Clinician communication strategies to navigate differences of opinion with patients

OBJECTIVE

We investigated communication strategies clinicians reported using to navigate differences of opinion with patients regarding medical decisions.

METHODS

Twenty physicians of various specialties participated in semi-structured interviews regarding their strategies for maintaining mutual respect when disagreeing with a patient. Reflexive thematic analysis was applied. Enrollment concluded upon theme saturation.

RESULTS

In an attempt to limit disagreements, physicians learned to gauge patient values, often deferring to clinicians being the expert on medicine and patients being the expert on themselves. Physicians noticed that disagreements were reinforced by prioritizing educational approaches. Strengthening the relationship by validating patient emotions was seen as a more effective strategy. Clinicians found it difficult to weigh relative potential for benefit to the relationship and feelings of moral distress in capitulating to patient preferences they disagreed with.

CONCLUSION

Physicians recognized the value of moving from educational to relationship building strategies to help limit and navigate disagreements. Key strategies include prioritizing gauging the patient's values and validating their emotions.

PRACTICE IMPLICATIONS

Anticipating disagreement, training clinicians to limit teaching, and instead prioritize a strong relationship to maintain trust and collaboration has the potential to improve patient health, with more limited resource use, and better experiences of care.

Hearing impaired persons' experiences with the online Swedish Individualized Active Communication Education (I-ACE) program: A feasibility study

Even with optimally fitted hearing aids, many individuals with hearing impairment struggle to hear in situations with difficult listening conditions. Active Communication Education (ACE) is an interactive group rehabilitation program aimed at helping people with hearing loss communicate more effectively using communication strategies to better cope with everyday life. To increase accessibility and allow more people to benefit from the ACE program, a modified individualized version was created. The purpose of this study was to examine the feasibility of providing the Swedish Individualized Active Communication Education (I-ACE) program via an online platform and to explore hearing impaired persons' experiences with the program. For five weeks, ten participants completed the Swedish I-ACE through an online platform. The participants were assigned a new chapter to complete each week and later received individual feedback on their work via the platform. The participants were asked to complete an evaluation form regarding the content and their experiences during and after completing the I-ACE. They were later interviewed to provide more detailed information on their experiences with the program. The program completion rate was 80 %. Participants found the I-ACE program to be informative and relevant but somewhat repetitive. However, only a few participants thought of the repetitiveness as negative. Few participants reported difficulties using the platform. This study indicated that it is feasible to provide the I-ACE program via an online platform and that the content of the program is informative, relevant, and comprehensible. Further research evaluating the effects of the I-ACE is warranted.

Sports Medicine Patient Experience: Implicit Bias Mitigation and Communication Strategies

Unconscious bias, also known as implicit bias, is the principal contributor to the perpetuation of discrimination and is a robust determinant of people's decision-making. Unconscious bias occurs despite conscious nonprejudiced intentions and interferes with the actions of the reflective and conscious side. Education and self-awareness about implicit bias and its potentially harmful effects on judgment and behavior may lead individuals to pursue corrective action and follow implicit bias mitigation communication strategies. Team physicians must follow existing communication strategies and guidelines to mitigate unconscious bias and begin an evolution toward nonbiased judgment and decision-making to improve athlete care.

E-mail as a way of communication during the ACWY meningococcal vaccination campaign in adolescents and young adults in the Region of Murcia

In 2019, ACWY meningococcal vaccination for people born between 2001 and 2007 was recommended. In Murcia, during the first 9 months, the coverage was 52.89%. This study is aimed to evaluate the effects of e-mail reminders on vaccination coverage. A longitudinal, prospective trial was performed on non-vaccinated individuals with e-mail addresses. An e-mail reminder was sent to people assigned to the intervention group (born in any month, except January and July), and 4 weeks later, the same was sent to the control group. Vaccination coverage was assessed before and 4 weeks after each intervention. After the first intervention, 5.15% of the participants in the intervention group were vaccinated (1.57% in the control group). The increased likelihood of being vaccinated if a person had been sent an e-mail was 1.033 (95% confidence interval, 1.019-1.047; p = 0.001). This study highlighted the impact of e-mail as an appropriate method of communication for vaccination programmes.

