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.

项目总结/摘要 沟通障碍（言语、语言和声音障碍）患者在以下方面存在差异： 获得和接受高质量的医疗保健服务。具体来说，他们报告的满意度较低， 护理质量和与提供者的沟通，并且有三倍的可能性经历 可预防的医疗事故，当他们在医院。在描述性研究中， 疾病（CD）指出，患者与提供者沟通的挑战是这些疾病的主要原因， 差距。有效的患者-提供者沟通已被确定为高质量护理的关键， 多项研究表明，它为患者带来了许多益处，包括改善对 医疗和护理满意度。到目前为止，还没有研究直接评估是否有 提供者在与有或没有CD的患者互动时的沟通行为差异。 也就是说，它是未知的供应商是否使用较少的以患者为中心的沟通与患者的CD。 此外，研究表明，提供者的特征，包括他们的隐性和显性偏见， 会显著影响他们在临床诊疗中的交流行为。虽然消极的暗示和 对残疾的明确偏见已经在一般人群中进行了测量，这些偏见还没有被 在医疗保健提供者中进行评估，也没有这些偏见对患者-提供者的潜在影响 通信被描述。在美国，所有医学生都必须接受以下方面的培训： 医患沟通。在他们的训练早期接受这种指导可以建立积极的行为 一旦他们成为执业医师，决定医学生是否使用更少的病人- 与CD患者进行集中沟通，以及他们是否有内隐和外显的残疾偏见， 直接为医学教育培训的发展提供信息。在目标1中，医学生以病人为中心的言语 和非语言交流将在与标准化患者的临床接触中进行比较， 口吃（言语障碍）、失语症（语言障碍）或没有CD。目标2：医疗 学生对残疾病人的隐性和显性偏见将被确定。目标3：医疗 学生将参加定性访谈，了解他们与CD患者互动的看法。 本研究将为医学生的沟通行为和沟通潜力提供必要的信息 偏见，可用于创建有效的干预措施，旨在改善供应商如何沟通， CD患者改善沟通的有效干预措施是消除贫困的必要步骤。 CD患者经历的医疗保健差异。