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PubMed2006

Identification of nutrition communication styles and strategies: a qualitative study among Dutch GPs.

OBJECTIVE: The objectives of this study were to identify nutrition communication styles of Dutch GPs, their strategies regarding nutrition communication and nutrition information seeking behaviours. Another aim is to provide a hypothetical model for nutrition communication style, including psycho-social and socio-demographic variables. METHODS: Nine focus groups with 81 GPs were used to obtain GPs' perceptions of nutrition communication. Data were analysed with the computer software program NUD*IST. RESULTS: Five nutrition communication styles were identified, namely informational, reference, motivational, confrontational and holistic style. Referring to a dietician, providing advice according to Dietary Guidelines, and offering written education materials were mentioned as strategies regarding nutrition communication. GPs sought nutrition information in scientific studies, specialist literature, and postgraduate training courses. CONCLUSION: The informational style of nutrition communication was dominant among Dutch GPs. GPs hardly provided maintenance advice for nutrition behaviour. Many GPs referred patients to dieticians, who were viewed as colleagues. GPs tried to get basic information about nutrition by scanning the literature, but they were seldom actively involved in seeking specific nutrition information. Although GPs felt that patients expect expert nutrition information, they perceived their nutrition knowledge as restricted. PRACTICE IMPLICATIONS: We advise to raise self-efficacy of GPs regarding nutrition communication and to build good collaboration with dieticians.

Attitude of Health Personnel↗
PubMed2006

Cultural differences in medical communication: a review of the literature.

OBJECTIVE: Culture and ethnicity have often been cited as barriers in establishing an effective and satisfying doctor-patient relationship. The aim of this paper is to gain more insight in intercultural medical communication difficulties by reviewing observational studies on intercultural doctor-patient communication. In addition, a research model for studying this topic in future research is proposed. METHODS: A literature review using online databases (Pubmed, Psychlit) was performed. RESULTS: Findings reveal major differences in doctor-patient communication as a consequence of patients' ethnic backgrounds. Doctors behave less affectively when interacting with ethnic minority patients compared to White patients. Ethnic minority patients themselves are also less verbally expressive; they seem to be less assertive and affective during the medical encounter than White patients. CONCLUSION: Most reviewed studies did not relate communication behaviour to possible antecedent culture-related variables, nor did they assess the effect of cultural variations in doctor-patient communication on outcomes, leaving us in the dark about reasons for and consequences of differences in intercultural medical communication. Five key predictors of culture-related communication problems are identified in the literature: (1) cultural differences in explanatory models of health and illness; (2) differences in cultural values; (3) cultural differences in patients' preferences for doctor-patient relationships; (4) racism/perceptual biases; (5) linguistic barriers. It is concluded that by incorporating these variables into a research model future research on this topic can be enhanced, both from a theoretical and a methodological perspective. PRACTICE IMPLICATIONS: Using a cultural sensitive approach in medical communication is recommended.

Attitude of Health Personnel↗
PubMed2006

The development of a scale to discover outpatients' perceptions of the relative desirability of different elements of doctors' communication behaviours.

OBJECTIVE: The objective of the study was to discover which aspects of doctor communication behaviours are more or less desirable to patients who are attending medical outpatients clinics. METHODS: Two hundred and twenty patients took part in the study, which was undertaken in four phases. In phase one, patients completed a 10-item questionnaire where they indicated, by means of a five-point scale, their preferences for doctor communication behaviours. In phases two and three patients qualitatively expressed the meaning that they ascribed to terminology that is used by some researchers to define doctor communication behaviours. In the final phase of the study a 12-item questionnaire was developed by integrating the phase one questionnaire and patients' report from phases two and three. Patients indicated, by means of a five-point scale, their preferences for different communication behaviours that might be used by doctors. Patient's preferences were ranked in terms of the most to the least preferred behaviours. RESULTS: The findings suggest that patients most prefer consultations where doctors give information spontaneously and display affective behaviours. They least preferred consultations where medical matters are discussed and where information is not forthcoming. Furthermore, the finding suggests that the use of blanket terms by researches in defining doctor communication can lead to differences in interpretation by patients. CONCLUSIONS: The methods developed in the study appear to provide a useful tool to discover patients' desires in terms of doctor communication. PRACTICE IMPLICATIONS: The rank scale developed in the study could prove useful to medical practice. It could, for example, provide a straightforward method whereby doctors could readily access researcher's recommendations about communication. Furthermore, the scale could be used in various healthcare settings in order to discover if different patient groups vary in terms of the doctor communication they desire.

