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PubMed1988

Retest stability of the communication profile for the hearing impaired.

Retest stability of the Communication Profile for the Hearing Impaired (CPHI) was assessed in a sample of 101 active-duty military personnel who attended the Aural Rehabilitation Program at Walter Reed Army Medical Center. Pretests were administered by referring audiologists; retests were administered from 6 to 40 weeks later, at the beginning of the rehabilitation program. Mean scores on 5 of the 25 scales of the CPHI decreased significantly (p less than 0.01) over time, but the changes were small in magnitude (approximately -0.20). Distributions of retest-test differences were used to establish criteria for inferring significant improvement in scores over time. Retest correlations for scales in the communication environment, communication strategies, and personal adjustment areas ranged from 0.58 to 0.78. Communication performance and communication importance were less stable (r = 0.28 to 0.54). Retest correlations were comparable for short versus long retest intervals, but varied as a function of military rank. Implications of the results for clinical use of the CPHI are discussed.

Adaptation, Psychological↗
PubMed1990

A critical reevaluation of the Quantified Denver Scale of Communication Function.

The Quantified Denver Scale of Communication Function (QDS) is a 25 item questionnaire developed to measure communication difficulties in adults with hearing impairment. This study reassessed the constructs, reliability, and validity of the scale, and developed a 5 item short version. The QDS was administered to 238 elderly individuals (137 with and 101 without hearing loss). Factor analysis using this sample identified only two subscale constructs as opposed to four originally proposed constructs. The validity of the new revised two-construct model was verified by four independent investigators who labeled the two constructs as measuring self isolation and communication function. The internal reliability of the revised scale was 0.97 and of both construct subscales was 0.95. Overall test-retest reliability was 0.73. Validity examined by comparing the revised scale with another well-known handicap measure, the Hearing Handicap Inventory for the Elderly, was adequate: overall scale correlations were 0.73 and subscale correlations ranged from 0.64 to 0.72. The accuracy of the revised QDS for discriminating between individuals with and without hearing loss was 73%. Stepwise discriminant analysis generated a 5 item short version scale which contained two questions from the long communication subscale and three from the long self-isolation subscale. The accuracy of the short QDS was 74%. We conclude that the revised QDS is a reliable and valid scale that can be used to assess self isolation and communication function in elderly individuals with hearing loss, and that a new 5 item short version performs as well as the original 25 item scale.

Aged↗
PubMed1997

Fundamentals for establishing a risk communication program.

This paper provides a suggested outline for developing a risk communication organizational plan that could be used by a variety of federal, state, or private agencies. Drawing on various techniques presented in the literature and on the authors' insights, suggestions are provided as to how to formulate and convey risk messages. First, the paper provides a few risk communication fundamentals including definitions, the goal of informing vs. influencing, the importance of public participation in risk management, building trust and credibility, the consideration of outrage, and the importance of oral and visual communications. Second, a stepwise approach synthesized by the authors is presented that can be applied in developing a risk communication program. The approach is a 13-step method based on the premise that the risk communication program should be dynamic, flexible, and involve interaction with the public at every possible step.

Communication↗
PubMed2006

Early language and communication development of infants later diagnosed with autism spectrum disorder.

It is well recognized that delayed "first words" is among the most common presenting symptoms of autistic spectrum disorders (ASD). However, data on earlier language and communication development in children with ASD are limited to retrospective reports from parents and from home videos. In this study, we prospectively collected parent report data on early communication and language development in 97 infant siblings of children with ASD and 49 low-risk controls. Parents completed the MacArthur Communicative Development Inventory--Infant Form at 12 and 18 months. Analysis compared 3 groups defined on the basis of diagnostic assessment at 24 months: (1) siblings with ASD (n = 15), (2) siblings not meeting diagnostic criteria for ASD (n = 82), and (3) low-risk controls, none of whom had ASD (n = 49). Children with ASD showed delays in early language and communication compared with non-ASD siblings and controls. At 12 months, the ASD group was reported to understand significantly fewer phrases and to produce fewer gestures. At 18 months, they showed delays in their understanding of phrases, comprehension and production of single words, and use of gestures. Siblings not diagnosed with ASD also used fewer play-related gestures at 18 months than low-risk controls, even when children with identified language delays were excluded. Overall, this prospective study confirms that delays in communication and language development are apparent early in life in children with ASD, and emphasizes that developmental surveillance should include monitoring for delays in gesture, which may be among the earliest signs of ASD.

