with the lateral femorotibial joint. Injection of the lateral femorotibial joint resulted in communication with the femoropatellar joint in 1 of 30 (3%) joints. Communication did not exist between the medial and lateral femorotibial joints.

Animals↗
PubMed1981

Performative bias in children's interpretations of ambiguous referential communications.

The hypothesis of this study was that young children respond incorrectly in interpreting ambiguous communications in referential tasks because they respond to the illocutionary performative force rather than the locutionary content of the communications. However, these children can evaluate locutionary adequacy when the performative force is deemphasized. In 2 experiments, young children were induced to discriminate between informative and ambiguous communications according to either the performative or locutionary adequacy of the communications. In experiment 1, kindergarten and second-grade children were asked to assign adequate communications to an informative speaker and ambiguous communications to an ambiguous speaker. In experiment 2, kindergarten children were required to choose an object or signal that an object choice was impossible in response to adequate or inadequate communications uttered by a speaker. The results of both experiments showed that correct responses of the kindergarten children to the ambiguous communications improved when they responded to the locutionary rather than the performative force of the communications.

Child↗
PubMed1978

[Relationship between the afferent artery and the site of neck of anterior communicating artery aneurysm, and hemodynamics in the anterior part of the circle of Willis (author's transl)].

Of 346 patients with direct intracranial surgery for an aneurysm of anterior communicating artery that we have experienced from June 1961 to September 1975, 213 patients having sufficient data were selected to study a relationship between hypoplasia of the A1 of the anterior communicating artery, and sites of an afferent artery and a neck of an aneurysm. 1. Ninety seven of 182 patients who had had the bilateral angiography before surgery had hypoplasia of the right A1, 90 of which (92%) had an afferent artery of an aneurysm only in the left A1. All 29 patients with hypoplasia of the left A1 had an afferent artery of an aneurysm only in the right A1. An afferent artery was limited to the dominant A1 in about 95% of them. 2. Angiography revealed that of 204 patients in whom the neck of an aneurysm in the anterior communicating artery was confirmed, 140 patients had hypoplasia of a unilateral A1. The neck of an aneurysm was located at the bifurcation of the dominant A1 and the anterior communicating artery in 48 of the 140 patient (34.3%), at the bifurcation of the non-dominant A1 and the anterior communicating artery in 14 patients (10.0%), and in the anterior communicating artery itself in 78 patients (55.7%). Cerebral angiography revealed that the neck of an aneurysm was more than 3 times greater at the bifurcation of the dominant A1 and the anterior communicating artery than at the bifurcation of the non-dominant A1 and the anterior communicating artery. 3. The above findings suggest that hemodynamics in the anterior part of the circle of Willis may participate in the initiation, growth, and rupture of an aneurysm of the anterior communicating artery.

Adult↗
PubMed2003

The interplay between education and research about patient-provider communication.

Attention to providers' communication skills is likely to increase, given the confluence of forces that have highlighted the importance of communication in healthcare. In the United States, interpersonal and communication skills have been explicitly identified as a priority throughout the continuum of medical education and practice. Ideally, theory and research inform teaching and assessment efforts by suggesting how communication behavior affects outcomes and by providing a conceptual framework for learning skills. This article illustrates the interplay between education and research by discussing examples of useful concepts (models of communication, issues of perceived control, and patterns of non-verbal communication) and understudied topics (physician verbalizations during patients' initial narratives, the mundane aspects of communication in healthcare, conceptual and operational definitions of empathy, and the effect of patient narratives on both patients and providers). Given the breadth and depth of experience, from screening and prevention to treatment and support, the context of cancer offers a promising laboratory for enhancing both education and research about provider-patient communication.

Clinical Competence↗
PubMed1998

An investigation of male attitudes toward marketing communications from dental service providers.

