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PubMed2002

Parent interaction course in order to enhance communication skills between parents and children following pediatric cochlear implantation.

OBJECTIVE: To assess the effect of a parent interaction training course on the communication skills of parents of young implanted children. The training course was designed to help parents to be less controlling in their interactions with their deaf children and to facilitate the development of spoken language. STUDY DESIGN: Prospective study comparing the communication skills of parents of deaf children fitted with cochlear implants before and after a parent interaction training course. SETTING: Pediatric tertiary referral center for cochlear implantation. METHODS: Video samples were taken of parents interacting with their children 1 month before the course (ranging from 15 days to 2 months) and after the course (ranging from 15 days to 1 month). Video samples were then transcribed orthographically and parents' turns in the interaction were assigned to one of two categories: (a) initiations--the parent initiates conversation or introduces a new topic and (b) responses--the parent responds to the child's previous turn. 12 months after completion of the course, the process was repeated in order to establish the relative permanence of changes in behavior. HYPOTHESIS: The parents' turns would shift from a predominance of initiations to a predominance of responses as a result of attendance on the course. This would demonstrate that the parents were less controlling of their children in communication and were exhibiting more contingent behavior--responding to their child's initiations rather than expecting the child to respond to theirs. PATIENTS: The study involved 17 parents of 11 implanted children. The mean age at implantation was 4 years (range: 2.2-6.3 years). The implant experience of the children ranged from 2 to 23 months at the time of the study. All children used total communication. RESULTS: The post-course initiations were half those of the pre-course ones (median from 14 decreased to 7) and the responses were almost double following the course (median from 8 increased to 14). Both differences were statistically significant (P < 0.05). 12 months after the course, the responses score remained high with a median score of 16.5. However, a slight but significant increase in the initiation scores was also noted (median from 7 to 8.5). Parental satisfaction of the course was found to be high as no families failed to attend on any of the occasions despite the great distances some of them had to travel. CONCLUSION: The format of the parent interaction training course was found to be highly acceptable to the parents and the components covered proved to be effective in promoting positive changes in parental communication behavior. Clinicians need to provide a responsive environment for implanted deaf children and help others to do the same. The training course provided a very useful forum to share insights and skills and to evaluate ways of enhancing the communication between parents and children following cochlear implantation.

Child↗
PubMed1997

The development of communication and language in deaf preschool children with cochlear implants.

The study is an ongoing longitudinal and qualitative psycho-social study of the communicative development in 19 preschool children with cochlear implants, using sign language. The children are video-recorded in natural interactional settings. Analysis of patterns of communication show that 16 of the children use sign language in communication with adults and peers. With regard to oral communication, 13 children were observed to utter single words or speech-like sounds upon an adult's request, but seldom used spoken words spontaneously. Six children used single spoken words in dialogues with adults if the content of the dialogue was about the here and now, and if the topic of reference was clear. None of the children in the study were able to take part in age-adequate play activities with peers when speech was used in communication. The results are discussed in reference to early mother-infant interaction, the development of communication and language, and the significance of early close relationships for children's social and emotional development.

Child↗
PubMed2001

Effective communication in health care: exploring the skills of the teachers.

Following the growing commitment to teach communication skills in health care, a project was designed to identify a group of Health Professionals with a responsibility for teaching communication skills in Health Care. This group would have their communication skills assessed, using positive feedback, and attend workshops to improve both their communication and teaching skills. Four key tutors were recruited to the study and were each asked to identify a further three tutors, in their own geographical area, to form a "cell". This sample of 16 tutors remained constant throughout the study. Skills were monitored by the assessment of audio-taped interviews, one made prior to the first workshop and two others at agreed intervals. Written feedback was given on the first interview, plus the option of verbal feedback on a skills study day. Written feedback was given on subsequent interviews. Changes in skills were monitored and baseline skills compared to previous skills training. The results show, with two exceptions, that there appears to be a link between baseline skills and previous training in communication skills. For three "cells", there are gains in overall scores from first to third interview, but for the fourth "cell", which had high baseline scores, there was only minimal change. The work suggests, that for those who teach Communication in Health Care, training is a pre-requisite. Further work is required in this area.

