Disparities in Patient-Centered Communication Experienced by Patients with Communication Disabilities

有沟通障碍的患者在以患者为中心的沟通中所经历的差异

• 批准号: 10393171
• 负责人: Megan A Morris
• 金额: $ 3.89万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-18 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10393171
• 关键词: Academy; Adherence; Affect; Aphasia; Attitude; Behavior; Caring; Characteristics; Communication; Communication Disability; Communication impairment; Consultations; Data; Development; Disabled Persons; Educational Intervention; Empathy; Exclusion; Exhibits; Eye; General Population; Health; Health Personnel; Healthcare; Hospitals; Implicit Association Test; Instruction; Interruption; Interview; Knowledge; Language Disorders; Measures; Medical; Medical Education; Medical Errors; Medical Students; Medicine; Nonverbal Communication; Patient-Centered Care; Patients; Perception; Physicians; Population; Prejudice; Provider; Quality of Care; Randomized; Reporting; Research; Roter; Speech; Speech Disorders; Standardization; Students; Stuttering; Surveys; Systems Analysis; Time; Training; Training Programs; Training and Education; United States; Voice Disorders; care outcomes; care providers; clinical encounter; communication behavior; design; disability; effective intervention; experience; explicit bias; health care disparity; health care quality; health care service; implicit bias; improved; language impairment; medical schools; patient oriented; patient population; patient-clinician communication; prevent; provider factors; satisfaction; skills; therapy development

PROJECT SUMMARY/ABSTRACT Patients with communication disorders (speech, language, and voice disorders) experience disparities in the access to and receipt of high-quality healthcare services. Specifically, they report lower rates of satisfaction with quality of care and communication with their providers and are three times more likely to experience a preventable medical error when they are in the hospital. In descriptive studies, patients with communication disorders (CD) state that challenges in patient-provider communication are a major contributor to these disparities. Effective patient-provider communication has been identified as essential to high-quality care and multiple studies demonstrate that it confers a host of benefits to patients, including improved adherence to medical treatment and satisfaction with care. To date, no studies have directly evaluated whether there are differences in providers’ communication behaviors when interacting with patients with or without a CD. Namely, it is unknown whether providers use less patient-centered communication with patients with CDs. Additionally, studies have demonstrated that provider characteristics, including their implicit and explicit biases, can significantly affect their communication behaviors during clinical encounters. While negative implicit and explicit biases toward disability has been measured in the general population, these biases have not been evaluated in healthcare providers, nor have the potential effects of these biases on patient-provider communication been described. In the United States, all medical students are required to receive training in patient-provider communication. Receiving this instruction early in their training establishes positive behaviors that they will use once they are practicing physicians. Determining whether medical students use less patient- centered communication with patients with CD and whether they have implicit and explicit disability biases will directly inform development of medical education trainings. In Aim 1, medical students’ patient-centered verbal and non-verbal communication will be compared during a clinical encounter with a standardized patient who stutters (speech disorder), has aphasia (language disorder), or does not have a CD. In Aim 2, medical students’ implicit and explicit biases towards patients with disabilities will be determined. In Aim 3, medical students’ will participate in qualitative interviews about their perceptions interacting with patients with a CD. The study will provide necessary information on medical students’ communication behaviors and potential biases that can be used to create effective interventions that aim to improve how providers communicate with patients with CD. Effective interventions to improve communication are a necessary step to elimination of healthcare disparities experienced by patients with CD.

项目摘要/摘要 沟通障碍（语音，语言和语音障碍）的患者在 获得和接收高质量的医疗服务。具体来说，他们报告了较低的满意度 与提供者的护理质量和沟通质量，体验的可能性要高三倍 他们在医院时可预防的医疗错误。在描述性研究中，交流患者 疾病（CD）指出，患者提供者沟通中的挑战是这些挑战的主要原因 差异。有效的患者提供者的沟通已被确定为高质量护理必不可少的 多项研究表明，它承认对患者的好处，包括提高依从性 医疗和护理满意度。迄今为止，尚无研究直接评估是否存在 与有或没有CD的患者互动时，提供者沟通行为的差异。 也就是说，尚不清楚提供者是否使用以患者为中心的CD患者的沟通。 此外，研究表明，提供商的特征，包括其隐式和明确的偏见， 在临床相遇期间，可以显着影响其沟通行为。而负面的隐式和 在普通人群中已经衡量了对残疾的明确偏见，这些偏见尚未 在医疗保健提供者中评估，这些偏见对患者提供者的潜在影响也没有 描述了沟通。在美国，所有医学生都必须接受培训 患者提供的沟通。在他们的培训初期接受这项指示建立了积极的行为 一旦他们执业医师，他们就会使用。确定医学生是否使用较少的患者 - 与CD患者进行的集中沟通以及他们是否具有隐式和明确的残疾偏见 直接告知医学教育培训的发展。在AIM 1中，医学生的以患者为中心的口头 在临床接触期间，将比较非语言交流的标准化患者 Stusters（语音障碍），失语症（语言障碍）或没有CD。在AIM 2中 将确定学生对残疾患者的隐性和明确偏见。在AIM 3中 学生将参加有关他们与CD与患者相互作用的看法的定性访谈。 该研究将提供有关医学生的沟通行为和潜力的必要信息 可用于创建有效干预措施的偏见，旨在改善提供者的交流方式 CD患者。有效改善沟通的干预措施是消除的必要步骤 CD患者经历的医疗保健分布。