OBJECTIVE: To identify the process by which males aged 25-34 who do not display regular attendance behaviour are exposed to, attend, comprehend and are persuaded by communications by general dental practitioners. DESIGN: Focus groups (of 1 hour duration) comprising 6-7 members, conducted over a period of 18 months, discussing five open-ended questions or statements. SETTING: The Manchester Metropolitan University, Crewe+Alsager Faculty, Cheshire, UK during 1995-96. SUBJECTS: 116 non-attending males (aged between 25-34 years) taken from professional lecturers (17%), full-time (50%) and part-time students (33%) with varying income and education levels. INTERVENTIONS: A theoretical linear-sequential model related to patients behaviour was considered in relation to the timing of communications but this was not tested. MAIN OUTCOME MEASURES: Views of group members concerning their attitudes, perceptions and experience of communications from GDPs. RESULTS: Informative oral communications were considered as important during treatment. Most written communications were cited as impersonal, health posters were perceived as negative being targeted at children only, general media articles on dentistry were not very evident or interesting, however, a practice brochure was viewed as a handy communication tool. CONCLUSIONS: General dental practitioners should look carefully at all of their own methods of communication with patients (from oral to written) and consider the value of their marketing and all areas of communications, especially when considering non-attenders and males (aged 25-34).

Adult↗
PubMed2004

Tutorial: teaching communicative rejecting to children with severe disabilities.

Children with severe disabilities typically require systematic instruction to develop their communication abilities. Intervention can begin by teaching functional communication skills related to requesting and rejecting. Although a considerable amount of research has focused on teaching requesting, there is an emerging literature on teaching rejecting. The aim of this tutorial is to review the emerging literature on teaching communicative rejecting to children with severe disabilities. This review considers (a) the definition of communicative rejecting, (b) reasons for teaching communicative rejecting, (c) types of communicative rejecting, and (d) empirically validated strategies for teaching communicative rejecting to children with severe disabilities. The authors include a case study to illustrate the major steps in teaching communicative rejecting to children with severe disabilities.

Adolescent↗
PubMed2006

Measuring communicative participation: a review of self-report instruments in speech-language pathology.

PURPOSE: To assess the adequacy of self-report instruments in speech-language pathology for measuring a construct called communicative participation. METHOD: Six instruments were evaluated relative to (a) the construct measured, (b) the relevance of individual items to communicative participation, and (c) their psychometric properties. RESULTS: No instrument exclusively measured communicative participation. Twenty-six percent (n = 34) of all items (N = 132) across the reviewed instruments were consistent with communicative participation. The majority (76%) of the 34 items were associated with general communication, while the remaining 24% of the items were associated with communication at work, during leisure, or for establishing relationships. Instruments varied relative to psychometric properties. CONCLUSIONS: No existing self-report instruments in speech-language pathology were found to be solely dedicated to measuring communicative participation. Developing an instrument for measuring communicative participation is essential for meeting the requirements of our scope of practice.

Communication↗
PubMed1989

Communicative profiles of preschool children with handicaps: implications for early identification.

The purpose of this study was to compare the communicative profiles of preschool children with handicaps to those of normal children functioning in the prelinguistic and one-word stage using standard sampling procedures. The children with handicaps included 4 with Down syndrome, 4 with specific language impairments, and 3 with autism. Measures obtained from the communication samples included rates of intentional communication and proportions of communicative functions, discourse structure, communicative means, and syllabic shape. The results of the children with Down syndrome fell within the normal range on all parameters. The common pattern displayed by the children with specific language impairments was a deviation in syllabic shape. The children with autism displayed adequate rates of communicating but fell outside of the normal range for their language stage on the other communicative parameters. Clinical implications of these findings for the early identification of children with communicative impairments are discussed.

Autistic Disorder↗
PubMed1991

Communication profiles of two types of gesture using nonverbal persons with severe to profound mental retardation.

A structured communication sampling procedure was used to measure the form and function characteristics of intentional communication acts produced by nonverbal adults with severe mental retardation. Four "contact" subjects (who communicated only with contact gestures) and 4 "distal" subjects (who used distal as well as contact gestures) participated in this study. All subjects produced communication acts that were coded as initiations, and all subjects produced protoimperative-type communication acts. However, contact subjects produced no protodeclarative-type communication acts, whereas all distal subjects produced some protodeclaratives. Distal subjects also produced significantly more repair/recast acts than did contact subjects. Other findings included a tendency for distal subjects to communicate at a higher rate, to initiate more communication acts, and to produce more accompanying wordlike vocalizations than contact subjects. These results are discussed in light of Werner and Kaplan's (1984) concept of distancing as central to symbolization. Implications for future research and for clinical practice are also discussed.

