Characterizing the impact of verbal communication and health literacy in the patient-surgeon encounter

Rainey, R.; Theiss, Lauren; Lopez, Elizabeth; Wood, Tara; Wood, Lauren N.; Marques, Isabel; Cannon, Jamie A.; Kennedy, Gregory D.; Hollis, Robert H.; Davis, Terry C.; Chu, Daniel I.

doi:10.1016/j.amjsurg.2022.04.034

Cited by 5 publications

(5 citation statements)

References 18 publications

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“…Patients receive similar written information regarding ERPs during their preoperative visit, but verbal communication can vary by provider. 29 We did see differences in component adherence rates among surgeons. However, we controlled for this in the regression analysis and included surgeons in the classification trees to account for these differences.…”

Section: Discussionmentioning

confidence: 73%

Preoperative Education is Associated with Adherence to Downstream Components and Outcomes in a Colorectal Surgery Enhanced Recovery Program

Jones,

Richman,

Rubyan

et al. 2024

Annals of Surgery Open

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Objective: This study evaluated the association between preoperative education and adherence to downstream components of enhanced recovery programs (ERPs) and surgical outcomes among patients undergoing elective colorectal surgery. Background: ERPs improve outcomes for surgical patients. While preoperative education is an essential component of ERPs, its relationship with other components is unclear. Methods: This was a retrospective cohort study of all ERP patients undergoing elective colorectal surgery from 2019 to 2022. Our institutional ERP database was linked with American College of Surgeons National Surgical Quality Improvement Program data and stratified by adherence to preoperative education. Primary outcomes included adherence to individual ERP components and secondary outcomes included high-level ERP adherence (>70% of components), length of stay (LOS), readmissions, and 30-day complications. Results: A total of 997 patients were included. The mean (SD) age was 56.5 (15.8) years, 686 (57.3%) were female, and 717 (71.9%) were white. On adjusted analysis, patients who received preoperative education (n = 877, 88%) had higher adherence rates for the following ERP components: no prolonged fasting (estimate = +19.6%; P < 0.001), preoperative blocks (+8.0%; P = 0.02), preoperative multimodal analgesia (+18.0%; P < 0.001), early regular diet (+15.9%; P < 0.001), and postoperative multimodal analgesia (+6.4%; P < 0.001). High-level ERP adherence was 13.4% higher (P < 0.01) and LOS was 2.0 days shorter (P < 0.001) for those who received preoperative education. Classification and regression tree analysis identified preoperative education as the first-level predictor for adherence to early regular diet, the second-level predictor for LOS, and the third-level predictor for ERP high-level adherence. Conclusion: Preoperative education is associated with adherence to ERP components and improved surgical outcomes.

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Section: Discussionmentioning

confidence: 73%

Preoperative Education is Associated with Adherence to Downstream Components and Outcomes in a Colorectal Surgery Enhanced Recovery Program

Jones,

Richman,

Rubyan

et al. 2024

Annals of Surgery Open

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“…The compression-restoration paradigm could be seen as modeling communication in real-world discourse where speech is often rapid and presented without interruption, potentially overloading the listener. In this regard, there is increasing interest in the medical literature on the detrimental effect of rapid speech on healthcare providers’ communication with patients, and especially for communication with patients unfamiliar with medical terms and procedures (Rainey et al, 2022). One would expect such effects to be exacerbated when dealing with individuals with hearing loss, or as in the present case, those who hear using a cochlear implant.…”

Section: Discussionmentioning

confidence: 99%

Strategic Pauses Relieve Listeners from the Effort of Listening to Fast Speech: Data Limited and Resource Limited Processes in Narrative Recall by Adult Users of Cochlear Implants

O’Leary,

Neukam,

Hansen

et al. 2023

Trends in Hearing

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Speech that has been artificially accelerated through time compression produces a notable deficit in recall of the speech content. This is especially so for adults with cochlear implants (CI). At the perceptual level, this deficit may be due to the sharply degraded CI signal, combined with the reduced richness of compressed speech. At the cognitive level, the rapidity of time-compressed speech can deprive the listener of the ordinarily available processing time present when speech is delivered at a normal speech rate. Two experiments are reported. Experiment 1 was conducted with 27 normal-hearing young adults as a proof-of-concept demonstration that restoring lost processing time by inserting silent pauses at linguistically salient points within a time-compressed narrative (“time-restoration”) returns recall accuracy to a level approximating that for a normal speech rate. Noise vocoder conditions with 10 and 6 channels reduced the effectiveness of time-restoration. Pupil dilation indicated that additional effort was expended by participants while attempting to process the time-compressed narratives, with the effortful demand on resources reduced with time restoration. In Experiment 2, 15 adult CI users tested with the same (unvocoded) materials showed a similar pattern of behavioral and pupillary responses, but with the notable exception that meaningful recovery of recall accuracy with time-restoration was limited to a subgroup of CI users identified by better working memory spans, and better word and sentence recognition scores. Results are discussed in terms of sensory-cognitive interactions in data-limited and resource-limited processes among adult users of cochlear implants.

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“…Rainey et al quantitatively characterized patient-surgeon conversations and noted that faster rates-of-speech were associated with significantly less patient-reported understanding ( p < 0.05). 67 In addition, surgeons spent on average more than twice as long with health literate patients compared with patients with inadequate health literacy (11.80 vs. 5.48 minutes), 67 a finding that may be attributable to patients with inadequate health literacy not being comfortable asking questions during consultations. Providers can address this by asking patients “What questions do you have?” instead of “Do you have any questions?,” and thereby encourage active participation in their surgical decision-making.…”

Section: Ways To Address Low Health Literacy (The Solutions)mentioning

confidence: 99%

Addressing Low Health Literacy in Surgical Populations

English,

Jones,

Chu

2024

Clin Colon Rectal Surg

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Health literacy is defined as the ability to obtain, engage, understand, and act upon health information to make decisions about health care. Health literacy is a key determinant of health outcomes and disparities including those in surgery. Over one-third of surgical patients suffer from low health literacy, with disproportionately higher rates among older, rural, and black patients. Low health literacy has been associated with poor adherence to preoperative and discharge instructions, longer lengths-of-stay, higher readmission rates, and higher health care costs. However, health literacy is modifiable, and therefore it is uniquely positioned for meaningful interventions at the patient, provider, and system level. These interventions include using more visual aids with patients and families (patient level), communicating in more understandable ways (provider level), and improving the organizational health literacy of hospitals (system level). Through high-quality research and multilevel interventions, significant opportunities exist to address low health literacy and improve outcomes, eliminate disparities, and reduce costs for this disparity population.

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Characterizing the impact of verbal communication and health literacy in the patient-surgeon encounter

Cited by 5 publications

References 18 publications

Preoperative Education is Associated with Adherence to Downstream Components and Outcomes in a Colorectal Surgery Enhanced Recovery Program

Preoperative Education is Associated with Adherence to Downstream Components and Outcomes in a Colorectal Surgery Enhanced Recovery Program

Strategic Pauses Relieve Listeners from the Effort of Listening to Fast Speech: Data Limited and Resource Limited Processes in Narrative Recall by Adult Users of Cochlear Implants

Addressing Low Health Literacy in Surgical Populations

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