The Effects of Virtual Caregiver Coaching in Antigua & Barbuda on the Implementation of EMT Language Support Strategies in Naturalistic Environments

This single-case multiple baseline design investigation set out to determine the effectiveness of using a telepractice service delivery model to coach caregivers in Antigua & Barbuda in the use of Enhanced Milieu Teaching (EMT) language support strategies with a child with language impairment. A slightly modified version of the Teach-Model-Coach-Review (TMCR) method was used during virtual instruction to train a caregiver on the language support strategies of environmental arrangement, matched turns, expansions, and time delay with milieu prompting. The caregiver attended sessions three times a week for up to 45 minutes for four weeks. The results of this study indicated a positive relationship between the intervention and caregiver use of strategies. The caregiver demonstrated increased responsiveness to the child's communication attempts and exhibited the use of language support strategies across activities. This study suggests that telepractice can be an effective service delivery model for providing coaching to caregivers.

Palliative Communication in the Pediatric Intensive Care Unit

Communication is a central aspect of nursing care and is especially important when pertaining to progressive illnesses and end of life. This article reviews basic palliative care terminology and outlines a variety of communication frameworks from the "dos" to the "don'ts." These communication strategies are meant to be added to the nurse's "toolbox" so that nurses may use them in various scenarios. These communication tools are meant to help mitigate the stress and discomfort nurses often feel when using palliative communication or delivering bad news.

Navigating language discordance in public health care in rural South Africa: a qualitative descriptive study of occupational therapists' perspectives

BACKGROUND

Language discordance occurs in healthcare when staff and service users do not share proficiency in the same language. It is a global phenomenon impacting on the quality of health services, as person-centred practice requires communication to establish partnerships and rapport. In a country as linguistically diverse as South Africa, effective ways to navigate language discordance in health care are urgently required, yet there is limited research. This study aimed to describe how occupational therapists navigated language discordance when working in the public health sector in KwaZulu-Natal.

METHODS

A qualitative descriptive design involved using purposive sampling to recruit occupational therapists as participants (n = 8) for 15 semi-structured interviews. Thematic analysis was used to analyse the data, which included reflective journal entries from all participants.

RESULTS

The four emergent themes were: (1) concurrent use of strategies, (2) I'm doing as much I can, what more can I do? (3) Language definitely impacts that therapy process and lastly, (4) systemic oppression perpetuating language discordance.

CONCLUSION

Language discordance is a complex context-specific phenomenon, therefore insight into concurrent use of strategies is important to practitioners to enable them to navigate language discordance and ensure provision of quality services. These insights are significant for healthcare professionals and resource allocators as they shed light on the shortcomings of advocating for a single strategy such as providing trained interpreters. Successful navigation is characterised by determination, being kind to oneself, willingness to learn and use of pragmatic and flexible approaches. To prepare to navigate language discordance in a low-resource context, education should extend in time and scope, to include multiple strategies, culture and relevant languages.

A systematic review of communication interventions for countering vaccine misinformation

BACKGROUND

Misinformation and disinformation around vaccines has grown in recent years, exacerbated during the Covid-19 pandemic. Effective strategies for countering vaccine misinformation and disinformation are crucial for tackling vaccine hesitancy. We conducted a systematic review to identify and describe communications-based strategies used to prevent and ameliorate the effect of mis- and dis-information on people's attitudes and behaviours surrounding vaccination (objective 1) and examined their effectiveness (objective 2).

METHODS

We searched CINAHL, Web of Science, Scopus, MEDLINE, Embase, PsycInfo and MedRxiv in March 2021. The search strategy was built around three themes(1) communications and media; (2) misinformation; and (3) vaccines. For trials addressing objective 2, risk of bias was assessed using the Cochrane risk of bias in randomized trials tool (RoB2).

RESULTS

Of 2000 identified records, 34 eligible studies addressed objective 1, 29 of which also addressed objective 2 (25 RCTs and 4 before-and-after studies). Nine 'intervention approaches' were identified; most focused on content of the intervention or message (debunking/correctional, informational, use of disease images or other 'scare tactics', use of humour, message intensity, inclusion of misinformation warnings, and communicating weight of evidence), while two focused on delivery of the intervention or message (timing and source). Some strategies, such as scare tactics, appear to be ineffective and may increase misinformation endorsement. Communicating with certainty, rather than acknowledging uncertainty around vaccine efficacy or risks, was also found to backfire. Promising approaches include communicating the weight-of-evidence and scientific consensus around vaccines and related myths, using humour and incorporating warnings about encountering misinformation. Trying to debunk misinformation, informational approaches, and communicating uncertainty had mixed results.

CONCLUSION

This review identifies some promising communication strategies for addressing vaccine misinformation. Interventions should be further evaluated by measuring effects on vaccine uptake, rather than distal outcomes such as knowledge and attitudes, in quasi-experimental and real-life contexts.

Communication skills utilized by physicians in the pediatric outpatient setting

Background

Effective communication has been shown to increase patient satisfaction. The objective of this study was to describe communication strategies employed by physicians, and determine if physician communication strategies affect caregiver perception of quality or satisfaction with physician communication in a pediatric ambulatory setting.