Adolescent↗
PubMedDate not supplied

The validity of functional assessments of communication and the Activity/Participation components of the ICIDH-2: do they reflect what really happens in real-life?

UNLABELLED: This paper aims to provide a better understanding of the nature of functional communication activities so that assessment and treatment efforts are based on a theoretical framework and empirical data. Three sources of information are discussed. The first is the Activity/Participation dimensions of the World Health Organization's International Classification of Functioning, Disability, and Health. The second source is existing assessments of functional communication. The final source is data obtained from observational studies conducted in our research unit. The studies have observed the everyday communication of people with aphasia, people with Traumatic Brain Injury (TBI), and patients in hospital. The simplification of real-life communication in the WHO classification scheme, the variability of item sampling in existing assessments, and the complexity of communication observed in real-life settings has led to the conclusion that there are three levels of functional communication assessment: generic, population-specific, and individualized. Clinicians may choose which level suits their purpose. When clinicians routinely choose from a range of sophisticated functional assessments to inform their therapy, the seed that Martha Taylor Sarno planted and nourished for the past 30 years or more will truly flourish throughout the world of speech-language pathology. LEARNING OUTCOMES: As a result of this activity, participants will (1) understand the theoretical framework and data base that motivates assessment and treatment of functional communication activities, (2) be able to discuss the World Health Organization's Classification of Functioning, Disability and Health and (3) gain information about functional assessment and observational sampling of real world communication activities across three levels.

Aphasia↗
PubMed1999

Communications disorders and the interactions and relation(s) to other disorders susceptibility.

Communication is the action and process of transmitting a message and the way in which this message is received and interpreted. We observe the social character of this action and its effectiveness. Evidently, in order to make communication effective, it is necessary for the attitude of the receiver to be socially, ideologically and psychologically receptive. Communication and language are practically two indistinguishable terms. In the case of a deaf child, the learning of cognitive abilities depends absolutely on how his environment educates him. Today we depend on new communication skills and their particular mission and meaning with reference to otolaryngology. In the age of communication in the 21st century, society will direct its resources toward strategy of preventive and medical care that will optimize the population's health communication. Otolaryngology will continue to grow and prosper by responding to these pressing human and social needs and building upon communications, and by incorporating them in this new domain, of language, thus we will be able to find the medical and surgical cures for communication disorders.

Child↗
PubMedDate not supplied

[Audit of a hospital internal communication].

OBJECTIVES: To know the current status of internal communication as perceived by the professional staff (physicians, nurses), middle-level managers, and executive team, and possible future strategies for improving internal communication as perceived by the professional staff. METHODS: The study approach consisted of qualitative methods such as focal groups and semistructured interviews. The study area was a regional hospital. Study subjects included the attending staff (physicians and nurses), middle-level managers (supervisors and department heads), and executives (area heads, nursing director, and medical director). From the base staff, 20 nurses and 18 physicians were chosen for four focal groups. Among the middle-level managers, 2 supervisors and 4 department heads were chosen randomly. Three executive officers were interviewed. RESULTS: The weak and strong points of the hospital's internal communication were shown. Nursing and medical staff noted as an important weak point the fact that they did not feel that directors were listening to them. The professional staff noted as a weak point that they do not receive congratulations or positive reinforcement of any type. With respect of downward information channels, the staff indicated that they do not work because their first information received is always in the form of rumors. The physicians evaluated as a strong point that information always passes through the department head. They evaluated as a strong point good intradepartmental relations. The nurses evaluated as a weak point the obstacles to communication that they encounter. They propose future improvements such as developing itinerant communication, electing directors, using informal channels, recognizing staff achievements, and developing a communication plan. CONCLUSIONS: Internal communication should be understood by executives as part of basic professional management strategy. Given the results of this audit, it will be important to establish an internal communication plan to advance hospital objectives in every sense, at every level and for all professional categories.

Administrative Personnel↗
PubMed1997

The communication atmosphere between physician colleagues: competitive perfectionism or supportive dialogue? A Norwegian study.

