Words of Preparation for Patients Through a series of simple steps, we can help clients with communication disorders plan ahead to get what they need from medical visits—despite their challenges. Features
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Features  |   March 2016
Words of Preparation for Patients
Author Notes
  • Michael I. Burns, PhD, CCC-SLP, is a lecturer and researcher in the Department of Speech and Hearing Sciences at the University of Washington in Seattle. He is an affiliate of ASHA Special Interest Group 10, Issues in Higher Education. mburns@uw.edu
    Michael I. Burns, PhD, CCC-SLP, is a lecturer and researcher in the Department of Speech and Hearing Sciences at the University of Washington in Seattle. He is an affiliate of ASHA Special Interest Group 10, Issues in Higher Education. mburns@uw.edu×
  • Carolyn R. Baylor, PhD, CCC-SLP, is an assistant professor in the Department of Rehabilitation Medicine and adjunct assistant professor in the Department of Speech and Hearing Sciences at the University of Washington. cbaylor@uw.edu
    Carolyn R. Baylor, PhD, CCC-SLP, is an assistant professor in the Department of Rehabilitation Medicine and adjunct assistant professor in the Department of Speech and Hearing Sciences at the University of Washington. cbaylor@uw.edu×
  • Kathryn M. Yorkston, PhD, CCC-SLP, is a professor and head of the Division of Speech Pathology in the Department of Rehabilitation Medicine at the University of Washington in Seattle. She is an affiliate of ASHA Special Interest Group 2, Neurophysiology and Neurogenic Speech and Language Disorders. yorkston@uw.edu
    Kathryn M. Yorkston, PhD, CCC-SLP, is a professor and head of the Division of Speech Pathology in the Department of Rehabilitation Medicine at the University of Washington in Seattle. She is an affiliate of ASHA Special Interest Group 2, Neurophysiology and Neurogenic Speech and Language Disorders. yorkston@uw.edu×
Article Information
Language Disorders / Features
Features   |   March 2016
Words of Preparation for Patients
The ASHA Leader, March 2016, Vol. 21, 52-56. doi:10.1044/leader.FTR3.21032016.52
The ASHA Leader, March 2016, Vol. 21, 52-56. doi:10.1044/leader.FTR3.21032016.52
It shouldn’t come as a surprise that, when it comes to their health care, people with communication disorders want to be treated like anyone else. Like all of us, they feel responsible for their own health and want to make their own health-related decisions.
As recounted in the book “Patient-Provider Communication,” our investigations indicate that, above all, patients prefer not to be hurried, wishing that providers would slow interactions so that they can express themselves and understand what is being said. They want providers to speak directly to them and respect their desire to chart their own care.
However, they are often given few opportunities to communicate during medical interactions, and may struggle to keep up with the conversation and understand complex medical information (see sources below). They may, as a result, rely heavily on providers, family and friends to help with communication during medical visits.
Despite this need for support and a team approach, these patients ultimately want to feel they’re driving message content and decision-making. But they often require third parties to help them schedule and prepare for visits and to facilitate communication during the visits. Speech-language pathologists and audiologists can do much to prepare these clients to advocate for themselves and to educate their providers about their needs, thus improving the likelihood of successful communication. We suggest using the PACT (Prepare, Ask questions, Create a plan, and Take away information) method to structure this education and training.

People with communication disorders prefer not to be hurried, wishing that providers would slow interactions so that they can express themselves and understand what is being said.

A PACT for preparation
Providers may lack training on communicating effectively with patients who have communication difficulties, making it necessary for the patients to step up and inform providers about their communication disorder and needs. We can help our clients do this by preparing them with the PACT method.
P—Prepare
Patients can organize information related to their medical and communication diagnoses to save time with providers. To help them, we can:
  • Educate patients and third parties on the structure and purpose of a typical medical visit. For example, providers will ask about the reason for the visit and gather information before developing a plan. Helping patients and third parties to understand the structure of a medical visit can help them prepare for and engage in each step in the encounter.

  • Help patients prepare a short summary of information related to their communication disorder and of preferences for how providers should communicate. Educate patients and third parties not to assume providers will know how to communicate with them—and advise that they offer this information as the medical visit begins.

