Book Description

Individuals with communication disorders form a vulnerable patient population in health care. Their problems with communication in medical interactions can lead to higher rates of medical errors, reduced accessibility to health care, and decreased satisfaction with services when compared with the average patient population. Communication Accommodation Theory (CAT) has recently been used in research to explain communication during medical interactions involving patients with communication disorders. However, this research focuses on dyadic medical interactions between patients and physicians, failing to consider the potential effects that caregivers can have on these interactions. The purpose of this study was to explore the experiences and perspectives of patients with communication disorders, their family caregivers, and physicians related to communication during medical interactions. In addition, this study examines the feasibility of CAT to help explain and predict communication during these medical interactions. A total of 18 individuals - six patients with a primary communication disorder diagnosis of aphasia, six family caregivers, and six practicing physicians - participated in semi-structured, face-to-face interviews. Participants were asked about their experiences with communication during triadic medical interactions. Interviews were audio and/or video recorded and then transcribed. Transcripts were coded and a thematic analysis was conducted. While patients and caregivers generally described their communication experiences as positive, all participants discussed challenges and frustrations they experienced when communicating during medical interactions. Three themes emerged from participants' experiences and perspectives: 1) patients and caregivers work as a team, 2) patients and caregivers want physicians to "just try" to communicate with the patient, and 3) physicians want to try to communicate with the patient, but may not know how. Patients and caregivers provided advice to help physicians improve their communication, and physicians suggested content areas to include in future communication skills training for medical students and practicing physicians. Results of this study suggested that although the participants' experiences were generally positive, the perspectives of patients and caregivers regarding communication during medical interactions seemed to be somewhat misaligned with those of physicians. Patients and caregivers discussed how some physicians seemed to be either unaware when patients were struggling to communicate, or did not to change their communication style to help patients. Physicians, on the other hand, seemed to acknowledge the importance of changing how they communicate to make accommodations for these patients, but discussed not having the education and training to know how. Results of this study also provided support for the use of CAT to represent communication during these medical interactions, and a working model of CAT is proposed. Participants frequently discussed the need for successful accommodation, or changing the way one communicates, during medical interactions to help facilitate the patients' increased understanding and ability to express themselves. However, over- and under-accommodation were commonly reported instead. Finally, results of this study highlighted the importance of speech-language pathologists (SLPs) in helping to improve communication during medical interactions involving patients with communication disorders. Implications for future research and clinical practice for physicians and SLPs are also discussed.