Patient-provider communication for patients with communication disorders

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DESCRIPTION (provided by applicant): Patients with communication disorders (speech, language, hearing, and cognitive-communication disorders) are a highly vulnerable population in healthcare. The prevalence of communication disorders is high among aging patients and in a number of settings including nursing homes, palliative care, and stroke units. Because of the communication barriers these patients face, they are at a higher risk for medical errors, poor health outcomes, low satisfaction with healthcare, and exclusion from shared decision-making and higher costs of care. One of the most significant barriers to care is that healthcare providers lack training in understanding the types and implications of different communication disorders, and the communication strategies that can be used to facilitate patient participation in healthcare. Many medical schools offer training in general patient-provider communication, but these programs do not address the unique communication needs of patients with communication disorders. The Joint Commission issued new guidelines in 2010 calling on healthcare facilities to ensure that all patients who are communicatively vulnerable, including those with communication disorders, be accommodated to have full access to healthcare. Existing research suggests that healthcare providers can benefit from training in how to communicate with patients with communication disorders, but this prior research is extremely scarce and limited to just two disorders - disregarding the broader range of disorders and specific strategies needed for each. This research team has developed a program to train healthcare providers how to recognize different types of communication disorders and use appropriate communication strategies with patients with communication disorders. In preliminary research, medical students completing the training have demonstrated gains in their knowledge of communication disorders as well as in self-ratings of competence and confidence for interacting with these patients. However, gains in theoretical knowledge do not necessarily translate into changes in skills and behaviors. In general patient-provider communication programs, students are often assessed with standardized patients to demonstrate new communication skills. However, protocols do not exist for training standardized patients to portray communication disorders. The purpose of this research is to build on existing foundations to 1) Develop protocols for training standardized patients to validly portray patients with speech and language disorders for the purposes of training and evaluating medical and nursing students for communicating with these patients; 2) Begin validation of an outcomes measure to assess students' communication skills with patients with communication disorders; and 3) Evaluate the sensitivity of the new standardized patient protocols and outcomes measure to changes in the skills of medical and nursing students in response to the training program developed by this team in prior research. The resources generated by this grant will be available to other institutions wishing to implement similar training, and will be used in future research targeting additional healthcare disciplines and other delivery modalities for this training.