Methods

This observational study was conducted at the Children’s Hospital of Philadelphia and consisted of video recordings of visits that were reviewed by research assistants for physician utilized communication strategies. Caregivers completed surveys on their preferred physician communication qualities, perception of communication quality, and satisfaction with communication. Correlation was performed between types of communication strategy and caregiver satisfaction with communication or perceived quality of communication. T-tests were run to see if there was a significant difference in patient perceived communication and satisfaction scores based on the communication strategies utilized during visits.

Results

There were five universally used communication strategies across the 84 clinic visits recorded, including: eye contact, good posture, speaking concisely, providing thorough explanations, and providing summary of next steps. The average number of communication strategies used was 15.95 (σ = 1.50) with physicians using at least 16 of the 18 communication strategies in 62% of the clinic visits. There was no correlation between the number of communication strategies physicians utilized and either the caregiver perception of communication quality score (CPCQ) or communication satisfaction (CS) score. Caregivers who preferred an authoritative approach but perceived a collaborative approach reported lower average CPCQ and CS scores compared to caregivers who had their communication expectations met.

Discussion

There are numerous tools designed to help the physician facilitate an effective working relationship with the patient. In our study, the universally used verbal communication strategies are generally recognized as components of an effective communication repertoire. Another part of effective communication is meeting communication expectations with the CS scores suggesting that caregivers felt their communication needs were being met. Dedicating clinical time to understanding this need may help improve the overall clinical experience.

Conclusion

Physicians utilize many of the suggested communication strategies to help facilitate an effective clinical encounter. Further studies on caregiver communication requirements and meeting caregiver communication expectations are needed.

Effective communication with caregivers to prevent unintentional injuries in children under seven years. A systematic review

OBJECTIVE

This review systematically examines the theory base and effectiveness of communication strategies (i.e., message content, message attributes, communication channels, and communicators) of interventions for caregivers to prevent unintentional child injuries.

METHODS

Relevant articles were searched in the databases Communication and Mass Media Complete, PsycInfo, Pubmed, and Google Scholar, the journal Injury Prevention, and the literature of included studies. A total of 71 articles reporting 67 different studies were included and fully coded. Quality was assessed using the Mixed Methods Appraisal Tool. Coded categories and their frequencies are described, and the effectiveness of different communication strategies is explored with crosstabs.

RESULTS

Only 17 studies stated the use of a specific theory base; Precaution Adoption Process-Model, Theory of Planned Behavior, and Health Belief Model were most often used. The message content of most studies aimed at knowledge dissemination; however, addressing behavioral determinants, such as risk perception and self-efficacy, was more effective. About half of the studies did not elaborate on message attributes; calls to action, exemplars, and tailoring were most often used, the latter being most effective. Communication channels ranged from printed products to face-to-face communication and digital media. In addition, studies specifying interpersonal communicators were highly effective.

CONCLUSION

The results of the review suggest that the following aspects can contribute to effective communication in child injury prevention: theory-based communication, addressing broad knowledge and further behavioral determinants, digital tailoring, and health professionals as communicators. However, a conclusive statement on the effectiveness of different communication strategies is hampered by the fact that they are not specified and/or confounded in many studies.

PRACTICE IMPLICATIONS

Communication strategies should be theory based and address, in addition to knowledge, behavioral determinants such as risk perception and self-efficacy. Moreover, digital tailoring is an advanced way of enhancing effectiveness and health professionals, such as pediatricians and clinic staff, are important multipliers.

Three strategies when physicians provide complex information in interactions with patients: How to recognize and measure them

OBJECTIVE

To define and operationalize three taught strategies for providing information in interactions with patients using videos collected in a randomized controlled trial (RCT).

METHODS

This was a qualitative exploratory study embedded in a randomized controlled design, using microanalysis of face-to-face dialogue as an inductive video analysis method to operationalize physicians' use of three information-provision strategies. Data were 34 video-recorded simulated (but unscripted) interactions between 17 physicians and 34 multiple sclerosis patients collected before and after a brief course on information provision. We operationalized (1) mapping the patient's preferences and (2) checking the patient's understanding, and pauses indicative of (3) portioning information.

RESULTS

Results are detailed analytical definitions, criteria, and assessable, quantifiable outcomes for each of the three strategies. Patients responded to portioning pauses as expected: whereas 91% of these pauses elicited an immediate patient response, only 23% of non-portioning pauses did so.

CONCLUSION

Our methods revealed how to define and evaluate information sharing strategies physicians used within the contingencies of clinical interaction.

