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PubMed2002

Studying communication about end-of-life care during the ICU family conference: development of a framework.

PURPOSE: Family-clinician communication in the intensive care unit (ICU) about withholding and withdrawing life support occurs frequently, yet few data exist to guide clinicians in its conduct. The purpose of this study was to develop an understanding of the way this communication is currently conducted. METHODS: We identified family conferences in the ICUs of 4 Seattle-area hospitals. Conferences were eligible if the physician leading the conference believed that discussion about withholding or withdrawing life support or the delivery of bad news was likely to occur and if all conference participants consented to participate. Fifty conferences were audiotaped, transcribed, and analyzed by using the principles of grounded theory. RESULTS: We developed 2 frameworks for describing and understanding this communication. The first framework describes communication content, including introductions, information exchange, discussions of the future, and closings. The second framework describes communication styles and support provided to families and other clinicians and includes a variety of techniques such as active listening, acknowledging informational complexity and emotional difficulty of the situation, and supporting family decision making. These frameworks identify what physicians discuss, how they present and respond to issues, and how they support families during these conferences. CONCLUSIONS: This article describes a qualitative methodology to understand clinician-family communication during the ICU family conference concerning end-of-life care and provides a frame of reference that may help guide clinicians who conduct these conferences. We also identify strategies clinicians use to improve communication and enhance the support provided. Further analyses and studies are needed to identify whether this framework or these strategies can improve family understanding or satisfaction or improve the quality care in the ICU.

Adolescent↗
PubMed2006

Communication in young children with motor impairments: teaching caregivers to teach.

Communication between caregivers and children with moderate to severe motor impairments is a tremendous challenge, and one that deserves attention as a central component of early intervention programs. This article examines a caregiver-training program that explored key elements to creating strong communicative interactions between young children with moderate to severe motor impairments and their primary caregiver. Three caregiver-child dyads participated in a 3-week treatment program teaching caregivers how to provide communicative opportunities, wait for a clear communication signal from their children, recognize their children's signal, and finally, shape a more advanced communicative behavior. These adult behaviors were designed to increase the children's use of conventional engaging signals of communication. Results revealed that caregivers demonstrated success learning all behaviors except for shaping during the brief treatment period. Children's engaging communicative behaviors increased correspondingly with the caregivers' changes. These findings have positive implications for caregiver training. Implications for "best practice" are considered.

Adult↗
PubMedDate not supplied

General practice and chiropractic in Norway: how well do they communicate and what do GPs want to know?

BACKGROUND: Some within the medical establishment believe that the education and training of chiropractors is grounded in orthodox medicine and that these professional groups share a common language allowing for close dialogue. However, levels of communication and collaboration often remain low. Furthermore, studies have shown chiropractors to be lax in providing written reports to referring clinicians, a practice important to both patient care and interprofessional relationships. OBJECTIVE: To investigate existing levels of communication between general practitioners (GPs) and chiropractors in Norway and to identify trends in GP preferences for future interprofessional communications. DESIGN AND SETTING: A postal survey was conducted on a random sample of 230 GPs in Norway. RESULTS: A response rate of 51% was achieved. All respondents reported having made at least one referral to a chiropractor. Most (63%) referred infrequently, and only 7% communicated often with a chiropractor. Of those who were in contact with a chiropractor, three fourths communicated by telephone. One fifth of the respondents negatively assessed the quality of written reports. Approximately one third of those GPs who had referred patients did not receive a report, despite this being obligatory in Norway. Twelve percent reported problems with terminology. A written report for future reporting was favored by 75% of the GPs, who wanted the report to contain information on examination findings, diagnosis, treatment, and advice given. CONCLUSION: In general, communications between GPs and chiropractors in Norway are not ideal, particularly with regard to frequency and written quality. However, this is not unique to Norway. With increasing emphasis on multidisciplinary health care, greater understanding and better communication is needed to optimize the benefits of such an approach to patient management. Relevant, timely, consistent reporting on a reciprocal basis, together with a shared vocabulary, should help this process.

Adult↗
PubMed1983

Paradox of the evolution of communication and of social interactivity.

