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At least 1,315 records · Page 73Linked to original sources
PubMed2004

A new social communication intervention for children with autism: pilot randomised controlled treatment study suggesting effectiveness.

BACKGROUND: Psychosocial treatments are the mainstay of management of autism in the UK but there is a notable lack of a systematic evidence base for their effectiveness. Randomised controlled trial (RCT) studies in this area have been rare but are essential because of the developmental heterogeneity of the disorder. We aimed to test a new theoretically based social communication intervention targeting parental communication in a randomised design against routine care alone. METHODS: The intervention was given in addition to existing care and involved regular monthly therapist contact for 6 months with a further 6 months of 2-monthly consolidation sessions. It aimed to educate parents and train them in adapted communication tailored to their child's individual competencies. Twenty-eight children with autism were randomised between this treatment and routine care alone, stratified for age and baseline severity. Outcome was measured at 12 months from commencement of intervention, using standardised instruments. RESULTS: All cases studied met full Autism Diagnostic Interview (ADI) criteria for classical autism. Treatment and controls had similar routine care during the study period and there were no study dropouts after treatment had started. The active treatment group showed significant improvement compared with controls on the primary outcome measure--Autism Diagnostic Observation Schedule (ADOS) total score, particularly in reciprocal social interaction--and on secondary measures of expressive language, communicative initiation and parent-child interaction. Suggestive but non-significant results were found in Vineland Adaptive Behaviour Scales (Communication Sub-domain) and ADOS stereotyped and restricted behaviour domain. CONCLUSIONS: A Randomised Treatment Trial design of this kind in classical autism is feasible and acceptable to patients. This pilot study suggests significant additional treatment benefits following a targeted (but relatively non-intensive) dyadic social communication treatment, when compared with routine care. The study needs replication on larger and independent samples. It should encourage further RCT designs in this area.

Autistic Disorder↗
PubMed2004

Patient-centered communication: do patients really prefer it?

OBJECTIVE: To investigate patient preferences for a patient-centered or a biomedical communication style. DESIGN: Randomized study. SETTING: Urgent care and ambulatory medicine clinics in an academic medical center. PARTICIPANTS: We recruited 250 English-speaking adult patients, excluding patients whose medical illnesses prevented evaluation of the study intervention. INTERVENTION: Participants watched one of three videotaped scenarios of simulated patient-physician discussions of complementary and alternative medicine (CAM). Each participant watched two versions of the scenario (biomedical vs. patient-centered communication style) and completed written and oral questionnaires to assess outcome measurements. MEASUREMENTS AND MAIN RESULTS: Main outcome measures were 1) preferences for a patient-centered versus a biomedical communication style; and 2) predictors of communication style preference. Participants who preferred the patient-centered style (69%; 95% confidence interval [CI], 63 to 75) tended to be younger (82% [51/62] for age < 30; 68% [100/148] for ages 30-59; 55% [21/38] for age > 59; P < .03), more educated (76% [54/71] for postcollege education; 73% [94/128] for some college; 49% [23/47] for high school only; P= .003), use CAM (75% [140/188] vs. 55% [33/60] for nonusers; P= .006), and have a patient-centered physician (88% [74/84] vs. 30% [16/54] for those with a biomedical physician; P < .0001). On multivariate analysis, factors independently associated with preferring the patient-centered style included younger age, use of herbal CAM, having a patient-centered physician, and rating a "doctor's interest in you as a person" as "very important." CONCLUSIONS: Given that a significant proportion of patients prefer a biomedical communication style, practicing physicians and medical educators should strive for flexible approaches to physician-patient communication.

Adult↗
PubMed2005

Teaching medical students the important connection between communication and clinical reasoning.