PRACTICE IMPLICATIONS

Findings provide applicable methods to teach, analyze, and evaluate information sharing strategies and indications for further training.

Perceived cardiovascular disease risk and tailored communication strategies among rural and urban community dwellers in Rwanda: a qualitative study

Background

In Rwanda, cardiovascular diseases (CVDs) are the third leading cause of death, and hence constitute an important public health issue. Worldwide, most CVDs are due to lifestyle and preventable risk factors. Prevention interventions are based on risk factors for CVD risk, yet the outcome of such interventions might be limited by the lack of awareness or misconception of CVD risk. This study aimed to explore how rural and urban population groups in Rwanda perceive CVD risk and tailor communication strategies for estimated total cardiovascular risk.

Methods

An exploratory qualitative study design was applied using focus group discussions to collect data from rural and urban community dwellers. In total, 65 community members took part in this study. Thematic analysis with Atlas ti 7.5.18 was used and the main findings for each theme were reported as a narrative summary.

Results

Participants thought that CVD risk is due to either financial stress, psychosocial stress, substance abuse, noise pollution, unhealthy diets, diabetes or overworking. Participants did not understand CVD risk presented in a quantitative format, but preferred qualitative formats or colours to represent low, moderate and high CVD risk through in-person communication. Participants preferred to be screened for CVD risk by community health workers using mobile health technology.

Conclusion

Rural and urban community members in Rwanda are aware of what could potentially put them at CVD risk in their respective local communities. Community health workers are preferred by local communities for CVD risk screening. Quantitative formats to present the total CVD risk appear inappropriate to the Rwandan population and qualitative formats are therefore advisable. Thus, operational research on the use of qualitative formats to communicate CVD risk is recommended to improve decision-making on CVD risk communication in the context of Rwanda.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13330-6.

Getting through COVID-19 together: Understanding local governments' social media communication

This study provides new insights into how local governments (LGs) manage pandemic-related crisis communication with citizens on their social media (SM) profiles. We analyze over 3000 posts published on SM profiles of selected LGs in Poland to get insights on rhetorical communication strategies during the COVID-19 pandemic. We document LGs as they go beyond the simple transmission of information to citizens and use SM in an engaging and educational manner. We found three types of rhetorical strategies and their resonance with the public. Our analysis suggests that LGs are likely to apply the Together communication strategy, which is the most engaging.

Communication strategies in the prevention of type 2 diabetes and gestational diabetes in vulnerable groups: a scoping review

BACKGROUND

The global prevalence of diabetes is nearly 9%, with an upward trend in type 2 diabetes mellitus (T2DM) and gestational diabetes (GDM). Although evidence shows that vulnerable groups are affected disproportionally, these groups are difficult to reach in terms of preventive measures. Currently, there is no gold standard regarding communication strategies and/or public awareness campaigns.

METHODS

We conducted a scoping review in September 2019. Two reviewers independently screened the results of the electronic literature search in several databases, including Medline, EMBASE, and PsycINFO. Extracted data were charted, categorized, and summarized.

RESULTS

All of the included articles (n=24) targeted T2DM; none targeted GDM. We identified the following five different vulnerable groups within the identified studies: migrants (n=9), ethnic groups such as African Americans (n=8), people with low socioeconomic status (n=3), older people (n=1), and people in need of care (n=1). Three categories of communication strategies were identified as follows: adapted diabetes prevention programs (n=21), community health workers (n=5), and technical approaches (n=9).

CONCLUSION

We found different approaches for preventive interventions for T2DM. Some of these approaches were already adapted to known barriers. Communication strategies should be adapted to barriers and facilitating factors to increase participation and motivation.

A distributed parallel firefly algorithm with communication strategies and its application for the control of variable pitch wind turbine

Firefly algorithm (FA) is a meta-heuristic optimization algorithm inspired by nature. Due to its superior performance, it has been widely used in real life. However, it also has some shortcomings in some optimization cases, such as low solution accuracy and slow solution speed. Therefore, in this paper, distributed parallel firefly algorithm (DPFA) with four communication strategies is presented to improve these shortcomings. The distributed parallel technique is implanted to divide the initial fireflies into several subgroups, and exchange the information based on communication strategies among subgroups after the fixed iteration. The communication strategies include the maximum of the same group, the average of the same group, the maximum of different groups and the average of different groups. For verifying its performance, this paper compared DPFA with famous optimization algorithms, and experimental results show that DPFA has stronger competitiveness under the test suite of CEC2013. Furthermore, the proposed DPFA is also applied to the PID parameter tuning of variable pitch wind turbine, and conducted experiments show that DPFA outperforms other algorithms. It can smooth the power output and reduce the impact on the power grid when the wind speed fluctuates.