Adult↗
PubMed2004

Assessing competence in communication and interpersonal skills: the Kalamazoo II report.

Accreditation of residency programs and certification of physicians requires assessment of competence in communication and interpersonal skills. Residency and continuing medical education program directors seek ways to teach and evaluate these competencies. This report summarizes the methods and tools used by educators, evaluators, and researchers in the field of physician-patient communication as determined by the participants in the "Kalamazoo II" conference held in April 2002. Communication and interpersonal skills form an integrated competence with two distinct parts. Communication skills are the performance of specific tasks and behaviors such as obtaining a medical history, explaining a diagnosis and prognosis, giving therapeutic instructions, and counseling. Interpersonal skills are inherently relational and process oriented; they are the effect communication has on another person such as relieving anxiety or establishing a trusting relationship. This report reviews three methods for assessment of communication and interpersonal skills: (1) checklists of observed behaviors during interactions with real or simulated patients; (2) surveys of patients' experience in clinical interactions; and (3) examinations using oral, essay, or multiple-choice response questions. These methods are incorporated into educational programs to assess learning needs, create learning opportunities, or guide feedback for learning. The same assessment tools, when administered in a standardized way, rated by an evaluator other than the teacher, and using a predetermined passing score, become a summative evaluation. The report summarizes the experience of using these methods in a variety of educational and evaluation programs and presents an extensive bibliography of literature on the topic. Professional conversation between patients and doctors shapes diagnosis, initiates therapy, and establishes a caring relationship. The degree to which these activities are successful depends, in large part, on the communication and interpersonal skills of the physician. This report focuses on how the physician's competence in professional conversation with patients might be measured. Valid, reliable, and practical measures can guide professional formation, determine readiness for independent practice, and deepen understanding of the communication itself.

Clinical Competence↗
PubMed2006

Disaster and emergency communications prior to computers/Internet: a review.

When communications are needed the most desperately and most urgently, the difficulty of effecting the desired communications increases exponentially. Recent natural disasters in different parts of the world have provided eloquent testament to this. The history of disaster or emergency communications can provide us with a foundation for understanding the problems encountered today, and can offer us insight into how we might improve the systems and processes for communications. The first applications of communication technology that allowed messages to be sent more rapidly than the fastest form of transportation were mainly military in origin. This review takes us from the days of optical or visual telegraphy, through the early development of mobile and radio communications, and up to the current sophisticated technologies. We pay particular attention to the use of amateur radio operators in times of emergency, and relate their activities to those of the most effective military communications. The germane assumption made in this discussion is that any emergency or disaster communications would necessarily be involved in response and resolution of medical aspects of those emergencies.

Communication↗
PubMed2002

Consultation planning to help breast cancer patients prepare for medical consultations: effect on communication and satisfaction for patients and physicians.

PURPOSE: To measure the prevalence of communication barriers between breast cancer patients and their physicians and to present the results of a study evaluating the impact of two visit preparation techniques on communication and satisfaction for breast cancer patients and their physicians. PATIENTS AND METHODS: We recruited 132 breast cancer patients from two outpatient cancer centers in a sequential, controlled trial. Ninety-four consented and completed the trial. Patients were assigned to one of two visit preparation interventions before their appointment with either a surgeon or a medical oncologist. In the control intervention, called Productive Listening, a researcher listened to and prompted patients to reflect on their experiences communicating with physicians. In the experimental intervention, called Consultation Planning, a researcher elicited questions and concerns, generated a printed agenda for the upcoming consultation, and engaged patients in techniques to improve communication with their physicians. Valid and reliable surveys measured communication barriers, satisfaction with the intervention, and patients' and physicians' satisfaction with the consultation. RESULTS: Sixty-four percent of the patients reported three or more communication barriers. Patients reported a significant reduction in communication barriers after both the intervention and the control session. Patients reported significantly higher satisfaction after the Consultation Planning sessions. Physicians reported significantly higher satisfaction with those patients who had participated in a Consultation Planning session. CONCLUSION: Visit preparation sessions help patients prepare for medical consultations and reduce barriers to communication. Consultation Planning sessions, in which a researcher solicited the patient's agenda, were more satisfying to patients and physicians than the Productive Listening sessions.

Adaptation, Psychological↗
PubMed1994

Play behavior and communication between deaf and hard of hearing children and their hearing peers in an integrated preschool.