Clinical Competence↗
PubMed2003

Underlying dimensions of verbal communication between dentists and patients in prosthetic dentistry.

The study explores whether the task-focused and socio-emotional dimensions of clinical communication is recognizable in the verbal communication context of prosthetic dentistry, as well as if there are other dimensions of communication in that context. Sixty-one audio recordings were made at three specialist clinics of prosthetic dentistry in Sweden. Sixty-one patients and 15 dentists participated. Sixty-one prosthetic rehabilitation periods were followed. Tooth- or implant-supported fixed prostheses were placed during this time. One visit near the end of each rehabilitation period was audiorecorded. The verbal communication was analyzed with the Roter Interaction Analysis System (RIAS)-dental. The categories were subjected to exploratory factor analysis. Patient and dentist verbal behavior could not be defined exclusively as socio-emotional or task-focused but had to be defined in other dimensions; Emotional exchange, information exchange-patient horizon, relation building exchange, information exchange-dentist horizon, and administrative and counseling exchange. Since the 'emotional exchange' factor was found to capture the largest share of the variance in the communicated patterns, the present study suggests that prosthetic care in dentistry is basically a human relationship with strong emotional communicative content.

Adult↗
PubMed2002

Empathic communication and gender in the physician-patient encounter.

Although empathy in the physician-patient relationship is often advocated, a theoretically based and empirically derived measure of a physician's empathic communication to a patient has been missing. This paper describes the development and initial validation of such a measure, the Empathic Communication Coding System (ECCS), which includes a method for identifying patient-created empathic opportunities. To determine the extent to which empathic communication varies with physician and patient gender, we used the ECCS to code 100 videotaped office visits between patients and general internists. While male and female patients created a comparable number of empathic opportunities, those created by females tended to exhibit more emotional intensity than those created by males. However, female patients were no more likely than male patients to name an emotion in their empathic opportunities. Physician communication behavior was consistent with the literature on gender differences: female physicians tended to communicate higher degrees of empathy in response to the empathic opportunities created by patients. The ECCS appears to be a viable and sensitive tool for better understanding empathy in medical encounters, and for detecting modest gender differences in patients' creation of empathic opportunities and in physicians' empathic communication.

Adult↗
PubMed2004

Empowering communication: a community-based intervention for patients.

The "How to Talk to Your Doctor" community education forums operate under the assumption that information exchange and consumer involvement in healthcare can empower communities in need. We report on the development and preliminary evaluation of this community-based intervention designed to activate and enhance patients' communicative abilities in the medical encounter. We review evidence supporting the feasibility of and benefits that can be expected from improving patients' communication competency. Our intervention is simple and flexible so, therefore, can be portable to a large number of communities. Our preliminary evaluation suggests that the intervention is well-received and produces improved self-perceptions of communication competence across diverse settings and participants. We describe our intervention and its development and dissemination as a model for improving patients' communicative abilities through a community-based, active learner approach. By sharing our experiences, the barriers we encountered, and our ongoing efforts to improve patient communication in the medical encounter, we hope to empower patients to communicate better with their physicians.

Communication↗
PubMed2004

Functional health literacy and the quality of physician-patient communication among diabetes patients.

While patients with poor functional health literacy (FHL) have difficulties reading and comprehending written medical instructions, it is not known whether these patients also experience problems with other modes of communication, such as face-to-face encounters with primary care physicians. We enrolled 408 English- and Spanish-speaking diabetes patients to examine whether patients with inadequate FHL report worse communication than patients with adequate FHL. We assessed patients' experiences of communication using sub-scales from the Interpersonal Processes of Care in Diverse Populations instrument. In multivariate models, patients with inadequate FHL, compared to patients with adequate FHL, were more likely to report worse communication in the domains of general clarity (adjusted odds ratio [AOR] 6.29, P<0.01), explanation of condition (AOR 4.85, P=0.03), and explanation of processes of care (AOR 2.70, p=0.03). Poor FHL appears to be a marker for oral communication problems, particularly in the technical, explanatory domains of clinician-patient dialogue. Research is needed to identify strategies to improve communication for this group of patients.