BACKGROUND: Medical students are rarely taught how to integrate communication and clinical reasoning. Not understanding the relation between these skills may lead students to undervalue the connection between psychosocial and biomedical aspects of patient care. OBJECTIVE: To improve medical students' communication and clinical reasoning and their appreciation of how these skills interrelate in medical practice. DESIGN: In 2003, we conducted a randomized trial of a curricular intervention at Johns Hopkins University School of Medicine. In a 6-week course, participants learned communication and clinical reasoning skills in an integrative fashion using small group exercises with role-play, reflection and feedback through a structured iterative reflective process. PARTICIPANTS: Second-year medical students. MEASUREMENTS: All students interviewed standardized patients who evaluated their communication skills in establishing rapport, data gathering and patient education/counseling on a 5-point scale (1=poor; 5=excellent). We assessed clinical reasoning through the number of correct problems listed and differential diagnoses generated and the Diagnostic Thinking Inventory. Students rated the importance of learning these skills in an integrated fashion. RESULTS: Standardized patients rated curricular students more favorably in establishing rapport (4.1 vs 3.9; P=.05). Curricular participants listed more psychosocial history items on their problem lists (65% of curricular students listing > or =1 item vs 44% of controls; P=.008). Groups did not differ significantly in other communication or clinical reasoning measures. Ninety-five percent of participants rated the integration of these skills as important. CONCLUSIONS: Intervention students performed better in certain communication and clinical reasoning skills. These students recognized the importance of biomedical and psychosocial issues in patient care. Educators may wish to teach the integration of these skills early in medical training.

Clinical Competence↗
PubMed1979

Egocentrism and inefficiency in the communication of families containing schizophrenic members.

Conceptual and methodological shortcomings of research on family and interactional psychopathology are owing mainly to the use of vague and ill-defined concepts of communication. Based on a theory of language use and communication within general social and cognitive psychology (e.g., Heider, Mead, Piaget, Rometvet) Blakar has outlined a methodology by which interaction is analyzed in terms of how and to what extent the participants (families) manage or fail to cope with the various prerequisites for successful communication under varying situational conditions. A study illustrating this program is presented: The interaction of twelve families, six with (Group S) and six without (Group N) a schizophrenic member, is analyzed in Blakar's communication conflict situation with respect to the members' ability to decenter and take the perspective of each other. Group S proved significantly more egocentric, their egocentric attitudes resulting, as would be expected, in very inefficient communication. Moreover, Group S were not able to adapt their pattern of communication to the changing situational requirements. Finally, the subtle interplay between the capacities and behavior of the individual members and the family system is illustrated: the egocentrism of the members resulted in "closed systems," and the closed systems hindered adequate feedback, forcing the members to decenter.

Adolescent↗
PubMed1983

Assessment of perceptual discrepancy: utility of the Primary Communication Inventory.

The Primary Communication Inventory was factor-analyzed in order to validate the subscales of this instrument. These subscales were derived by Navran (20) on the basis of face validity and were labeled verbal and nonverbal communication subscales. The analysis yielded two factors. However, they could not be labeled verbal and nonverbal. Instead, the factors were interpreted as: (a) the individual's perceptions of own communication ability, and (b) the spouse's perceptions of the individual's communication ability. The scoring of the Primary Communication Inventory was revised and used as a measure of perceptual discrepancy between husbands and wives. Interestingly, discrepancy within the marital dyad was greater for the nondistressed participants than for the distressed participants. The results illustrate the potentially adaptive nature of positive perceptual distortion within the marital dyad and the potential utility for future research of calculating perceptual discrepancy scores for each spouse using the Primary Communication Inventory.

Adult↗
PubMed1986

Communication deviances in parents of schizophrenics.

In an attempt to make a multimethod assessment of communication deviance in parents of schizophrenics, a communication conflict situation (CCS) and the TAT were used to obtain qualitative and quantitative measures of communication for a sample of 50 parental couples, 21 of which were parents of schizophrenics, 9 were parents of nonpsychotic psychiatric patients, and 20 were parents of normals. The results were a general confirmation of earlier reports that communication deviance is an outstanding characteristic in families with a schizophrenic offspring. The most important finding, however, was that parents of paranoid and nonparanoid schizophrenics score very differently on a majority of the communication variables. Parents of nonparanoid schizophrenics form one extreme on a continuum of communication deviance, and parents of paranoid schizophrenics and normals the other. Egocentrism, measured by CCS, turned out to be the single qualitative variable with best discriminating power across all groups.

Adult↗
PubMed1993

Competence in children at risk for psychopathology predicted from confirmatory and disconfirmatory family communication.