  • Identify what information would be important for patients to bring. For example, information related to their insurance, names of providers, lists of medications (including dosage and purpose) and a copy of any advanced directives (if the provider does not already have a copy).

  • Encourage patients to bring any existing communication materials or devices, and to introduce them into the visit from the start.

  • Help patients practice communicating a brief description of current symptoms, using various methods as appropriate (for example, key words and pictures).

  • Define with patients and third parties the preferred role(s) each will play to enhance communication effectiveness during the medical visit, as well as the providers’ role. Prepare patients and third parties to communicate these preferences to the provider at the start of the visit.

Patients with communication disorders commonly struggle to contribute to the development of a treatment plan, and report feeling a lack of participation in medical decisions (despite being present).

A—Ask questions
Even patients who don’t have communication disorders tend to ask few questions during medical visits, and doing so is even more daunting for patients with communication problems. To assist them, we can:
  • Help patients and third parties prioritize important questions to ask and have them practice communicating those questions using preferred communication methods.

  • Coach patients and third parties on common questions that are often asked during medical visits. These questions can concern the diagnosis, tests to be given, treatment options or medications.

  • Develop simple communication boards or a list of simple words/phrases to help patients ask and answer common questions during a medical visit. You can use online resources for patient-provider communication tools.

  • Help patients and third parties advocate for having providers modify questions so that the patient can successfully answer them (for example, simplifying the number of words used in a question to decrease comprehension demands). For patients who have trouble speaking, consider having this request written out ahead of time or included on a communication board.

  • Advocate for providers to allow extra time for patients to answer questions and to ask questions during the visit.

  • Have the patient or third party call ahead to see if there are any questions they can prepare answers for to save time during the visit.

C—Create a plan
Patients with communication disorders often struggle to contribute to the development of a treatment plan and report feeling a lack of participation in medical decisions (despite being present). We can:
  • Help patients communicate how much they want to be involved in decisions about their care.

  • Help patients develop ways to advocate for their goals/outcomes for the medical visit (for example, seeking information on a specific medication).

  • Help patients communicate how they would like information summarized to them as part of creating a plan (for example, treatment options presented as a list of single words or short phrases).

  • Develop simple communication boards or a list of simple words/phrases to help patients communicate preferences during planning.

Alerting providers to patients’ communication preferences and needs can significantly bolster patients’ self-efficacy and health care satisfaction. Most importantly, it can improve their health outcomes.

T—Take away information
Patients often leave medical visits with written health information (for example, listings of new medications and exercises to complete). However, these materials are often not accessible to patients with communication disorders, especially those with reading comprehension deficits. We can:
  • Help patients and third parties clearly communicate the specific information they would like to take home with them.

  • Coach patients and third parties on the most patient-appropriate format or level of complexity for this health information.

  • Provide a summary of this preferred format and level of complexity for patients and third parties to share with providers.

  • Help patients and third parties better understand the information they received during their most recent medical visit.

Participation-focused interventions like PACT can help improve interactions between providers and people with communication disorders by promoting more direct communication and patient autonomy. Alerting providers to patients’ communication preferences and needs can significantly bolster patients’ self-efficacy and health care satisfaction. Most important, it can improve their health outcomes.
Sources
Blackstone, S., Beukelman, D., & Yorkston, K. (Eds.). (2015). Patient-provider communication: Roles for speech-language pathologists and other health care professionals. San Diego: Plural Publications.
Blackstone, S., Beukelman, D., & Yorkston, K. (Eds.). (2015). Patient-provider communication: Roles for speech-language pathologists and other health care professionals. San Diego: Plural Publications.×
Burns, M., Baylor, C., Dudgeon, B., Starks, H., & Yorkston, K. (2015). Asking the stakeholders: Perspectives of individuals with aphasia, their family caregivers, and physicians regarding communication during medical interactions. American Journal of Speech-Language Pathology, 24, 341–357. [Article] [PubMed]
Burns, M., Baylor, C., Dudgeon, B., Starks, H., & Yorkston, K. (2015). Asking the stakeholders: Perspectives of individuals with aphasia, their family caregivers, and physicians regarding communication during medical interactions. American Journal of Speech-Language Pathology, 24, 341–357. [Article] [PubMed]×
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March 2016
Volume 21, Issue 3