Communication Barriers↗
PubMed2000

Pharmacists' evaluation of key communication skills in practice.

This paper reports the results of a major research initiative into the identification of key communication skills in community pharmacist-patient consultations. It is now widely accepted that the quality of practitioner-patient communication is fundamental to effective health care. However, an analysis of the literature pertaining to the communication issues facing health professionals in general and pharmacists in particular emphasised the need for more empirical research, to chart what pharmacists themselves deemed to be the nature and range of skills which contribute to effective communication performance in community pharmacy practice. The main aim of this research investigation was, therefore, to identify what constituted effective communicative performance by community pharmacists. This paper provides full details of the repertoire of skills and sub-skills identified as being the core communicative elements of practice. The results of this research will have relevance for health professionals and behavioural scientists, and will also contribute to the assurance of quality within the field of community pharmacy practice.

Adult↗
PubMed2000

Alzheimer's disease and other dementias. Implications for physician communication.

This article addresses the importance of language, speech, and communication accommodations between the physician and the patient with dementia. Following a brief summary of common profiles of speech, language, and communication in several different types of dementia, the authors discuss key elements based on a comprehensive model of communication enhancement for individuals with dementia. The primary emphasis of this article is that physicians must select individually tailored communication strategies drawn from a sound knowledge of patients' skills. More importantly, the article stresses that communication is not just the exchange of information, but communication includes components that help establish mutual respect and maintain patients' self-identity and autonomy.

Aged↗
PubMed1999

Evaluation of communication surrounding the implementation of the resident assessment instrument.

Two outcomes of the introduction of the Resident Assessment Instrument at Sunnybrook Health Sciences Centre in 1996 were (1) a communication plan and (2) patient unit RAI communication centres. This article describes a survey that was used to evaluate the effectiveness of the plan and centres in implementing the RAI Staff identified the InfoRAInbow Newsletter as the most useful communication strategy. Satisfaction with communication about the RAI implementation was only 57 percent. Further investigation of this level of satisfaction is required. This result may be attributed to the "choices" staff make as to whether or not to read information, or to environmental factors that occurred at the time of the survey's completion. Future directions for improving the RAI Communication Plan should focus on environmental factors that may impede communication of information, especially information that affects integration of the RAI into the clinical care system.

Canada↗
PubMed2003

The role of mother-daughter sexual risk communication in reducing sexual risk behaviors among urban adolescent females: a prospective study.

PURPOSE: To prospectively examine the relationship between mother-daughter communication about sex and selected sexual risk behaviors among inner-city adolescent females. METHODS: Participants were 219 sexually experienced females, 12 to 19 years of age, recruited from an inner-city adolescent medicine clinic in Philadelphia, PA, and randomly assigned to the control group of an HIV-risk reduction intervention study. Analyses were limited to data from control group participants to avoid confounding intervention effects. Poisson regression was employed to model three self-reported sexual risk behaviors: number of male sexual partners, number of episodes of sexual intercourse, and number of episodes of unprotected intercourse. Mediation effects were evaluated using variables from the Theory of Planned Behavior. Data were analyzed using Poisson regression. RESULTS: Higher levels of mother-daughter sexual risk communication were associated with fewer episodes of sexual intercourse and unprotected intercourse at 3-month follow-up. There was evidence that the relationship of communication to unprotected intercourse was mediated by condom use self-efficacy. Mother-daughter sexual risk communication was not significantly associated with adolescents' reports of numbers of male sexual partner. CONCLUSIONS: This prospective study supports the notion that mothers who communicate with their daughters about sex can affect their daughters' sexual behaviors in positive ways. These findings lend support for the design and implementation of family-based approaches to improve parent-adolescent sexual risk communication as one means of reducing HIV-related sexual risk behaviors among inner-city adolescent females.