The relationship between confirmation/disconfirmation in parental and family communication and offspring social competence was examined in 59 families in which at least one of the parents had been hospitalized for a functional psychiatric disorder. Communication samples were obtained using the Consensus Rorschach procedure both with parental couples and with parent-child family units. The communication was analyzed using the Confirmation-Disconfirmation Coding System (CONDIS). The competence at school of 7-and 10-year-old boys was rated by both peers and teachers. Competence at home was rated by the parents. The results indicated that the more competent the high-risk children were, both at school and at home, the more their family communicated in confirmatory ways and the less they communicated in disconfirmatory ways. Furthermore, although the parental couple CONDIS score and the family CONDIS score were modestly correlated, each contributed separately to the prediction of offspring competence. These communication data were not significantly related to parental psychopathology, neither severity of parental impairment nor the diagnosis of the patient-parent.

Adult↗
PubMed2006

Can spouses provide knowledge of each other's communication patterns? A study of self-reports, spouses' reports, and observational coding.

The purposes of this study were (1) to assess individuals' self-reports of communication and their reports about their spouses' communication in order to examine the congruence of spousal views and (2) to investigate whether each report provided unique information about observed marital interactions. These associations were evaluated in a sample of 119 longtime married couples. The Verbal Aggression and Cooperation subscales from the Conflicts and Problem-Solving Scales were used as measures of negative and positive aspects of communication. The findings indicated that self-reports of both verbal aggression and cooperation were strongly associated with the same individual's report of his or her spouse's verbal aggression and cooperation. Conversely, self-reports were only moderately associated with reports made by spouses (e.g., the husband's report of his wife's communication). Hence, within-reporter agreement was higher than between-reporter agreement about marital communication. When entered into regression models, reports made by spouses, but not self-reports, explained unique variance in observations of marital hostility and affection. There was one exception: Wife self-report of verbal aggression explained unique variance in coders' ratings of wife hostility, controlling for husband report of wife verbal aggression. Findings indicate the importance of assessing partners' views of one another's communication for the most accurate portrayal of marital interactions. Implications for research and clinical work are discussed.

Adult↗
PubMed1986

Suicidal communication of persons attempting suicide and responses of significant others.

Forty consecutively admitted suicide attempt patients in an intensive care unit, their therapists, and 70 significant others of 37 of the patients, were investigated by means of 300 semi-structured interviews. The patients belonged to three diagnostic groups: neurosis, alcohol and drug abuse, and prepsychosis/psychosis. Thirty-seven of the patients had communicated their suicidal intentions to people around them. All patients used protracted indirect verbal communication. Immediately before the suicide attempt, most of the neurotics continued often to indirect verbal communication, amplified by demanding behaviour. Drug and alcohol abusers, moreover, also employed direct verbal communication, and prepsychosis/psychosis patients indirect non-verbal communication. The majority of significant others understood the patients' suicidal communication and responded with near-total silence. Ambivalence about continuing the relationship characterised most partners of patients in all diagnostic groups, and also persons other than partners in the abuse group. Ambivalence about helping the patient, and aggression expressed by significant others were most prevalent in the abuse group.

Adult↗
PubMed2001

Effects of perceived patient attributes on dentist communication behavior.

The current study was designed to assess the relationship between dentists' communication behavior and their perception of patient attributes such as likeability, manageability, and prognosis. Six AEGD residents were videotaped, and their verbal and nonverbal communication behavior was analyzed in the manner described. Each resident was administered a 20-item questionnaire to determine his/her perception of patient attributes. For overall dentist nonverbal behavior, perception of the patient and the amount of recognized interruptions that the dentist allowed were significantly correlated (r = 0.28, p < 0.05). When the three dentist perception subcategories--Likeability, Manageability, and Prognosis--were analyzed, verbal and nonverbal communication leads were significantly correlated with the dentists' perceptions of patient attributes in each. The hypothesis of a relationship between patient communication behavior and the dentists' perceptions of patient attributes was supported. The results suggest that dentists alter their communication behavior depending on their assessment of various patient qualities. Whether training in interviewing techniques and communication behavior would have an effect on this process is unknown and should be addressed.

Attitude of Health Personnel↗
PubMed1981

Visual communication and the content and style of conversation.