Autistic Disorder↗
PubMed1998

Interdisciplinary collaboration and discharge planning communication for elders.

The effects of personal characteristics and perceptions of interdisciplinary collaboration on discharge planning communication were examined for nurses, physicians, and social workers in two hospitals. The model for the study explained 61.7% of the variance in discharge planning communication for nurses. For all 142 health professionals, communication openness with social workers, problem solving between nurses and physicians, and collaboration with social workers were important to discharge planning communication. For nurses, communication satisfaction with patients and families also was important.

Adult↗
PubMed1993

Physician frustration in communicating with patients.

In this study, the nature of practicing physicians' "frustrating" visits was explored and a guide to help physicians identify problems in communicating with patients was developed. The study included 1,076 practicing physicians who attended a voluntary workshop on physician-patient communication. The physicians were from multiple specialties and diverse work settings geographically dispersed throughout the United States. The method included development of a preliminary item pool (descriptions of frustrating patients and occasions) by experienced physicians and teachers of medical communication, additions/deletions/revisions of items within the pool, empirical analyses to reduce redundancy and group-like items, and construct validation of the final 25-item questionnaire. Factor analysis was used to identify subscales. Physicians most often attributed communication problems to the patient rather than to their own limitations. Seven types of communication problems (subscales) were identified, including: 1) lack of trust/agreement, 2) too many problems, 3) feeling distressed, 4) lack of understanding, 5) lack of adherence, 6) demanding/controlling patient, and 7) special problems. Primary care physicians reported greater problems than specialists on four subscales. Physicians practicing in health maintenance organizations reported greater problems than physicians in fee-for-service practice on five subscales. Seven sources of frustration physicians experience in their work with patients were identified. Understanding these frustrations will allow physicians to reflect on their own experiences and potentially improve the quality of their patient visits.

Adult↗
PubMed1996

Patient-doctor communication in cross-national perspective. A study in Mexico.

The authors assessed the cross-national replicability previously used to study medical encounters in the United States by adapting them to Mexico. The main research questions focused on information-giving, gender and social class differences in communication, and attention to socioemotional concerns in primary encounters. Sixty-two primary care encounters were audiotaped. Questionnaires were translated into Spanish, then translated back into English. Coding and transcription techniques were taught to Spanish-speaking researchers. Measures of communication were treated as dependent variables and were related by nonparametric statistical analyses to characteristics of physicians, patients, and clinical settings. Doctors in Mexico spent an average of 2.1 minutes (+/- 1.7 standard deviation [SD]), or 16.7% (+/- 10.7 SD) of total interaction time, in information-giving. Mexican doctors asked an average of 27.3 questions per encounter (+/- 18.0 SD), whereas patients asked an average of 1.5 questions (+/- 2.0 SD). Substantial interphysician variability was observed in total time of interaction (Kruskal-Wallis analysis of variance, chi-square = 27.2, P = 0.000), physician time in information giving (chi-square = 16.4, P = 0.022), and physician questions (chi-square = 36.7, P = 0.000). Patient characteristics associated with physician information-giving included male gender (chi-square = 4.1, P = 0.04) and age (Kendall's tau-b = .17, P = 0.05) but not education (tau-b = .08, P = 0.41). Information-giving in public clinics did not differ from that in private practices (chi-square = 0.0, P = 0.91). A bootstrap approach to multiple nonlinear regression permitted additional analysis of physicians', patients', and situational characteristics in explaining measures of patient-doctor communication; this analysis further demonstrated the importance of interphysician variability in communicative behavior. Previous methods for studying patient-doctor communication can be adapted and replicated in a non-English-speaking society. With certain exceptions, findings from Mexico were similar to those obtained in the United States.

Adult↗
PubMed2002

Racial differences in how patients perceive physician communication regarding cardiac testing.