Open and supportive communication is probably one of the most important promotors of learning, coping and satisfaction at the workplace. The aim of this paper is to describe and predict the communication atmosphere between Norwegian physicians. Twenty statements describing communication, as perceived by the physicians themselves, were presented to a random sample of the members of the Norwegian Medical Association of which more than 90% of the physicians in the country are members (N = 2628). In general, this investigation indicates that the communication atmosphere among Norwegian physicians is characterised by support and mutual respect. More than half of the respondents fully agreed that communication between colleagues in the workplace is marked by solidarity, and that experienced colleagues show respect for the less experienced in both personal and professional matters. Physicians working in hospitals described the communication atmosphere as substantially more selfish and competitive than non-hospital physicians, whilst general practitioners considered the atmosphere between colleagues to be more supportive than non-specialists. In addition, high perceived stress was associated with the perception of a less supportive atmosphere. However, the strongest predictor of the communication atmosphere was clearly the physician's perceived autonomy. The comprehensive retrenchment programmes implemented in Norwegian hospitals during recent years have increased stress and restricted professional autonomy among both physicians and other occupational groups. Our findings indicate that the communication atmosphere necessary to secure continuity of knowledge within the medical profession may have been jeopardised by this process. In the long term, this may prove hazardous to the quality of medical care.

Adult↗
PubMed2003

Consumer-provider communication research with special populations.

As the US population becomes increasingly diverse, understanding consumer-provider communication among special populations becomes of paramount importance. Cultural competence is a key element in improving communication between non-minority providers and minority patients. This includes overcoming sociocultural and linguistic barriers that hinder access to care and diminish quality consumer-provider communication. Of special concern is the lack of cancer prevention communication between providers and their special population patients. More research is needed to understand cancer communication needs and barriers among special populations, and to direct effective interventions to improve consumer-provider communication for special populations. To this end, interactive training to improve communication skills among oncologists and medical students, increasing the availability of trained medical translators, increasing the number of health professionals from special populations, and increasing the number of special population participants in communication research are recommended. Furthermore, research should focus on identifying and overcoming cultural factors that negatively impact consumer-provider interactions.

Clinical Competence↗
PubMed2000

A pain monitoring program for nurses: effects on communication, assessment and documentation of patients' pain.

Nurses need to be informed about the patient's pain to be able to take appropriate measures to alleviate pain. However, communication, assessment, and documentation of pain by nurses is often a problemfor hospitalized patients. In this study we aimed to overcome the main barriers by developing, implementing, and evaluating a Pain Monitoring Program (PMP) for nurses. The PMP consists of two components: educating nurses about pain, pain assessment and pain management; and implementing daily pain assessment by means of a numeric rating scale. We describe the effects of the PMP on communication about pain between nurses and patients and between physicians and patients, agreement between patients 'pain intensity and nurses estimations of patients'pain intensity, and documentation about pain in the nursing records. Factors that might influence communication, assessment, and documentation are also discussed. The effects of the PMP were measured in a quasi-experimental design with a nonequivalent control group. In total, 703 patients participated: 358 patients in the control group and 345 in the intervention group. Results of the control group showed that communication about pain between nurses and patients, agreement between patients' and nurses pain ratings, and documentation about pain in nursing records, remain inadequate. Patients'pain intensity and age were related to communication, assessment, and documentation. Communication and documentation is better in patients with moderate to severe pain than in patients with mild pain, and assessment is better in patients with mild pain. Older patients communicate less with nurses and physicians about pain, and nurses document less about pain in nursing recordsfor older patients compared with younger patients. The PMPproved to be effective in improving nurses'assessment of patients 'pain and documentation about pain in nursing records. Patients' pain intensity and care setting were related to the efficacy of the PMP Communication about pain between patients and nurses, and between patients and physicians did not improve as a result of the PAIP Based on this study it can be concluded that in using a simple method such as the numeric rating scale, together with an education program, attention is focused in a systematic way on patients'pain complaints and creates a common language between patients and nurses. Because the PMP proved effective in a heterogenous population in multiple care settings, it is recommended to implement the PMP in nursing practice.

Aged↗
PubMed2001

Listening to patients and responding with care: a model for teaching communication skills.

BACKGROUND: Listening to patients and responding with care requires answering two simple but not so obvious questions: Does the clinician know how to listen? and Does the clinician know how to show patients that he or she cares? The initial task for the clinican is to learn to use listening skills to identify the way in which a patient is most comfortable interacting. Once this is accomplished, the clinician uses this information to move closer to where the pateint is comfortable communicating. MODEL FRAMEWORK: The framework for this model is the continuum of two intersecting axes. The horizontal axis poles are inquisitive and assertive. The vertical axis poles are objective and subjective. People who are most comfortable communicating in an inquisitive way and tend to be objective are called investigators. Those who are most comfortable communicating in an inquisitive way but are subjective in nature are called unifiers. People who are most comfortable communicating in an assertive way and favor subjectivity are called energizers. Those who are most comfortable communicating in an assertive way and tend to be objective are called enterprisers. PUTTING THE MODEL TO WORK: The progression of the typical medical interview, which involves gathering information, making decisions, addressing patient concerns, and discussing long-term outcomes requires the clinician to communicate in all four communication modes. Learning to identify how he or she is most comfortable communicating may help the clinician make a smooth transition from one mode to another.