Sixty preschoolers (30 deaf and hard of hearing, 30 hearing) were observed in their integrated school during "centers" and outdoor play. Half the children experienced auditory communication and half total communication modes of communication. All children had known their classmates for six months to three years. It was found that all children preferred to play and communicate with same-hearing status children, however 63% of all children communicated with children of other-hearing status. Amounts of social play and communication differed somewhat between the two communication environments, and context of interaction was related to the behavior and communication of children who were deaf and hard of hearing. Implications are discussed for the education of young children who are deaf and hard of hearing--specifically that educational and social benefits accrue to those who are integrated throughout the school day (across context) and have access to hearing classmates and classmates who are deaf and hard of hearing.

Child, Preschool↗
PubMed1997

Couple communication patterns of maritally aggressive and nonaggressive male alcoholics.

OBJECTIVE: This study was conducted to examine the associations between communication problems and marital violence in couples with a male alcoholic, and to determine whether the communication correlates of marital violence found in nonalcoholic community samples also characterize male alcoholics' relationships. METHOD: Ninety newly abstinent treatment-seeking male alcoholics and their wives completed a 10-minute problem discussion while both partners were sober. Their communication behaviors were coded with the Marital Interaction Coding system. Couples were separated into maritally aggressive (n = 60 couples) and nonaggressive (n = 30 couples) groups on the basis of any husband-to-wife physical aggression in the previous 12 months. RESULTS: The base-rate percentage of aversive-defensive communication was significantly higher for couples with a physically aggressive husband than for couples with a nonaggressive husband. The base-rate percentage of facilitative-enhancing communication did not differ significantly between groups. In sequential analyses, physically aggressive husbands, but not their wives, displayed more negative reciprocity than their nonaggressive counterparts. Alcoholic husbands in general displayed lower rates of facilitative-enhancing communication than did their wives. CONCLUSIONS: Husband-to-wife marital aggression was associated with problematic communication among couples with an alcoholic husband during a sober interaction in a laboratory setting, extending prior nonalcoholic community sample research to male alcoholics' relationships. The maritally aggressive alcoholics were high in negative responses contingent upon their wives' prior negative behavior, and were unlikely to terminate aversive interchanges. Communication problems may be important in understanding and treating co-occurring alcoholism and marital violence.

Adult↗
PubMed1992

A survey of the communication-impaired population of Tayside.

There are few published surveys that are designed specifically to describe the total population of clients with communication disorders who might potentially benefit from the use of a communication aid. Such data, however, would be useful in planning the funding and staffing of rehabilitation services in a region. Figures are also needed to identify populations whose needs are currently not being met and thus to establish areas of future developments both for service and research purposes. The survey reported here was carried out as part of a project concerned with the provision of augmentative communication to the neurologically impaired child and young adult. It was intended to produce a broad description of the communication-impaired population in Tayside. The survey was then used to identify detailed information about clients who may benefit from using a communication aid, and it also highlighted some provision and research issues. Access to communication aids for the non-speaking population was found to have been restricted by lack of funding, resources and opportunities for training for therapists in the use of augmentative and alternative communication. Future research and development should particularly address the needs of the aphasic population whose needs were not found to be met by currently available communication aids.

Communication Devices for People with Disabilities↗
PubMed1994

An analysis of the communication of adult residents of a long-term care hospital as perceived by their caregivers.

Different groups of caregivers (nurses, orderlies, professionals, student orderlies and volunteers) who were in frequent interaction with residents from a long-term care hospital were interviewed with a nominal group process. They were asked to identify concrete situations of communication in which residents with no trouble communicating, residents with aphasia and residents with dementia need to express and/or comprehend a message. A total of 196 statements were recorded and coded using a qualitative approach into different categories of communication acts specific to daily life situations and several categories of generic communication acts, which are unrelated to the daily routine of care and treatment. The results show that communication in daily life situations varies little in relation to the different residents. However, residents with language disorders are perceived to be less involved in generic communication acts than residents with no communication disorder. They also demonstrate that the perceptions of communication of the different caregivers vary. The results are discussed in relationship to the conception of an evaluation instrument for language-impaired long-term care residents, which will help in determining intervention as well as the objective evaluation of its effects.

Activities of Daily Living↗