Nicole Agaronnik1, Eric G Campbell2, Julie Ressalam2, Lisa I Iezzoni3,4. 1. Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston, MA, USA. 2. Center for Bioethics and Humanities, University of Colorado School of Medicine, Aurora, CO, USA. 3. Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston, MA, USA. liezzoni@mgh.harvard.edu. 4. Department of Medicine, Harvard Medical School, Boston, MA, USA. liezzoni@mgh.harvard.edu.
Abstract
BACKGROUND: Patient-centered care for people with disability requires effective communication and compliance with the Americans with Disabilities Act (ADA). OBJECTIVE: To understand physicians' perspectives on communication experiences with people with disability. DESIGN: Twenty semi-structured individual interviews. Interview recordings were transcribed verbatim for analysis. SETTING: Massachusetts, October 2017-January 2018. PARTICIPANTS: Twenty physicians ranging from 8 to 51 years in practice in primary care or 4 other specialties. MEASUREMENTS: Commonly expressed themes around communication with people with disability. RESULTS: Concerns coalesced around 4 broad categories: communication experiences with people who are deaf or hard of hearing, communication with people who are blind or have vision impairment, communication with people who have intellectual disability, and recommendations for improving communication. Although participants in this study reported various efforts to communicate effectively with patients with hearing or vision loss or intellectual disability, many gaps appear to remain, as well as instances where physicians' preferences run counter to patients' wishes and the ADA. Examples include physicians' preferences for remote, online sign language interpreters despite patients desiring in-person interpreters and suggesting that patients arrange for their own interpreters. Few educational materials are available in braille, and electronic medical records may not allow documents to be printed in large font for persons with low vision. Communicating with patients with intellectual disability raised particular concerns, with participants often preferring to interact with caregivers and minimal efforts to involve patients. CONCLUSIONS: Effective communication is necessary for ensuring the quality of health care for people with disability, and it is legally required under the ADA. Our results suggest that important gaps may remain in ensuring effective communication, and some practicing physicians could benefit from formal training in effective methods for communicating with patients with disability.
BACKGROUND:Patient-centered care for people with disability requires effective communication and compliance with the Americans with Disabilities Act (ADA). OBJECTIVE: To understand physicians' perspectives on communication experiences with people with disability. DESIGN: Twenty semi-structured individual interviews. Interview recordings were transcribed verbatim for analysis. SETTING: Massachusetts, October 2017-January 2018. PARTICIPANTS: Twenty physicians ranging from 8 to 51 years in practice in primary care or 4 other specialties. MEASUREMENTS: Commonly expressed themes around communication with people with disability. RESULTS: Concerns coalesced around 4 broad categories: communication experiences with people who are deaf or hard of hearing, communication with people who are blind or have vision impairment, communication with people who have intellectual disability, and recommendations for improving communication. Although participants in this study reported various efforts to communicate effectively with patients with hearing or vision loss or intellectual disability, many gaps appear to remain, as well as instances where physicians' preferences run counter to patients' wishes and the ADA. Examples include physicians' preferences for remote, online sign language interpreters despite patients desiring in-person interpreters and suggesting that patients arrange for their own interpreters. Few educational materials are available in braille, and electronic medical records may not allow documents to be printed in large font for persons with low vision. Communicating with patients with intellectual disability raised particular concerns, with participants often preferring to interact with caregivers and minimal efforts to involve patients. CONCLUSIONS: Effective communication is necessary for ensuring the quality of health care for people with disability, and it is legally required under the ADA. Our results suggest that important gaps may remain in ensuring effective communication, and some practicing physicians could benefit from formal training in effective methods for communicating with patients with disability.
Entities:
Keywords:
Americans with Disabilities Act; blind; communication; deaf; disability; hard of hearing; intellectual disability; vision impairment
Authors: Nili Amir; Lauren D Smith; Anne M Valentine; Monika Mitra; Susan L Parish; Tiffany A Moore Simas Journal: Disabil Health J Date: 2021-12-17 Impact factor: 2.554
Authors: Lisa I Iezzoni; Sowmya R Rao; Julie Ressalam; Dragana Bolcic-Jankovic; Nicole D Agaronnik; Tara Lagu; Elizabeth Pendo; Eric G Campbell Journal: Health Aff (Millwood) Date: 2022-01 Impact factor: 6.301
Authors: Lisa I Iezzoni; Sowmya R Rao; Julie Ressalam; Dragana Bolcic-Jankovic; Nicole D Agaronnik; Karen Donelan; Tara Lagu; Eric G Campbell Journal: Health Aff (Millwood) Date: 2021-02 Impact factor: 6.301
Authors: Lindsay L Shea; Alec Becker; Brian K Lee; Kaitlin Koffer Miller; Dylan Cooper; Kristy Anderson; Mark S Salzer; David J Vanness Journal: Vaccine Date: 2022-04-22 Impact factor: 4.169
Authors: Lisa I Iezzoni; Sowmya R Rao; Julie Ressalam; Dragana Bolcic-Jankovic; Karen Donelan; Nicole Agaronnik; Tara Lagu; Eric G Campbell Journal: Jt Comm J Qual Patient Saf Date: 2021-06-23