Talking About Dog and Cat Nutrition with Clients

Veterinary health care teams understand that acceptance of, and adherence to, dietary recommendations by clients depends on effective, continuous communication. Despite decades of available research and training, and the availability of numerous balanced commercial, balanced homemade, and veterinary therapeutic diets, our collective ability across the profession to consistently help clients change behaviors and feeding practices to improve patient health remains difficult. Based on the long-standing, evidence-based approach of motivational interviewing, a paradigm shift is suggested for veterinary health care teams to empower clients to make their own arguments for change and take positive action for the health of their pet.

Forest bioeconomy in the media discourse in Spain

Media can play a key role in shaping public opinion and setting a policy agenda by conveying and influencing public discourse. This article evaluates how the Spanish media has covered the topic of the forest bioeconomy and what kind of discourse it has produced and reproduced around it. For this purpose, we analysed the content of 204 national and regional newspaper articles. The results reveal the scarce penetration of the forest bioeconomy in media and some weaknesses in the narrative production and communicative dimension. The discourse is mainly constructed by governments with a limited presence of multiple stakeholders and an absence of conflict and divergent or alternative views. In addition, the discourse only addresses regional or local problems within the framework of an extended and dominant paradigm of economic growth considering the forest bioeconomy as an opportunity to combat fire, rural abandonment, smallholdings, and poor forest management. We conclude that media is not using its strategic potential and capacity as a public space. To become agents of change, the media should reflect a forest bioeconomy based on successful experiences of innovation and valorization, and adopt a transformative social vision that gives relevance to the interconnection between multiple stakeholders, forest multifunctionality and rural development.

Development of the Communication and Acceptance Scale (CAS) for group aural rehabilitation

OBJECTIVE

The aim of the current study was to develop a reliable instrument for the Active Communication Education (ACE) programme evaluating changes in communication strategies and the emotional consequences, knowledge and acceptance of hearing loss and to examine its reliability and face, content and construct validity.

DESIGN

Semistructured interviews and questionnaires were conducted with participants and clinicians engaged in the ACE intervention.

STUDY SAMPLE

The psychometric properties were evaluated in two phases for two samples of adults with hearing loss who participated in the ACE programme, including 61 and 41 participants, respectively.

RESULTS

The final Communication and Acceptance Scale (CAS) contained 18 items, and the reliability of the overall scale (Cronbach's alpha 0.86) and the test-retest reliability (r = 0.89, p < 0.001) were good. The construct validity, evaluated with principal component analysis, suggested a five-factor solution explaining 72% of the variance. The questionnaire revealed statistically significant short- and long-term effects of the ACE programme. Both participants and clinicians found the questionnaire relevant, useful and easy to administer.

CONCLUSION

The CAS questionnaire was found to be valid and reliable, but because of the low sample size, further analysis with a larger population is needed.

Factors influencing the need for recovery in employees with hearing loss: a cross-sectional study of health administrative data

Objective

Need for recovery is a predictor of work stress and health problems, but its underlying factors are not yet well understood. We aimed to identify hearing-related, work-related, and personal factors influencing need for recovery in hearing-impaired employees.

Methods

We retrospectively identified hearing-impaired employees (N = 294) that were referred to the Amsterdam University Medical Center between 2004 and 2019. Routinely obtained healthcare data were used, including a survey and hearing assessments. A directed acyclic graph was constructed, revealing the hypothesized structure of factors influencing need for recovery as well as the minimal set of factors needed for multiple regression analysis.

Results

Four variables were included in the regression analysis. In total, 46.1% of the variance in need for recovery was explained by the factors feeling that something should change at work (B = 19.01, p < 0.001), self-perceived listening effort (B = 1.84, p < 0.001), personal adaptations scale score (B = − 0.34, p < .001), and having a moderate/poor general health condition (B = 20.06, p < 0.001). Although degree of hearing loss was associated with self-perceived listening effort, the direct association between degree of hearing loss and need for recovery was not significant.

Conclusions

The results suggest that the way employees perceive their hearing loss and how they cope with it directly influence need for recovery, rather than their measured degree of hearing loss. Additionally, general health condition was found to be an independent factor for need for recovery. The results should be confirmed by future, longitudinal research.

Paid worker and unfamiliar partner communication training: A scoping review

BACKGROUND

Communication partner training could be employed to train people working in the community to facilitate interaction with individuals who live with a variety of communication disorders. However, current evidence syntheses are limited to a single disorder (e.g., aphasia) and focus on a variety of familiar and unfamiliar communication partners. An understanding of the scope of literature across the evidence-base of acquired neurological populations may provide a better basis to develop interventions and future research tailored for community workers.

