Who said dialogue conversations are easy? The communication between communication vulnerable people and health‐care professionals: A qualitative study

Abstract

ObjectiveTo gain insight into how communication vulnerable people and health‐care professionals experience the communication in dialogue conversations, and how they adjust their conversation using augmentative and alternative communication (AAC) or other communication strategies.MethodsCommunication vulnerable clients and health‐care professionals in a long‐term care institution were observed during a dialogue conversation (n = 11) and subsequently interviewed (n = 22) about their experiences with the conversation. The clients had various communication difficulties due to different underlying aetiologies, such as acquired brain injury or learning disorder. Results from the observations and interviews were analysed using conventional content analysis.ResultsSeven key themes emerged regarding the experiences of clients and professionals: clients blame themselves for miscommunications; the relevance of both parties preparing the conversation; a quiet and familiar environment benefitting communication; giving clients enough time; the importance and complexity of nonverbal communication; the need to tailor communication to the client; prejudices and inexperience regarding AAC. The observations showed that some professionals had difficulties using appropriate communication strategies and all professionals relied mostly on verbal or nonverbal communication strategies.ConclusionProfessionals were aware of the importance of preparation, sufficient time, a suitable environment and considering nonverbal communication in dialogue conversations. However, they struggled with adequate use of communication strategies, such as verbal communication and AAC. There is a lack of knowledge about AAC, and professionals and clients need to be informed about the potential of AAC and how this can help them achieve equal participation in dialogue conversations in addition to other communication strategies.

The use of PROMs and shared decision‐making in medical encounters with patients: An opportunity to deliver value‐based health care to patients

“…Currently, it may remain unclear for clinicians what type of values need to be discussed in SDM. Asking what treatment patients prefer is different from asking about broad motivation goals in life, and discussion of motivations obviously requires time, especially with patients with low health literacy . However, if patient values remain unexplored and no assistance is provided in preference construction, patients will likely more often agree to treatment they do not actually prefer, leading to silent misdiagnoses and overtreatment …”

“…More attention is also needed for the integration of PROMs in choice talk. This talk about the trade‐offs between patients' values is a core element of both SDM and VBHC's “personal value”, but also known to be difficult to apply . Yet training of professionals in choice talk will probably not provide the magic bullet, given their limited time for the consultation .…”

“…values is a core element of both SDM and VBHC's "personal value", but also known to be difficult to apply. 15 Yet training of professionals in choice talk will probably not provide the magic bullet, given their limited time for the consultation. 13 The use of decision aids as well as patient activation tools (eg, Ask 3 Questions Campaign 90 ) could further enable clinicians practicing choice talk and probably also boost the integration of aggregated PROMs scores.…”

“…Despite being so heavily embraced by scientific scholars and policymakers, formal implementation of SDM in practice has proven to be challenging . One key barrier seems to be the perceived time needed to practice SDM, addressing both risk communication and clarification of patients' values . Although clinicians generally support SDM, they are also often hesitant to practice it and often revert to a more authoritarian conversational model …”

“…3,[7][8][9][10] One key barrier seems to be the perceived time needed to practice SDM, [11][12][13] addressing both risk communication and clarification of patients' values. 12,14,15 Although clinicians generally support SDM, they are also often hesitant to practice it and often revert to a more authoritarian conversational model. 10,[16][17][18] In the Netherlands, the recent emphasis on value-based health care (VBHC) in health policy is thought to provide new opportunities for SDM, especially by using information based on patient-reported outcome measures (PROMs) in routine medical encounters.…”