Communication between individuals of a species is likely to increase the capacity to acquire skills useful for survival and propagation and thus may confer important selective advantages. Since interaction occurs between two or more individuals, the selective process is frequency dependent, and the analysis shows that communication cannot initially increase at a reasonable rate when it is limited to random unrelated individuals, so that it is likely to abort for stochastic reasons. However, this bottleneck is removed if the communication process takes place in the nuclear family or among close relatives or if aggregation of communicators occurs because of assortative mating or meeting. Use of the individual conditional fitnesses we have introduced earlier permits an exact analysis. We show that, in general, the initial rate of increase can be geometric if and only if, in the class of selective models considered, the conditional probability of a communicator interacting with another contains a positive constant term. In our discussion of communication, cost factors for the act of communication have been omitted. However, the model has been generalized to include cooperativeness, and also altruism, or competition, by introducing costs. There is a close relationship among these situations, and the same considerations about the initial bottleneck and its resolution also extend to them. The models given here are for haploids but they extend to diploids and the conclusions are similar.

Altruism↗
PubMed2006

Social communication skills in persons with post-acute traumatic brain injury: three perspectives.

OBJECTIVE: To describe social communication skills problems identified by individuals with traumatic brain injury (TBI) compared to significant other (SO) and clinician ratings; and associations between these skills and participation outcome measures. DESIGN: Cohort study. METHODS: Sixty individuals with TBI > or = 1 year post-injury were administered measures of social communication, societal participation, social integration and life satisfaction. Clinicians and SOs rated the social communication skills of the subjects. RESULTS: Subjects were able to identify social communication skills problems, associated with lower ratings of community integration and satisfaction with life. Males reported higher scores in social communication and social integration than females. SOs and clinicians identified more social skills problems than subjects. CONCLUSIONS: Persons with TBI experience social communication skills deficits, associated with decreased societal participation and life satisfaction. Further research is needed to determine efficacy of social communication skills treatment and association with improved participation and satisfaction with life.

Adult↗
PubMed2006

Functional communication and executive function in aphasia.

The purpose of this exploratory study was to investigate the relationship between functional communication and executive function ability in aphasia. Twenty-five participants with aphasia underwent examination with an extensive test battery including measures of functional communication, executive function ability, and language impairment. Compared to published norms, most participants did not perform within normal limits on the executive function tests. As expected, the correlation between severity of language impairment and functional communication ratings exceeded that among the executive functioning and functional communication measures. Eight of ten correlation coefficients for the relationship between executive functioning and functional communication reached statistical significance suggesting a clear relationship between scores on the executive functioning measures and functional communication ability. Based on these results, it appears that decreased executive functioning ability may coincide with decreased functional communication ability in persons with aphasia.

Adult↗
PubMed2001

Grief communication, grief reactions and marital satisfaction in bereaved parents.

This study examined if attitudes about grief communication are related to grief reactions and marital satisfaction in bereaved parents. The sample consisted of 36 couples who experienced the loss of a child. For the couple as a unit, the relation between attitudes about communication and grief changed over time, and the nature of the change was related to the level of communication; positive attitudes about open communication were related to high grief in the early stages of bereavement and to low grief in later stages. No relation to marital satisfaction was found. Spouses were correlated in their attitudes about communication, but women valued open communication significantly more than men. Positive attitudes about grief communication were related to men's grief reactions but not marital satisfaction; whereas for women, positive attitudes were related to marital satisfaction but not grief.

Child↗
PubMed2005

A computerised communication aid for people with aphasia.

PURPOSE: To develop a portable computerised communication aid for aphasic people to support communication in everyday life. METHOD: A multidisciplinary team of aphasiologists, augmentative and alternative communication specialists, speech and language therapists and technicians developed a portable, modular system, PCAD (portable communication assistant for people with dysphasia), running on a commercially available handheld computer. The system was tested in a multiple case study. Aphasia therapy services In the UK, Portugal and The Netherlands referred 28 people with aphasia, who were considered eligible for a computerised communication aid. Participants were trained following a protocol and used the device in self-chosen real life settings. RESULTS: Six of the 28 selected aphasic patients decided not to test the device; 22 participated in the training. All 22 learned to operate the aid, 17 used it functionally, in everyday life. Five people did not use the aid outside the therapy room, although they were able to operate the aid and to use it in role play. These unsuccessful clients were younger, and tended to have a shorter duration of the aphasia. CONCLUSIONS: Carefully selected aphasic patients may benefit from a computerised communication aid, using it functionally in everyday communicative settings.