AIMS

To explore the scope of literature on paid worker and unfamiliar partner communication training for acquired neurogenic communication disorders with a focus on describing: 1) the types of communication disorders addressed by interventions; 2) the types of learners who received the interventions; 3) the nature of the interventions; and 4) the reported effects on trainees and people with a communication disorder.

METHODS & PROCEDURES

A scoping review was conducted. Studies were selected by a systematic keyword search, undertaken through four databases. Eligibility criteria included studies that: (i) reported an intervention directed at paid workers or unfamiliar partners where the primary goal was to improve communication with people with acquired neurogenic communication disorders, (ii) reported original results, (iii) contained quantitative or qualitative data on the effects of the intervention, (iv) were written in English or French and (v) were published in a peer-reviewed journal. The PRISMA-ScR was used to guide design and reporting of the scoping review.

RESULTS

Seventy publications met the inclusion criteria. Interventions were mostly disorder-specific and addressed communication with people with dementia, aphasia or traumatic brain injury. 15/70 studies examined training programs that were not restructured to a specific population (e.g., aphasia). Learners were mostly working or studying in the healthcare field and only 2/70 studies included community workers without primarily health training. Sixty different interventions were reported and were mostly delivered by speech-language pathologists. Training varied in terms of duration (a few minutes to 46 h) and content, but many shared training methods (e.g., presentation of theory on communication disorders). Nearly all studies demonstrated positive results, 23/26 studies suggested that paid worker and unfamiliar partner communication training may increase the knowledge of trainees, 24/26 studies suggested that it could improve their confidence when interacting with people with a communication disorder and 44/46 studies suggested that it could improve the trainees' communication abilities.

CONCLUSION

A small developing evidence-base exists for communication training programs for paid and unfamiliar communications partners that focuses beyond a single diagnosis or disorder. However, there is very limited knowledge on interventions for community workers from non-health professions. Future research should focus on the evaluation of existing programs tailored to, or explicitly designed for this context with the aim of identifying active ingredients that lead to improved and sustainable outcomes.

[Public perception of climate change and implications for risk communication]

Man-made climate change is associated with several weather and environmental changes that can influence the extent of certain health risks. The article gives an overview of the challenges of communicating these health risks. Theoretical considerations are linked with the results of a representative population survey, in which 1018 participants aged 14 years and above were polled about their perception of climate change and its associated health risks.According to the survey results, the majority of the population is convinced that climate change is actually taking place. However, the data suggest that respondents regard the topic with psychological distance. Health risks associated with climate change also play a relatively minor role in the participants' perception.The theoretical considerations in connection with the empirical results show that targeted communication measures are needed to enhance awareness of the health risks associated with climate change among the general public. This requires not only a comprehensive provision of information, but also instructions and action plans for the practical implementation of that knowledge. Communication measures should take into account factors that can influence risk perception and the willingness to act. They should also be embedded in a strategic communication concept that allows different target groups to be addressed.

Strategies to reduce diagnostic errors: a systematic review

Background

To evaluate the effectiveness of audit and communication strategies to reduce diagnostic errors made by clinicians.

Methods

MEDLINE complete, CINHAL complete, EMBASE, PSNet and Google Advanced. Electronic and manual search of articles on audit systems and communication strategies or interventions, searched for papers published between January 1990 and April 2017. We included studies with interventions implemented by clinicians in a clinical environment with real patients.

Results

A total of 2431 articles were screened of which 26 studies met inclusion criteria. Data extraction was conducted by two groups, each group comprising two independent reviewers. Articles were classified by communication (6) or audit strategies (20) to reduce diagnostic error in clinical settings. The most common interventions were delivered as technology-based systems n = 16 (62%) and within an acute care setting n = 15 (57%). Nine studies reported randomised controlled trials. Three RCT studies on communication interventions and 3 RCTs on audit strategies found the interventions to be effective in reducing diagnostic errors.

Conclusion

Despite numerous studies on interventions targeting diagnostic errors, our analyses revealed limited evidence on interventions being practically used in clinical settings and a bias of studies originating from the US (n = 19, 73% of included studies). There is some evidence that trigger algorithms, including computer based and alert systems, may reduce delayed diagnosis and improve diagnostic accuracy. In trauma settings, strategies such as additional patient review (e.g. trauma teams) reduced missed diagnosis and in radiology departments review strategies such as team meetings and error documentation may reduce diagnostic error rates over time.

Trial registration

The systematic review was registered in the PROSPERO database under registration number CRD42017067056.