OBJECTIVES: Recent studies documenting racial variation in the use of cardiac procedures highlight the need to understand if there are racial differences in processes of communication and decision making. Investigations of patients' perceptions of their interaction with providers regarding cardiac testing were conducted. METHODS: Four focus groups were convened with 13 patients who had undergone cardiac stress testing with positive results, stratified by race (white vs. black). Verbatim transcripts of discussions of their interactions with providers relating to their cardiac problems were analyzed qualitatively by a team of behavioral scientists and general internists to identify significant dimensions of communication and patient-provider relationships. RESULTS: Four domains of communication were identified that appeared to bear on patients' comfort and preferences regarding cardiac procedures. First, the substance of the information that was provided by physicians and other providers was described as incomplete, vague, ambiguous, and unclear. Second, some recommendations either were inconsistent with expectations or awakened fears based on distressing previous experiences. Third, patients said they needed to be convinced of the need for additional, invasive tests and therapeutic procedures, and in some cases providers' arguments failed in this regard. Fourth, the patients highlighted the importance of trusting their provider. Although there were no apparent differences by race in patients' perception of the information they received, black patients consistently expressed a preference for building a relationship with physicians (trust) before agreeing to an invasive cardiac procedure, and just as consistently complained that trust was lacking. Conversely, white patients tended to emphasize that they were inadequately convinced of the need for recommended procedures. CONCLUSIONS: This study provided qualitative information regarding patients' perceptions of physician-patient communication and racial differences in such perceptions. For both black and white patients, we found problematic aspects of the patients' experiences regarding communication about cardiac testing. Our findings suggest that although patients desire clarity from physicians, they are often confused regarding the information received. Both a lack of substance and vagueness of the information received may be linked to feelings of mistrust toward physicians when considering further diagnostic testing. Mistrust may be a source of some of the documented racial variation in health care utilization.

Black or African American↗
PubMedDate not supplied

Supportive communication with implantable cardioverter defibrillator patients: seven principles to facilitate psychosocial adjustment.

METHODS: This article incorporates known findings from the psychological literature regarding health behaviors and adjustment to cardiac illness with identified psychosocial needs of implantable cardioverter defibrillator (ICD) patients. An emphasis is placed on healthcare providers' unique ability to facilitate adjustment during routine patient contacts. RESULTS: Seven principles of supportive communication are presented to enhance healthcare providers' awareness of the psychosocial needs of ICD patients. A table of "quotes" representing each principle is provided to show how each form of supportive communication may be delivered to optimize health outcomes for ICD patients. CONCLUSIONS: Brief, routine communication between healthcare providers and ICD patients about psychosocial issues can facilitate patient adjustment. Although not sufficient to meet the needs of all ICD patients, supportive communication bolsters problem-solving and coping strategies of most ICD patients. For patients with more severe psychological adjustment difficulties, supportive communication may lead to better identification of patients who would benefit from referrals to mental health professionals.

Communication↗
PubMed1984

Interpersonal competence and communication in the delivery of nursing care.

Despite the importance generally attributed to communication in nursing, little systematic attention has been directed toward exploring the interface between communication and the delivery of nursing care. The primary factors that have tended to impede research have been the inability of emerging models of nursing to conceptualize communication from an adequate perspective and level and the lack of theoretic exemplars for guiding specific lines of investigation. This article suggests that one potential exemplar for guiding nursing communication research lies in the area of interpersonal competence. It is suggested that research can be profitably aimed at understanding how the social cognitive and communicative abilities of nurses interrelate with the sociocultural context in health care to influence interpersonal competence.

Adult↗
PubMed2006

Improving education on doctor-patient relationships and communication: lessons from doctors who become patients.

PURPOSE: Medical education faces challenges in training empathetic doctors who have good patient communication skills. The author aimed to understand insights that doctors who become patients may gain concerning ways to improve doctor-patient relationships and communication in order to improve medical education. METHOD: From 1999 to 2002, based in New York, the author conducted two in-depth, semistructured, two-hour interviews with each of 50 doctors who had serious illnesses concerning their overlapping experiences of being health care workers and becoming patients. Interviews examined their views about these issues and how their perspectives changed as a result of patienthood. RESULTS: These doctor-patients questioned whether and to what degree empathy could be taught, but nonetheless provided several techniques for improving communication with patients related to process and content of care. Processes included charting at the bedside rather than at the nursing station, acknowledging having kept patients waiting, and increasing awareness of nonverbal aspects of care. Content issues included communicating directly about taboo topics and being more sensitive in discussing "bad news," adherence, and nonmedical concerns. CONCLUSIONS: Doctors reported increased sensitivity to patients' experiences and empathy in doctor-patient communication. These findings can help in teaching doctors to see more clearly that their specific point of view differs from that of patients, and can be limiting. This study also sheds light on the wide separation between intellectual and experiential learning, which needs to be addressed further in medical education and research.