Adult↗
PubMed2004

Disability prevention and communication among workers, physicians, employers, and insurers--current models and opportunities for improvement.

PURPOSE: To review prevailing models of disability management and prevention with respect to communication, and to suggest alternative approaches. METHOD: Review of selected articles. RESULTS: Effective disability management and return to work strategies have been the focus of an increasing number of intervention programmes and associated research studies, spanning a variety of worker populations and provider and business perspectives. Although primary and secondary disability prevention approaches have addressed theoretical basis, methods and costs, few identify communication as a key factor influencing disability outcomes. Four prevailing models of disability management and prevention (medical model, physical rehabilitation model, job-match model, and managed care model) are identified. The medical model emphasizes the physician's role to define functional limitations and job restrictions. In the physical rehabilitation model, rehabilitation professionals communicate the importance of exercise and muscle reconditioning for resuming normal work activities. The job-match model relies on the ability of employers to accurately communicate physical job requirements. The managed care model focuses on dissemination of acceptable standards for medical treatment and duration of work absence, and interventions by case managers when these standards are exceeded. Despite contrary evidence for many health impairments, these models share a common assumption that medical disability outcomes are highly predictable and unaffected by either individual or contextual factors. As a result, communication is often authoritative and unidirectional, with workers and employers in a passive role. CONCLUSION: Improvements in communication may be responsible for successes across a variety of new interventions. Communication-based interventions may further improve disability outcomes, reduce adversarial relationships, and prove cost-effective; however, controlled trials are needed.

Communication↗
PubMed2006

The cost-effectiveness of health communication programs: what do we know?

While a considerable body of evidence has emerged supporting the effectiveness of communication programs in augmenting health, only a very small subset of studies has examined also whether these programs are cost-effective, that is, whether they achieve greater health gains for available financial resources than alternative interventions. In this article, we examine the available literature on the cost-effectiveness of health behavior change communication programs, focusing on communication interventions involving mass media, and, to a lesser extent, community mobilization and interpersonal communication or counseling. Our objective is to identify the state of past and current research efforts of the cost-effectiveness of behavior change communication programs. This review makes three principal conclusions. First, the analysis of the cost-effectiveness of health communication programs commonly has not been performed. Second, the studies reviewed here have utilized a considerable diversity of methods and have reflected varying levels of quality and adherence to standard cost-effectiveness methodologies. This leads to problems of transparency, comparability, and generalizability. Third, while the available studies generally are indicative of the cost-effectiveness of communication interventions relative to alternatives, the evidence base clearly needs to be expanded by additional rigorous cost-effectiveness analyses.

Cost-Benefit Analysis↗
PubMedDate not supplied

Recommendations to improve health risk communication: lessons learned from the U.S. Public Health Service.

The growth in the public's concern over a variety of environmental health risks has placed new requirements and demands on U.S. Public Health Service (PHS) agencies for information that describes and explains the nature of risk in clear and comprehensible terms. Experience has shown, however, that merely disseminating information without reliance on communication principles can lead to ineffective health messages and public health actions. This article presents the findings of a study conducted by the Subcommittee on Risk Communication and Education of the Environmental Health Policy Committee (EHPC), PHS, on how PHS agencies are communicating information about health risk; how effective these communications have been; and what specific principles, strategies, and practices best promote effective health risk communication. The purpose of the Subcommittee's study was to develop specific recommendations that would help PHS decision makers and health risk communicators improve the effectiveness of health information provided to, and received from, the public. The study suggests fundamental principles drawn from a series of case studies from PHS agencies about how best to plan and carry out risk communication activities.

Communication↗
PubMedDate not supplied

The field of health communication today: an up-to-date report.

One important starting point for the field of health communication was the Stanford Heart Disease Prevention Program, a multiyear community intervention that began 25 years ago. Health communication is a specialty field of communication study that includes the media agenda-setting process for health issues; media advocacy for health; scientific communication among biomedical scientists; doctor-patient communication; and, particularly, the design and evaluation of preventive health communication campaigns, the focus of this article. Health communication study today is a well-established, expanding specialty in the United States and abroad.

Communication↗
PubMedDate not supplied

An assessment of the health communication job market across multiple types of organizations.

