Chapter Outline
Patient-Centered Communication
Health Literacy and Cultural Competency
Interprofessional Communication
“Communication between and among human beings is complex. It occurs at many levels simultaneously. Doctors, allied health professionals, and public health communications experts grapple with how best to reach their audiences most effectively.”
Communication skills are crucial in the effective and efficient delivery of health care. They are needed in order to build trusting relationships, to relay important and critical health information, and to negotiate best plans of care with patient shared decision making that ultimately leads to lifestyle change and treatment adherence. Communication skills are also critical in managing emotionally charged situations such as trauma and end-of-life situations. To maintain and improve a patient’s health and medical care, communication skills are considered one of the most important skills students must learn and master in medicine. Studies have shown that communication has the ability to not only improve patient satisfaction and safety but also contributes to improved health outcomes. Conversely, miscommunication and disregard for patient understanding and preferences contribute to health care disparities. Patient safety, satisfaction, and value hinge on progress made in communication.
To help put health care communication issues into perspective for students and clinicians, this chapter focuses on five topics of discussion. These topics address patient-centered communication, health literacy and cultural competency, interprofessional communication, information technology (IT), and professionalism.
Patient-Centered Communication
“Extensive research has shown that no matter how knowledgeable a clinician might be, if he or she is not able to open good communication with the patient, he or she may be of no help.”
The medical literature regarding patient-centered communication is often confusing because there are seemingly different terms that ultimately mean the same thing. To begin a discussion about patient-centered communication, it is prudent to first define what is meant in this chapter by patient-centered communication.
“Early work to define communication skills relevant to medical practice used the terms physician-patient communication or excellence in communication. The term patient centered communication has emerged in more recent writings on the subject.” Patient-centered communication can further be defined by the targeted goals and outcomes of patient interactions. To what extent these goals and outcomes are directly related to interpersonal communication is not easy to determine because of coexisting variables. Essentially, effective patient–provider communication is evaluated and measured in terms of the patient’s ability to follow through with medical recommendations, self-managing chronic medical conditions, and adopting preventive health behaviors.
Identifying the goals and desired outcomes for a patient’s health and well-being is usually not the hardest part of the clinician–patient encounter. It is, however, the first step in the process of patient-centered communication. Standing between goals and outcomes is the ability to effectively communicate so that both the patient and provider feel good about the process and progress of health management.
There are two major communication obstacles in health care delivery that make up the majority of problematic communication. These obstacles are found in communication breakdowns and common communication barriers that hinder effective and collaborative communication. To create the best health outcomes possible for the patient, identifying where these more common areas of communication breakdowns usually occur and recognizing these barriers of communication will help promote successful encounters. Acquiring the knowledge and skills to overcome communication obstacles has far-reaching positive implications in patient and provider health outcomes satisfaction.
Communication Breakdowns
“Communication is a two-way street. Differences in knowledge, perceptions, and decisions frequently surface when people communicate. This can cause disagreement, misunderstanding, and conflict. However, the communication process is not harmed if disagreement is managed constructively.” According to The Joint Commission, identified areas of communication breakdown occur between ineffective or incomplete communications among clinicians, the patient, and the patient’s caregivers. This takes into account forms of communication such as written, verbal, and recorded. Other areas of breakdowns include those having to do with patient education and patient accountability. When are these breakdowns most likely to happen? Communication breakdowns occur across the continuum of care and often involve ambiguity regarding responsibilities. Communication breakdowns result in incomplete or misunderstood diagnostic and therapeutic instructions and subsequently have a negative effect on patient mortality and morbidity. In patient referrals, quality of care often suffers from interprofessional miscommunication, which can lead to poor continuity of care, unnecessary diagnostic procedures, delayed diagnoses, polypharmacy, and increased litigation risk.
Effective communication relies on the patient and everyone involved in the patient’s care to be clear and in sync. The patient and the caregivers must be clear about the plan and understand their tasks and responsibilities in carrying out the plan. The degree to which this can happen influences patient safety and treatment adherence, cumulating in improved health outcomes.
Barriers of Communication
The barriers that hinder effective communication are vast. They also overlap and correspond with reasons for breakdowns in communication. Common barriers of communication are differences and competency in language, education, cultural responsiveness, and health literacy. Lack of perceived courtesy, respect, and engagement interwoven through all aspects of care are also common recurring themes in barriers to effective health care communication.