Electronic supplementary material

The online version of this article (10.1186/s12911-019-0901-1) contains supplementary material, which is available to authorized users.

Decision-making at the limit of viability: the Austrian neonatal choice context

BACKGROUND

We aimed to explore the shared decision-making context at the limit of viability (weeks 22-25 of gestation) through analyzing neonatologist's communication strategies with parents and their possible impact on survival and neurodevelopmental impairment (NDI) outcomes.

METHODS

A mixed methods approach was applied where a systematic literature search and in-depth semi-structured interviews with five heads of neonatology departments and one clinical ethicist from the Austrian context were integrated into a literature review. The aim was to identify decision practice models and the choice context specific to Austria.

RESULTS

Professional biases, parental understanding, and the process of information giving were identified as aspects possibly influencing survival and NDI outcomes. Institutions create self-fulfilling prophecies by recommending intensive/palliative care based upon their institutional statistics, yet those vary considerably among high-income countries. Labelling an extremely preterm (EP) infant by the gestational week was shown to skew the estimates for survival while the process of information giving was shown to be subject to framing effect and other cognitive biases.

CONCLUSION

Communication strategies of choice options to parents may have an impact on the way parents decide and hence also on the outcomes of EP infants.

Communication strategies in the prevention of type 2 and gestational diabetes in vulnerable groups: protocol for a scoping review

BACKGROUND

The global prevalence of diabetes mellitus is nearly 9%, with an upward trend in type 2 and gestational diabetes mellitus (T2DM/GDM). Evidence shows that vulnerable groups are affected disproportionally. Therefore, there is an increasing need to implement policies to prevent risk factors for T2DM/GDM and to promote a healthy lifestyle. However, up to now, no gold standard in terms of communication strategies and/or public awareness campaigns is known.

METHODS/DESIGN

We will conduct a systematic scoping review to evaluate communication strategies in the prevention of T2DM/GDM in vulnerable groups. Two reviewers will independently screen the results of the electronic literature search in PubMed, EMBASE, PsycINFO, PSYNDEX, Social Science Citation Index, and CINAHL. Extracted data will be charted, categorized, and summarized.

DISCUSSION

The results will be used to inform the National education and communication strategy on diabetes mellitus in Germany. In particular, the results will be discussed in focus groups of experts to develop recommendations for communication strategies.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO does not register scoping reviews.

The Impact of Communication Strategies on Faculty Members' Readiness for Curricular Change

Curricular change is the "new normal" for medical schools. Assessing faculty readiness, perceptions about the necessity and urgency of change, and confidence in the capacity of the organization to successfully implement the process, have been identified as essential to managing the curricular change process. We used The Medical School's Organizational Readiness for Curriculum Change Questionnaire (MORC) to assess and monitor faculty readiness for change. This 53-item survey uses a 5-point Likert scale to assess 3 factors. This project focused on the seven-item Communication subscale in order to guide the strategy for informing and involving faculty in the curricular change process. The MORC was distributed electronically to full-time faculty in December 2014 (pre-change), August 2016 (mid-change), and September 2017 (post-change). Respondents reported significantly increasing support and positive attitudes about curricular change, supporting the hypothesis that the communication strategies informed by MORC findings had a positive impact on faculty members' perceptions of the process. As the leading faculty concerns reported in the MORC shifted from the merits of change to practical concerns about implementation, we adapted communications to address their priorities. The MORC proved useful in capturing quantitative data on faculty perceptions of curricular change but its value was limited by low response rates and unrepresentative samples. Scientists, full professors and tenure track faculty members were overrepresented in survey respondents. Survey lengths were identified as limiting participation. Our experience supports the development of a shorter version of MORC to retain validity and reliability while potentially increasing response rate.

Factors affecting the implementation of childhood vaccination communication strategies in Nigeria: a qualitative study

BACKGROUND

The role of health communication in vaccination programmes cannot be overemphasized: it has contributed significantly to creating and sustaining demand for vaccination services and improving vaccination coverage. In Nigeria, numerous communication approaches have been deployed but these interventions are not without challenges. We therefore aimed to explore factors affecting the delivery of vaccination communication in Nigeria.

METHODS

We used a qualitative approach and conducted the study in two states: Bauchi and Cross River States in northern and southern Nigeria respectively. We identified factors affecting the implementation of communication interventions through interviews with relevant stakeholders involved in vaccination communication in the health services. We also reviewed relevant documents. Data generated were transcribed verbatim and analysed using thematic analysis.