Aged↗
PubMed2000

Effects of electronic communication in general practice.

OBJECTIVE: To obtain insight into the effects of electronic communication on GPs by studying those publications in literature describing the effects of structured electronic clinical communication in general practice. METHODS: We retrieved all publications in the English language indexed in MEDLINE under the MESH term 'Computer Communication Networks' AND having either 'family practice' or 'primary health care' as MESH term OR 'GP', or 'GPs' as text word. RESULTS: A total of 176 publications were retrieved of which 30 publications met the criteria. In 28 of these 30 publications potential effects were described; one described claimed effects, three described demonstrated effects with subjective data and five described demonstrated effects with objective data. The studies documented, furthermore, effects on the speed of communication, the content of information and records, a change of processes involved in the communication, quality of care, costs, workload of physicians, appreciation of physicians, confidentiality, and adherence. CONCLUSIONS: We conclude that only a few studies evaluated electronic communication versus paper communication. Of these studies, only a few report improvement. Our final conclusion is that, so far, literature has not shown that the positive effects can be explained by electronic communication as such.

Computer Communication Networks↗
PubMed1994

Interactive communication between children: learning how to make language work in dialogue.

In this paper we investigate the development of interactive communication skills in 170 children aged seven to thirteen. Using a communication task that allows extended dialogues between pairs of young speakers, we are able to assess both the overall communicative success achieved by any pair; and from an analysis of the dialogues we can identify several interactive strategies that characterize older and more successful communicators. Successful communication involves the active involvement of both participants: asking and answering questions, volunteering information and responding sensitively to contributions from their partners. In contrast to the process of language acquisition, the development of these interactive skills takes place over an extended time period and subjects vary greatly in their ability to communicate effectively. For many analyses differences in the communicative success achieved by subjects differ more within than between age groups. For example, a substantial minority of our oldest subjects communicate no better than children six years younger.

Adolescent↗
PubMed1997

The bystander effect exerted by tumor cells expressing the herpes simplex virus thymidine kinase (HSVtk) gene is dependent on connexin expression and cell communication via gap junctions.

To elucidate the role gap junctions play in the bystander effect, we examined the cytotoxic effect of herpes simplex virus thymidine kinase (HSVtk) modified tumor cells on gap junction communication-deficient tumor cells and their connexin transfectants. Communication competent Walker 256 tumor cells engineered to express the HSVtk gene (Walker-tk+) when cocultured with N2A mouse neuroblastoma and PC12 rat pheochromocytoma cells with absent endogenous junctional conductance showed no bystander cytotoxicity. Transfection of N2A cells with the rat connexin37 gene (5Q) and PC12 cells with the human connexin43 gene rendered them susceptible to bystander cell death. Additionally, communication-deficient N2A cells transfected with the HSVtk gene failed to exert a bystander effect, whereas N2A transfectants coexpressing the connexin37 and HSVtk genes (5Qtk+ cells) exerted bystander cytotoxicity on gap junction communication-competent 5Q but not on communication-deficient N2A cells in vitro. In vivo experiments also showed tumor growth inhibition of communication-competent 5Q but not communication-incompetent N2A cells by 5Qtk+ cells. In conclusion, these results indicate that in several cellular environments the bystander effect is dependent on connexin expression and gap junctional communication between HSVtk-positive and HSVtk-negative cells.

Animals↗
PubMed2004

Communication of epidemiology study results by industry: the Dow Chemical Company approach.

Communicating epidemiology study results to subjects, affected workers, and community members is an important part of compliance and alignment with our company's policies, industry's Responsible Care Principles, and the doctrines of Good Epidemiology Practices. It is the responsibility of the investigators to interpret their research appropriately for each audience, and to assure that all who have a need or right to know get information in a form meaningful to them. We discuss study communication with examples from a recent evaluation of communication efforts within Dow and our experience with occupational and community studies on dioxin. We also discuss how we currently structure worker and community communication based on this experience. Since each Dow protocol must include a communication plan, when we agree to undertake a study, we are also agreeing to communicate study results. Depending upon the nature and type of the study, there may also be some prestudy communication. We encourage all investigators to share the results of their studies more broadly than just scientific publication and plan for the study communication before the study is initiated.