This study seeks to answer three questions: (1) What is the employment outlook for health communication practitioners? (2) What specialized knowledge and skills should a competent health communication practitioner possess? and (3) How much academic training or professional experience is necessary to become a competent health communication practitioner? To this end, 104 employers of health communication practitioners, representing different types of large, medium, and small companies and organizations from various regions of the United States, were interviewed by telephone. The interview protocol was based on nine core health communication responsibilities identified by a working group of health communication academicians and practitioners. The study suggests a positive employment outlook, where those seeking jobs in health communication before the year 2000 could enjoy varied job opportunities in the wake of an anticipated moderate expansion in the field. Those with 1 to 10 years of experience are most in demand. While an undergraduate degree provides an academic background to perform most responsibilities, for six of the nine core responsibilities an advanced degree was preferred by at least one-third of respondents.

Employment↗
PubMed2004

Effects of a course on ophthalmologist communication skills: a pilot study.

INTRODUCTION: Although the issue of communication skills is now considered crucial for ophthalmology, no previous research has discussed training in this field. This study aimed to discuss the effects of a 16 hour communication skills course for ophthalmologists. In particular the study assessed the interest of participants with respect to the topic and the efficacy on participants' communication skills, at least in a laboratory setting. MATERIALS AND METHODS: Eleven ophthalmologists participated in the course. Learner satisfaction was evaluated using a questionnaire with a six-point Likert scale. Course efficacy was assessed by a comparison between communicative behaviour of ophthalmologists in videoed role playing before and immediately after attending the course. Videoed consultations were coded using the Patient Centred Score Sheet (PCSS) and the Roter Interaction Analysis System (RIAS). The Wilcoxon signed rank test was used for statistical analysis. FINDINGS: The course obtained high satisfaction in participants (mean score 5.1). In the post test role playing, patient centredness increased significantly (p < 0.01). Furthermore, ophthalmologists improved their competence in using open ended questions (p < 0.02), process categories (e.g. orientation statement) (p < 0.05) and social communication categories (e.g. personal statement) (p < 0.01). DISCUSSION: According to our findings, ophthalmologists did show satisfaction for the course. Results also indicate that the course positively influenced ophthalmologist communication competence, at least in a laboratory setting. After the course, participants became more attentive to patients' psychosocial needs, both in terms of general quality of consultation (patient centredness) and in terms of using specific interpersonal skills. Present results are considered preliminary, and further research is needed with a larger sample and including an evaluation of the effects on ophthalmologists' communication skills in clinical practice.

Adult↗
PubMed2006

Student attitudes towards communication skills training in a medical college in Western Nepal.

CONTEXT: Previous studies have shown that students have both positive and negative attitudes towards communication skills training. However, studies in Nepal are lacking. OBJECTIVES: The present study was carried out to determine the positive and negative attitudes of student respondents using the previously validated communication skills attitude scale (CSAS) (see Appendix). METHODS: The study was carried out among third- and fourth-semester students at the Manipal College of Medical Sciences, Pokhara, Nepal. These students are in the pre-clinical part of their course and learn the basic science subjects through an integrated, system-based curriculum. Gender, age, nationality of the respondents, occupation of parents, medium of instruction at school, attitude towards communication skills training during the clinical years, and self-rating of communication abilities were recorded. Association of the positive and negative attitudes with these variables was determined using appropriate statistical tests (p < 0.05). FINDINGS: A total of 123 students participated in the study; 74 (60.2%) were male, and 104 (84.5%) had studied in English-medium schools. The median positive attitude score was 51 (inter-quartile range 7). Nationality and attitude towards communication skills training during the clinical years showed a significant association. The mean negative attitude scale score was 31.18 (SD = 4.96). A significant association was noted with attitude towards communication skills training during the clinical years. Both scales range from 13-65, with higher scores indicating stronger attitudes. CONCLUSIONS: Communication skills training should be modified and strengthened. Formal courses during the clinical years are required. Training sessions for the faculty and further studies across different semesters and in different medical colleges in Nepal are needed.

Adolescent↗
PubMedDate not supplied

Using an interdisciplinary approach to training to develop the quality of communication with adults with profound learning disabilities by care staff.