RESULTS

We used the SURE framework to organise the identified factors (barriers and facilitators) affecting vaccination communication delivery. We then grouped these into health systems and community level factors. Some of the commonly reported health system barriers amongst stakeholders interviewed included: funding constraints, human resource factors (health worker shortages, training deficiencies, poor attitude of health workers and vaccination teams), inadequate infrastructure and equipment and weak political will. Community level factors included the attitudes of community stakeholders and of parents and caregivers. We also identified factors that appeared to facilitate communication activities. These included political support, engagement of traditional and religious institutions and the use of organised communication committees.

CONCLUSIONS

Communication activities are a crucial element of immunization programmes. It is therefore important for policy makers and programme managers to understand the barriers and facilitators affecting the delivery of vaccination communication so as to be able to implement communication interventions more effectively.

A family information brochure and dedicated website to improve the ICU experience for patients' relatives: an Italian multicenter before-and-after study

PURPOSE

Good communication between ICU staff and patients' relatives may reduce the occurrence of post-traumatic stress disorder, anxiety or depression, and dissatisfaction with clinicians. An information brochure and website to meet relatives' needs were designed to explain in technical yet simple terms what happens during and after an ICU stay, to legitimize emotions such as fear, apprehension, and suffering, and to improve cooperation with relatives without increasing staff workload. The main outcomes were improved understanding of prognosis and procedures, and decrease of relatives' anxiety, depression, and stress symptoms.

METHODS

In this prospective multicenter before-and-after study, a self-administered questionnaire was used to investigate relatives' understanding of prognosis, treatments, and organ dysfunction, families' satisfaction, and symptoms of anxiety, depression, and post-traumatic stress.

RESULTS

A total of 551 relatives received questionnaires in nine Italian ICUs; 332 (60%) responded, 144 before and 179 after implementation of the brochure and website. Of the 179 relatives who responded after, 131 (73%) stated they had read the brochure and 34 (19%) reported viewing the website. The intervention was associated with increased correct understanding of the prognosis (from 69 to 84%, p = 0.04) and the therapeutic procedures (from 17 to 28%, p = 0.03). Multivariable analysis, together with non-modifiable factors (relative's gender, education level, relationship to patient, and patient status at ICU discharge), showed the intervention to be significantly associated with a lower incidence of post-traumatic stress symptoms (Poisson coefficient = -0.29, 95% CI -0.52/-0.07). The intervention had no effect on the prevalence of symptoms of anxiety and depression.

CONCLUSION

An information brochure and website designed to meet relatives' needs improved family members' comprehension and reduced their prevalence of stress symptoms.

The Effect of Communication Strategy Training on the Development of EFL Learners' Strategic Competence and Oral Communicative Ability

This study examines the effect of communication strategy instruction on EFL students' oral communicative ability and their strategic competence. In a 14-week English as a Foreign Language (EFL) course (English Use II) based on Communicative Language Teaching approach, 80 learners were divided into two groups. The strategy training group ([Formula: see text]) received CS training based on a training program designed for the purpose of the present research, whereas the control group ([Formula: see text]) received only the normal communicative course using Click On 3, with no explicit focus on CSs. The communication strategies targeted in the training program included circumlocution (paraphrase), appeal for help, asking for repetition, clarification request, confirmation request, self-repair, and guessing. Pre- and post-test procedures were used to find out the effect of strategy training on language proficiency and CS use. The effect of the training was assessed by three types of data collection: the participants' pre- and post-IELTS speaking test scores, transcription data from the speaking IELTS test, and 'Click On' Exit Test scores. The findings revealed that participants in the strategy training group significantly outperformed the control group in their IELTS speaking test scores. The results of the post-test transcription data also confirmed that the participants in the strategy training group used more CSs, which could be attributed to the CS training program. The findings of the present research have implications for language teachers, and syllabus designers.

Improving communication for immunisation in Africa: contribution of the Vaccines for Africa website

ABOUT THE AUTHORS: C. Wiysonge is a medical epidemiologist and Vaccinology Programme Manager at the Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa. He previously worked for the Expanded Programme on Immunisation in Cameroon and has been a consultant on vaccines and immunisation for WHO and the GAVI Alliance. Z. Waggie is a Paediatrician and Senior Clinical Research Officer at the Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa. L. Rhoda is a communications specialist and Communications Manager at the South African Tuberculosis Vaccine Initiative, University of Cape Town, South Africa. G. Hussey is a Paediatric Infectious Diseases Clinical Specialist and Professor of Child and Adolescent Health, Director of the Institute of Infectious Disease and Molecular Medicine, and Director of the South African Tuberculosis Vaccine Initiative, University of Cape Town, South Africa. He has been a WHO part-time consultant on vaccines and immunisation for the past 10 years.