Adolescent↗
PubMedDate not supplied

Doctor's responses to patients' concerns; an exploration of communication sequences in gynaecology.

AIMS: Like other medical doctors, gynaecologists have difficulty attending to psychosocial issues and concerns. Communication training has proven to be effective in teaching them to spend more time on discussing these factors. However, whether or not they do this in response to patients' utterances remains unclear. The question is how gynaecologists respond to patients' concerns, whether or not they do this adequately and what the effects of a communication training are on the use of these communication sequences. METHODS: Nineteen gynaecologists participated in a study which examined the effects of a three-day residential communication training. Before and after the training the gynaecologists videotaped series of consecutive outpatient visits. The communication during these visits was rated using the Roter Interaction Analysis System. Gynaecologists' responses to patients' concerns were examined at lag one, i.e. immediately following the patient's concern. RESULTS: The most prevalent responses made by the gynaecologists were showing agreement and understanding and giving medical information. Affective responses were observed less. At postmeasurement, the gynaecologists responded neither more adequately nor inadequately to patients' concerns. CONCLUSIONS: The gynaecologists did not respond in a very affective way to patients' concerns. However, the patients did not express many concerns. Future studies should focus on more prevalent communication behaviours and incorporate more lags.

Attitude to Health↗
PubMed2001

Physiological levels of melatonin enhance gap junction communication in primary cultures of mouse hepatocytes.

Gap junction communication is known to be involved in controlling cell proliferation and differentiation, and seems to play a crucial role in suppression of tumor promotion. Melatonin, a hormone secreted by the pineal gland, has putative oncostatic properties. Intercellular communication through gap junctions was assessed by microinjecting Lucifer yellow fluorescent dye into primary hepatocytes and visualizing the spread of the dye to adjacent neighboring cells using phase contrast/fluorescent microscopy. Treatment of primary hepatocyte cultures with a physiological range of melatonin concentrations for 24 h prior to microinjection resulted in significant enhancement in intercellular communication at 0.2 and 0.4 nmol/L but not at lower (0.1 nmol/L) or higher (0.8 or 1.0 nmol/L) concentrations. A time-dependent study showed that the changes in intercellular communication began 10 h after melatonin treatment and reached a maximum at 12 h of treatment. This nonlinear, functional gap junction response to melatonin occurred in the physiological concentration range detected in blood of mammals during nightly releases of the hormone by the pineal gland. These melatonin levels may affect the ability of gap junction communication to exert cell growth control in vivo. The uneven decline between individuals in nocturnal release of melatonin that occurs with age could identify potentially sensitive subpopulations susceptible to developing pathologies involving alterations in biological processes dependent on gap junction communication.

Analysis of Variance↗
PubMed2002

Developmental changes in mother-infant face-to-face communication: birth to 3 months.

This study documented the growth of the earliest form of face-to-face communication in 16 mother-infant dyads, videotaped weekly during a naturalistic face-to-face interaction, between 1 and 14 weeks, in 2 conditions: with the infant in the mother's arms and with the infant semi-reclined on a sofa. Results showed a curvilinear development of early face-to-face communication, with a significant increase occurring between Week 4 and Week 9 depending on the dyad. After 2 months, trajectories diverged into 2 groups: I whose duration of face-to-face communication continued to increase and I whose duration peaked and then began to decrease. After the 1st month, the duration of face-to-face communication was significantly longer when the infant was on the sofa rather than in the mother's arms. In the latter condition, during the 3rd month, girls spent a significantly longer time than boys in face-to-face communication. These findings suggest that context (infant being held vs. not being held) interacts with the infant's age and sex in affecting mother-infant communication.

Adult↗
PubMed1985

Emotional communication in close relationships.