Chemical Industry↗
PubMed1988

Communication breakdowns in normal and language learning-disabled children's conversation and narration.

The frequency and type of communication breakdowns occurring in the speech of 7 language learning-disabled children (LLD), aged 9:10-11:1 (years:months), were examined in two conditions, conversation and narration, and compared to a group of 7 normal peers matched for chronological age and 7 peers matched for mean length of communication unit in conversation. Types of communication breakdowns examined included stalls, repairs, and abandoned utterances. The LLD group incurred a significantly greater rate of communication breakdowns per communication unit in narration than conversation compared to control group differences. Mean length of communication unit was also significantly greater in narration than conversation for the LLD group compared to controls. For all groups, across both speech sample conditions, longer communication units contained more breakdowns than shorter ones. The groups did not differ in the types of breakdowns. Communication unit length and the nature of the narrative task may account for the increased dysfluencies in LLD children's speech.

Child↗
PubMed1999

Verbal communication: what do critical care nurses say to their unconscious or sedated patients?

The importance of using verbal communication in the care of critically ill patients has long been known. Both qualitative and quantitative studies have presented evidence of the benefits of effective communication. This non-participant observational study aimed to explore how much and what types of verbal communication critical care nurses use when caring for unconscious or sedated patients. Sixteen critical care nurses were observed in 4-hour episodes and their verbal communication was transcribed and timed at source. Seven categories of verbal communication and a 'core concept' emerged on analysis of the raw data. Medical investigations/interventions performed on the patients increased the amount of communication used. The participants in this study were found to use a greater variety and amount of verbal communication than participants in other studies. The findings of this study highlight the need for formal support systems and continued education for nurses about the benefits of verbal communication.

Analgesia↗
PubMed2002

The relationship between medical students' attitudes towards communication skills learning and their demographic and education-related characteristics.

INTRODUCTION: The General Medical Council (GMC) has stressed the importance of medical students' attitudes towards learning. However, few studies have explored medical students' attitudes towards communication skills learning. This study explores the relationship between the attitudes of medical students at two different schools and their demographic and education-related characteristics. METHODS: A total of 490 medical students from the Universities of Nottingham (Years 1 and 2) and Leicester (Year 1) completed the 26-item Communication Skills Attitude Scale (CSAS) and a personal details questionnaire satisfactorily. The relationships between students' attitudes and their demographic and education-related characteristics were analysed separately for Nottingham and Leicester students using both univariate and multivariate statistics. RESULTS: The attitudes of Nottingham and Leicester medical students towards communication skills learning were significantly associated with a number of demographic and education-related characteristics. Both Nottingham and Leicester students with more positive attitudes towards communication skills learning tended to be female, tended to think their communication skills needed improving and tended not to have parents who were doctors. Both Nottingham and Leicester students with more negative attitudes towards communication skills learning tended to think their communication skills did not need improving. DISCUSSION: The results indicate that medical students' attitudes towards communication skills learning are associated with their demographic and education-related characteristics. These findings have a number of implications for educational practice and further research and these are discussed in this paper.

Adult↗
PubMed2001

Parent-adolescent communication and sexual risk behaviors among African American adolescent females.

OBJECTIVE: To examine associations between parent-adolescent communication about sex-related topics and the sex-related communication and practices of African American adolescent females with partners, as well as their perceived ability to negotiate safer sex. DESIGN: A theory-guided survey and structured interview were administered to 522 sexually active African American females 14 to 18 years old. Recruitment sites were neighborhoods with high rates of unemployment, substance abuse, violence, and sexually transmitted diseases. Multivariate analyses, controlling for observed covariates, were used to identify the association of less frequent parent-adolescent communication with multiple assessed outcomes. RESULTS: Less frequent parent-adolescent communication (scores below the median) was associated with adolescents' non-use of contraceptives in the past 6 months (adjusted odds ratio [AOR] = 1.7) and non-use of contraceptives during the last 5 sexual encounters (AOR = 1.6). Less communication increased the odds of never using condoms in the past month (AOR = 1.6), during the last 5 sexual encounters (AOR = 1.7), and at last intercourse (AOR = 1.7). Less communication was also associated with less communication between adolescents and their sex partners (AOR = 3.3) and lower self-efficacy to negotiate safer sex (AOR = 1.8). CONCLUSIONS: The findings demonstrate the importance of involving parents in human immunodeficiency virus/sexually transmitted disease and pregnancy prevention efforts directed at female adolescents. Pediatricians and other clinicians can play an important role in facilitating parent-adolescent communication about sexual activity.

Adolescent↗