Adult↗
PubMed2005

Communication in palliative care: a review of recent literature.

PURPOSE OF REVIEW: The quality of communication with patients, family, and team members is an extremely important element in palliative cancer care. The current paper reviews the literature on these topics as published in 2004. RECENT FINDINGS: Trust was found to be a major factor for relationship building. Information gathered by patient self-report is the method of choice, given improved insight in symptom prevalence, duration, frequency, and interference. Cultural factors in information giving, the optimal process and content, and the difficulty of conveying hope were addressed. Decision making in palliative care requires a complex integration of conceptual knowledge, ethical and legal implications, and communication skills. Aspects of manageability are explored. Although health care providers must communicate about emotions, the existential distress of cancer patients and carers often goes overlooked in the last phases of life. SUMMARY: Themes included the education of health care providers, the need to care for carers, and interdisciplinary communication. Little attention was given to the growing population of elderly patients. Observer-based studies are unfortunately scarce, making the practice of palliative communication unseen. Finally, few studies report the cost-effectiveness of palliative care interventions though such studies may enhance palliative care and convince policy makers of the need to support such care. More empirical work is needed to improve the level of quality needed to ensure a good remaining lifetime for cancer patients whose disease cannot be cured.

Communication↗
PubMed2005

Patient-physician communication in oncology: past, present, and future.

PURPOSE OF REVIEW: Contemporary oncology practice acknowledges the importance of partnering with the patient and family in dealing with the illness. Patients also value their physicians as important sources of support when they provide information about the illness, encouragement, and hope, discuss treatment options, and address their concerns. For this reason outcomes associated with the quality of the physician-patient relationship have received increasing recognition. This review highlights relevant studies bearing on important outcomes of communication with the cancer patient and discusses the implication for training oncologists of the future. RECENT FINDINGS: Evidence is mounting that effective and empathic communication with the cancer patient and family can influence desirable outcomes in cancer care, which affect patient quality of life, satisfaction with care, and medical outcomes. Evidence also exists that communication and interpersonal skills can be taught and learned. Oncology training programs traditionally do not offer experience in this aspect of care although communication skills have now been defined as a core competency for oncology trainees. Finding motivated faculty to teach and providing time and structure in the curriculum are also major obstacles to be overcome. SUMMARY: Communication skills are the cornerstone of comprehensive cancer care. Learning this aspect of patient care can expand the supportive role of the oncologist especially at crucial times for the patient and family such as diagnosis, disease recurrence, and transition to palliative care.

Communication↗
PubMed2003

Doctor-patient communication: results of a four-year prospective study in rectal cancer patients.

PURPOSE: The purpose of the study was to examine the effect of communication on rectal cancer patients' quality of life over four years. Previous studies have either used short follow-up periods or examined only certain aspects of quality of life, such as anxiety and depression. METHODS: In a prospective, observational study, rectal cancer patients, recruited by clinicians over a two-year period, were sent questionnaires over four years. The clinical details of these patients were recorded by the Munich Cancer Registry. The psychological scores from the European Organization for Research and Treatment of Cancer QLQ-C30 and CR38 were the main outcome variables. RESULTS: Thirty-nine percent of the sample reported that some aspect of the communication they received was unclear (incomprehensible or too little). More than 60 percent wished to speak more with their physician. Younger patients and those in larger hospitals were more likely to report unclear communication (P < 0.05). Analyses of covariance, controlled for age, gender, adjuvant therapy, stoma, education, clinic, and comorbidity, demonstrated that role, emotional, and social functioning scores were consistently lower in patients reporting unclear communication. Additionally, these patients experienced more problems sleeping, poorer body image, more financial worries, and a worse future perspective. Repeated measures analyses indicated that sleeping problems and emotional and social functioning difficulties persisted for at least three years. CONCLUSION: Reports of unclear communication were associated with poorer quality of life in rectal cancer patients without disease progression.

