Patient-provider communication for patients with communication disorders

描述(由申请人提供)：患有沟通障碍(言语、语言、听力和认知沟通障碍)的患者在医疗保健中是一个高度脆弱的群体。沟通障碍在老年患者中的患病率很高，在包括疗养院、姑息治疗和中风病房在内的许多环境中都是如此。由于这些患者面临沟通障碍，他们面临着更高的医疗差错风险、糟糕的健康结果、对医疗保健的低满意度，以及被排除在共同决策和更高的医疗成本之外。医疗保健最大的障碍之一是医疗保健提供者 缺乏了解不同沟通障碍的类型和影响的培训，以及可用于促进患者参与医疗保健的沟通策略。许多医学院提供一般患者-提供者沟通方面的培训，但这些项目并没有解决沟通障碍患者的独特沟通需求。联合委员会在2010年发布了新的指导方针，呼吁医疗机构确保所有沟通脆弱的患者，包括那些沟通障碍的患者，都能得到充分的医疗保健。现有的研究表明，医疗保健提供者可以从如何与沟通障碍患者沟通的培训中受益，但这一先前的研究极其稀少，仅限于两种障碍-忽略了更广泛的障碍范围和每种障碍所需的具体策略。这个研究小组开发了一个项目，培训医疗保健提供者如何识别不同类型的沟通障碍，并使用适当的沟通策略与沟通障碍患者。在初步研究中，完成培训的医学生在沟通障碍的知识以及与这些患者互动的能力和信心的自我评级方面取得了进展。然而，理论知识的获得并不一定会转化为技能和行为的改变。在一般的患者-提供者交流项目中，学生通常会与标准化的患者一起进行评估，以展示新的沟通技能。然而，目前尚不存在训练标准化患者描绘沟通障碍的方案。这项研究的目的是建立在现有的基础上，1)制定培训标准化患者的方案，以有效地描述言语和语言障碍患者，以培训和评估医学生与这些患者沟通的能力；2)开始验证结果指标，以评估学生与沟通障碍患者的沟通技能；以及3)评估新的标准化患者方案和结果指标对医学生和护理学生技能变化的敏感性，以响应本团队在先前研究中开发的培训计划。这笔赠款产生的资源将可用于希望实施类似培训的其他机构，并将用于未来针对该培训的其他保健学科和其他交付方式的研究。

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.