Emotional communication patterns characterizing interactions between partners in close relationships were investigated by asking 29 couples who were married or living together to engage in a videotaped discussion of a problem they were having in their relationship. In a later experimental session, partners identified specific communications that they believed had an important influence on the discussion and then rated the communications in terms of the feelings the communicator intended to convey and the recipient's reactions. Partners attempted to reciprocate both the positive and negative feelings that they perceived their partner to express toward them. However, only negative feelings were actually reciprocated. This was because subjects were sensitive to differences in the negative feelings their partners reported expressing and interpreted those feelings correctly, but they were inaccurate in perceiving their partners' expressions of positive feelings. Men (but not women) interpreted their partners' failures to express love as an indication of hostility, whereas women (but not men) interpreted their partners' lack of hostility as an indication of love. These and other results were conceptualized in terms of a general model of emotional communication. Parameters of the model pertaining to the hostility of partners' communications were often related to women's satisfaction with their relationship and their beliefs about relationships in general. However, they were unrelated to men's satisfaction and general beliefs. This suggested that women are generally more adversely affected by overt expression of hostility than are men.

Adolescent↗
PubMed1997

Effects of communication, information overlap, and behavioral consistency on consensus in social perception.

Three experiments (N = 69, 162, and 201, respectively) were conducted to test the mathematically derived predictions of the Weighted Average Model (D. A. Kenny, 1991) of consensus in interpersonal perception. Study 1 estimated the effect of perceiver communication. Study 2 estimated the effects of communication and stimulus overlap, and Study 3 estimated the effects of communication, overlap, and target consistency on consensus. The strongest consensus was found when perceivers communicated about highly overlapping information about targets who were cross-situationally consistent. Conversely, the lowest level of consensus was observed when perceivers did not communicate and had nonoverlapping information about targets who were cross-situationally inconsistent. Both stimulus variables (overlap and consistency) and an interpersonal variable (communication) affected consensus as predicted by the Weighted Average Model.

Adolescent↗
PubMed1986

Relationship of physicians' nonverbal communication skill to patient satisfaction, appointment noncompliance, and physician workload.

A field study of 28 residents in family practice was conducted. Physicians' self-reports of empathy, self-monitoring ability, and affective communication skill as well as their objectively measured nonverbal communication skills were examined as predictors of patient satisfaction, appointment noncompliance, and physician workload (schedule density). Physicians completed the Hogan Empathy Scale, Snyder Self-Monitoring Scale, Affective Communication Test, short form of the Profile of Nonverbal Sensitivity, and a nonverbal encoding task. Patient satisfaction with communication, affective care, and technical care was assessed using a 25-item, visit-specific satisfaction scale. Appointment records were used to determine the number of patients seen by each physician and the compliance of patients with scheduled appointments. Results indicated that the three self-report measures were unrelated to the measures of patient noncompliance and patient satisfaction, but self-reported affective communication ability was significantly correlated with physician workload. Objectively measured physician sensitivity to audio communication predicted patient compliance: More sensitive physicians experienced fewer unrescheduled appointment cancellations. Nonverbal encoding skill was significantly related to patient satisfaction with affective care and to physician workload.

Adult↗
PubMed2002

Computer-assisted communication and team decision-making performance: the moderating effect of openness to experience.

This study examined the effects of computer-assisted communication on team decision-making performance as a function of the team's openness to experience. Seventy-nine teams performing a multiple-cue probability learning task were randomly assigned to 1 of 2 experimental conditions: (a) verbal communication or (b) computer-assisted communication (which combined verbal and computerized communication). The results indicated that access to computer-assisted communication improved the decision-making performance of teams, but only when the teams were high in openness to experience. This effect was observed using both global openness and more specific openness facets, as well as a variety of team-level aggregation strategies. Moreover, the beneficial effects of openness in computer-assisted conditions were mediated by the efficiency with which teams integrated verbal and computerized forms of communication.

Adult↗