Adult↗
PubMed2006

Risk communication in completed series of breast cancer genetic counseling visits.

PURPOSE: There is no consensus on how best to communicate risk in breast cancer genetic counseling. We studied risk communication in completed series of counseling visits and assessed associations with counselees' postcounseling risk perception and satisfaction. METHODS: Pre- and postcounseling questionnaires and videorecordings of all visits were available for 51 affected and unaffected women from families with no known BRCA1/2 mutation, who fulfilled criteria for DNA testing. We developed a checklist for assessing risk communication and counselors' behaviors. RESULTS: General risks were mainly communicated in initial visits, while counselee-specific risks were discussed mainly in concluding visits. The risks discussed most often were conveyed only numerically or qualitatively, and most were only stated positively or negatively. Counselors regularly helped counselees to understand the information, but seldom built on counselees' pre-existing perspective. Counselees' breast cancer risk perception after counseling was unrelated to whether this risk had been explicitly stated. The number of general risks discussed was negatively associated with counselees' satisfaction about counseling. CONCLUSION: Findings suggest that counselors' authority prevails over mutuality with individual counselees, in their communication about risks.

Adolescent↗
PubMed2005

Therapists' communication styles and parents' global trust in the therapists: a comparison between Jewish and Bedouin parents.

PURPOSE: This study was designed to examine the level of global trust in therapists for two groups of Israeli parents, Jews and Bedouin, and to assess which of three interpersonal communication styles significantly explain global trust in the therapists. METHODS: A total of 193 parents of children ranging from six months to six years of age participated in this study. Parents' perceptions regarding their communication with the center's therapists were measured by 15 items clustered into three dimensions of communication: caring, collaboration, and interest. RESULTS: Parents of both cultural groups expressed high levels of global trust in the center's therapists. Jewish parents trusted their children's therapists significantly more than their Bedouin counterparts and ranked the therapists' caring and collaboration more highly. The communication style of caring was found to be the sole contributor to the variability in global trust. CONCLUSIONS: Effort should be undertaken to develop effective communication styles for the dimension of caring to increase therapists' ability to promote global trust in their patients' parents.

Adult↗
PubMed2003

A private ultraviolet channel in visual communication.

Although private communication is considered an important diversifying force in evolution, there is little direct behavioural evidence to support this notion. Here, we show that ultraviolet (UV) signalling in northern swordtails (Xiphophorus) affords a channel for communication that is not accessible to their major predator, Astyanax mexicanus, the Mexican tetra. Laboratory and field behavioural experiments with swordtails (X. nigrensis) and predators (A. mexicanus) demonstrate that male UV ornamentation significantly increases their attractiveness to females but not to this predator, which is less sensitive to UV. UV reflectance among swordtail species correlates positively with tetra densities across habitats, and visual contrast estimates suggest that UV signals are highly conspicuous to swordtails in their natural environment. Cross-species comparisons also support the hypothesis that natural selection drives the use of UV communication. We compared two species, one with high (X. nigrensis) and one with low (X. malinche) Mexican tetra densities. Xiphophorus nigrensis males reflect significantly more UV than X. malinche, exhibit significant UV sexual dimorphism, and UV is a salient component of the sexual communication system. In X. malinche, however, males reflect minimally in the UV, there is no UV sexual dimorphism, and UV does not play a part in its communication system.

Animal Communication↗
PubMed2004

The disadvantage of combinatorial communication.

Combinatorial communication allows rapid and efficient transfer of detailed information, yet combinatorial communication is used by few, if any, non-human species. To complement recent studies illustrating the advantages of combinatorial communication, we highlight a critical disadvantage. We use the concept of information value to show that deception poses a greater and qualitatively different threat to combinatorial signalling than to non-combinatorial systems. This additional potential for deception may represent a strategic barrier that has prevented widespread evolution of combinatorial communication. Our approach has the additional benefit of drawing clear distinctions among several types of deception that can occur in communication systems.

Animal Communication↗