Previous research suggests that visual communication plays a number of important roles in social interaction. In particular, it appears to influence the content of what people say in discussions, the style of their speech, and the outcomes they reach. However, the findings are based exclusively on comparisons between face-to-face conversations and audio conversations, in which subjects sit in separate rooms and speak over a microphone-headphone intercom which precludes visual communication. Interpretation is difficult, because visual communication is confounded with physical presence, which itself makes available certain cues denied to audio subjects. The purpose of this paper is to report two experiments in which the variables were separated and content and style were re-examined. The first made use of blind subjects, and again compared the face-to-face and audio conditions. The second returned to sighted subjects, and examined four experimental conditions: face-to-face; audio; a curtain condition in which subjects sat in the same room but without visual communication; and a video condition in which they sat in separate rooms and communicated over a television link. Neither visual communication nor physical presence proved to be critical variable. Instead, the two sources of cues combined, such that content and style were influenced by the aggregate of available cues. The more cueless the settings, the more task-oriented, depersonalized and unspontaneous the conversation. The findings also suggested that the primary effect of cuelessness is to influence verbal content, and that its influence on both style and outcome occurs indirectly, through the mediation of content.

Adult↗
PubMed2005

Multichannel time-reversal processing for acoustic communications in a highly reverberant environment.

The development of time-reversal (T/R) communication systems is a recent signal processing research area dominated by applying T/R techniques to communicate in hostile environments. The fundamental concept is based on time-reversing the impulse response or Green's function characterizing the uncertain communications channel to mitigate deleterious dispersion and multipath effects. In this paper, we extend point-to-point to array-to-point communications by first establishing the basic theory to define and solve the underlying multichannel communications problem and then developing various realizations of the resulting T/R receivers. We show that not only do these receivers perform well in a hostile environment, but they also can be implemented with a "1 bit" analog-to-digital converter design structure. We validate these results by performing proof-of-principle acoustic communications experiments in air. It is shown that the resulting T/R receivers are capable of extracting the transmitted coded sequence from noisy microphone array measurements with zero-bit error.

Acoustics↗
PubMed1999

General practice registrar responses to the use of different risk communication tools in simulated consultations: a focus group study.

OBJECTIVES: To pilot the use of a range of complementary risk communication tools in simulated general practice consultations; to gauge the responses of general practitioners in training to these new consultation aids. DESIGN: Qualitative study based on focus group discussions. SETTING: General practice vocational training schemes in South Wales. PARTICIPANTS: 39 general practice registrars and eight course organisers attended four sessions; three simulated patients attended each time. METHOD: Registrars consulting with simulated patients used verbal or "qualitative" descriptions of risks, then numerical data, and finally graphical presentations of the same data. Responses of doctors and patients were explored by semistructured discussions that had been audiotaped for transcription and analysis. RESULTS: The process of using risk communication tools in simulated consultations was acceptable to general practitioner registrars. Providing doctors with information about risks and benefits of treatment options was generally well received. Both doctors and patients found it helped communication. There were concerns about the lack of available, unbiased, and applicable evidence and a shortage of time in the consultation to discuss treatment options adequately. Graphical presentation of information was often favoured-an approach that also has the potential to save consultation time. CONCLUSIONS: A range of risk communication "tools" with which to discuss treatment options is likely to be more applicable than a single new strategy. These tools should include both absolute and relative risk information formats, presented in an unbiased way. Using risk communication tools in simulated consultations provides a model for training in risk communication for professional groups.

Attitude of Health Personnel↗
PubMed1974

Communications between general practitioners and consultants.

During 1972-3 a survey was made of the pattern of communication between 80 consultants in four hospitals in south-east England and 100 general practitioners in the catchment areas of these hospitals. This aimed to identify the factors which affect the efficiency of communication between these two groups and to look for ways of improving this.Face to face contact between consultants and general practitioners was extremely limited. The main communication links were the letters of referral and discharge, but even this form of communication had serious defects. Though most doctors were satisfied with communications in general the evidence suggested ways of improving communication between consultants and general practitioners, such as encouraging domiciliary visits where both doctors are present and consultant sessions in health centres, but that any innovation in this field could only be successful if the attitude of the consultants and general practitioners were in harmony with the new venture.

Communication↗
PubMedDate not supplied

Improving clinical communication: a view from psychology.