The study examines the effects of training on care staff's communication to service users with profound and severe learning disabilities. An interdisciplinary therapeutic training programme aimed to improve care staff's cognitions about disability, to alter their communicative practice and to provide them with practical solutions to the communication difficulties of the service users. Participants were each video recorded with a single service user before and during training. The recordings formed the basis of the communication workshops. Both baseline and final recordings were evaluated using criteria based on verbal and non-verbal interactions. The criteria assessed alterations in the care staff's language use, verbal responses, and interpretation and praise of service users' communication. The use of posture, position, eye contact and gaze monitoring during interactions was also evaluated. The pre- and post-training analysis demonstrated alterations and improvements in care staff's use of verbal communication as well as gaze monitoring and position during interactions. A follow-up study 6 months later showed many of the post-training positive changes had been maintained or had continued to develop. It is suggested that the success and implementation of the communication training in the workplace was due to the collaborative therapeutic nature of the training package. The interdisciplinary and integrated training programme had facilitated a willingness to change and led to the development of a positive view of each other's practice. The recommendations from each of the therapist's training programme formed an integral part of the care staff's new care plans for each service user. This contributed to the continuing development the care staff's therapeutic role.

Adult↗
PubMedDate not supplied

Elicited and spontaneous communicative functions and stability of conversational measures with children who have pragmatic language impairments.

BACKGROUND: The preliminary phase of a project aimed at establishing appropriate outcome measures for intervention with children who have pragmatic language impairments (PLI) is reported. Assessment methods for children with PLI are considered in the context of developing outcome measures for intervention studies. Communicative function assessments in elicitation and conversational contexts are compared. The stability of measures derived from conversational profiling is also considered. AIMS: To investigate the utility of an elicited communicative function assessment in discriminating the pragmatic characteristics of children with PLI and to compare this method to conversational profiling. An additional aim was to estimate the degree of variation on conversational indices derived from interactions with children with PLI. METHODS & PROCEDURES: Fifteen children with PLI (mean age 9; 5 years) and an age-matched control group were assessed on two occasions on a new communicative function elicitation task and on a conversation task. A checklist of communicative functions was employed in analysing the elicitation and the conversation tasks. An analysis of conversation was carried out to derive conversational indices such as verbosity and meshing. OUTCOMES & RESULTS: The elicitation task failed to discriminate between the PLI and control groups and showed a strong ceiling effect. Significant between-group differences were found for both communicative function in conversation measures and on conversational indices. The variation in conversation indices is relatively small compared with the baseline measures. CONCLUSIONS: A more representative picture of communicative function ability arises from unstructured tasks rather than from structured elicitation tasks for the age group of children with PLI. The elicitation procedure outlined in this paper might be better suited to a younger age group. Differences between communicative function performance on elicitation and conversation situations suggest a strong effect of context on the pragmatic performance of children with PLI. The conversational indices reported show sufficient stability to be employed in an outcome measure provided the minor variations indicated are factored into estimates of change.

Assertiveness↗
PubMed1990

Differential phosphorylation of the gap junction protein connexin43 in junctional communication-competent and -deficient cell lines.

Connexin43 is a member of the highly homologous connexin family of gap junction proteins. We have studied how connexin monomers are assembled into functional gap junction plaques by examining the biosynthesis of connexin43 in cell types that differ greatly in their ability to form functional gap junctions. Using a combination of metabolic radiolabeling and immunoprecipitation, we have shown that connexin43 is synthesized in gap junctional communication-competent cells as a 42-kD protein that is efficiently converted to a approximately 46-kD species (connexin43-P2) by the posttranslational addition of phosphate. Surprisingly, certain cell lines severely deficient in gap junctional communication and known cell-cell adhesion molecules (S180 and L929 cells) also expressed 42-kD connexin43. Connexin43 in these communication-deficient cell lines was not, however, phosphorylated to the P2 form. Conversion of S180 cells to a communication-competent phenotype by transfection with a cDNA encoding the cell-cell adhesion molecule L-CAM induced phosphorylation of connexin43 to the P2 form; conversely, blocking junctional communication in ordinarily communication-competent cells inhibited connexin43-P2 formation. Immunohistochemical localization studies indicated that only communication-competent cells accumulated connexin43 in visible gap junction plaques. Together, these results establish a strong correlation between the ability of cells to process connexin43 to the P2 form and to produce functional gap junctions. Connexin43 phosphorylation may therefore play a functional role in gap junction assembly and/or activity.

Animals↗