Another barrier to clinician–patient communication is patient interruptions, particularly as they relate to the time constraints of the patient encounter. The skill and art of history taking are the most important parts in the diagnostic workup of patients for practicing clinicians. An estimated 70% to 90% of a diagnosis is made from the patient’s history alone. Studies of clinician–patient visits, unfortunately, show that patients are often not provided the opportunity to tell their stories. This is often due to time constraints and interruptions, which compromise diagnostic accuracy. In such circumstances, the patient can perceive that what he or she is saying is not important, which leads to patients feeling reluctant about offering additional information. When patients are interrupted, the provider risks the opportunity of collecting essential information. The patient’s feeling rushed or interrupted also undermines the patient–provider relationship.
One of the most dangerous consequences of breaches in communication are those of medical errors. The ways in which medical errors can happen when caring for patients is not hard to understand given the potential for miscommunication as previously discussed. However, what bears specific mention is written prescriptions. Written prescriptions have often been identified as one cause for medication errors. Illegible handwriting and medication mix-ups caused by similar-sounding names of medications lead to misinterpreted dosages and incorrect medication administration. Verbal instructions to patients in regard to medication use and adverse effects in place of written instructions have also been an identified culprit in medical errors. This is especially dangerous when the patient does not feel like he or she shares in the decision-making process and either does not feel capable of questioning the caregiver or is unable to reach the ear of the caregiver. Table 21.1 illustrates breakdowns and barriers to communication, any or all of which can impact patient safety and treatment adherence.
| Breakdown in Communications | Barriers to Communication |
|---|---|
| Interprofessional communication | Language, courtesy, respect, engagement, time constraints of patient encounters |
| Provider–patient communication | Health literacy, language, cultural competency, courtesy, respect, engagement |
| Provider–patient–caregiver communication | Cultural competency, health literacy, language, courtesy, respect, engagement |
| Interprofessional–patient–caregiver communication | Courtesy, respect and engagement, health competency, language, time constraints of patient encounters |
| Incomplete or misunderstood instructions | Time constraints of patient encounters, courtesy, respect, engagement, language, cultural competency |
Health Literacy and Cultural Competency
Health literacy is a broad term with a specific purpose of alerting health care providers to a significant barrier to equitable access and utilization of health care. Poor health literacy is not simply a matter of one’s educational level, language skills, culture, or ethnicity. There are many components contributing to poor health literacy, and health literacy is important and applicable to everyone. Ultimately, anyone who needs any type or form of health care services needs health literacy skills. Many studies have shown a link between poor health literacy and poor health outcomes. This equates to health disparities.
Health literacy is defined by the Institute of Medicine’s report, Health Literacy: A Prescription to End Confusion, as “the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.” More recently, the definition has broadened to include a focus on the specific skills needed to navigate the health care system and the importance of clear communication between health care providers and their patients.
Poor health outcomes caused by poor health literacy place a responsibility on health care providers to not only be cognizant of this as a major health disparity but also to remain vigilant against it in practice. Overcoming health literacy problems for improved patient outcomes is an achievable task. The first step is recognizing the factors involved in creating the disparity with the individual or community served, and the second is implementing tools that overcome these disparities.
Common identifiable factors impeding health literacy have been illuminated in many studies. These include how information is communicated, experience with the health care system, the format of the deliverables, linguistic and cultural variables, access to health care, age, low socioeconomic status, and patient–provider relationship.
Research linking ways to overcome poor health literacy and improve health outcomes is ongoing. Some ways to overcome literacy barriers have become common practices, such as printing patient information in different languages and delivering information in plain language, thereby eliminating practice-specific jargon. Strategies such as tailored and targeted health communication that enhance information relevance to the intended audience have also shown some promising benefits.
Cultural respect has been demonstrated to overcome major components of health literacy having to do with ethnicity, equity, and access to care. When a clinician is respectful and responsive to health beliefs, cultural beliefs and practices, and linguistic needs, many study outcomes show remarkable efficacy in decreasing disparity and providing high-quality access to care. Conversely, when patients experience a stereotype threat in the clinical settings, it can have devastating effects on health outcomes and can be considered a health disparity.
It is the imperative to teach current and future clinicians the skills for acquiring cultural competency and cultural respect. Cultural competency is the ability to incorporate a set of behaviors, attitudes, and policies that come together in a system or agency or among professionals that enable effective work in cross-cultural situations. Cultural competency is an important skill to possess in order to overcome barriers to health care access, patient safety issues, and overall outcomes in terms of screening, diagnostics, and treatment adherence. Attaining cultural competency begins by self-reflection, and it requires an honest, ongoing assessment of biases that can impede delivery of care caused by a lack of respect and understanding toward patients or other health professionals.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