Recent research has studied the communication behaviors of clinical hospital workers and observed a tendency for these workers to use communication behaviors that were often inefficient. Workers were observed to favor synchronous forms of communication, such as telephone calls and chance face-to-face meetings with colleagues, even when these channels were not effective. Synchronous communication also contributes to a highly interruptive working environment, increasing the potential for clinical errors to be made. This paper reviews these findings from a cognitive psychological perspective, focusing on current understandings of how human memory functions and on the potential consequences of interruptions on the ability to work effectively. It concludes by discussing possible communication technology interventions that could be introduced to improve the clinical communication environment and suggests directions for future research.

Attitude of Health Personnel↗
PubMed2004

Communication skills training in postgraduate medicine: the development of a new course.

It has long been accepted that communication is of central importance in healthcare, and a core aspect of clinical competence. Many educational institutions and Royal Colleges now reflect this and consider communication skills a priority in postgraduate examination. The new examination "Practical Assessment of Clinical and Examination Skills" has replaced the Royal College of Physicians MRCP part 2 clinical and oral examination. This examination now consists of five clinical stations, two of which focus on communication skills. A short course for postgraduate trainees has been designed to address the communication skills requirements of the part 2 clinical examination. The aims, development, and content of the course are described. Emphasis is placed on candidates practising skills with patients and receiving feedback during the course. Evidence suggests that practice with feedback is an essential ingredient of communication skills courses, and is more effective than other methods such as observing experts or video examples, or simply discussing issues in communication. Results of a preliminary evaluation indicate that the course was perceived as valuable by candidates and that the aims, format, and content were appropriate. Although the preliminary evaluation was largely positive, it could be argued that the acid test of the effectiveness of a course is an objective evaluation of skills, observed before and after the course, a development that is being considered for future evaluation of the course. Recommendations for applying this type of training to postgraduate trainees in any branch of medicine are given.

Clinical Competence↗
PubMed2000

The impact of hearing on communication.

The study was designed to assess the impact of hearing impairment on communication between older hospital patients and medical staff and to see whether intervention to improve hearing influences perceived communication. Structured interviews were held with 200 mentally alert elderly hospital in-patients before and after the introduction of voice amplifiers and acetate cards depicting a hearing problem. Prior to intervention 22% of patients rated communication with their doctor as poor or unsatisfactory. Following intervention there was a significant improvement (Chi-square p=0.006), with only 6% of patients reporting communication with their doctor as poor or unsatisfactory. Most of the patients who felt communication was unsatisfactory could not hear what was being said. We conclude that simple measures can improve the number of older patients hearing what their doctor says and improve their perception of communication with the hospital doctor.

Aged↗
PubMed2005

Communication failures in patient sign-out and suggestions for improvement: a critical incident analysis.

BACKGROUND: The transfer of care for hospitalized patients between inpatient physicians is routinely mediated through written and verbal communication or "sign-out". This study aims to describe how communication failures during this process can lead to patient harm. METHODS: In interviews employing critical incident technique, first year resident physicians (interns) described (1) any adverse events or near misses due to suboptimal preceding patient sign-out; (2) the worst event due to suboptimal sign-out in which they were involved; and (3) suggestions to improve sign-out. All data were analyzed and categorized using the constant comparative method with independent review by three researchers. RESULTS: Twenty six interns caring for 82 patients were interviewed after receiving sign-out from another intern. Twenty five discrete incidents, all the result of communication failures during the preceding patient sign-out, and 21 worst events were described. Inter-rater agreement for categorization was high (kappa 0.78-1.00). Omitted content (such as medications, active problems, pending tests) or failure-prone communication processes (such as lack of face-to-face discussion) emerged as major categories of failed communication. In nearly all cases these failures led to uncertainty during decisions on patient care. Uncertainty may result in inefficient or suboptimal care such as repeat or unnecessary tests. Interns desired thorough but relevant face-to-face verbal sign-outs that reviewed anticipated issues. They preferred legible, accurate, updated, written sign-out sheets that included standard patient content such as code status or active and anticipated medical problems. CONCLUSION: Communication failures during sign-out often lead to uncertainty in decisions on patient care. These may result in inefficient or suboptimal care leading to patient harm.

Chicago↗