Instrumental and affective communication with patients with limited health literacy in the palliative phase of cancer or COPD

BMC Palliative Care

Liesbeth M. van Vliet¹  Janneke Noordman²  Lotte Schulze²  Ruud Roodbeen³  Sandra van Dulmen⁴  Gudule Boland⁵  Maria van den Muijsenbergh⁶ 

[1] Department of Health, Medical and Neuropsychology, Institute of Psychology, Leiden University, Leiden, Netherlands;Nivel (Netherlands institute for health services research), PO Box 1568, 3500 BN, Utrecht, Netherlands;Nivel (Netherlands institute for health services research), PO Box 1568, 3500 BN, Utrecht, Netherlands;Department of Tranzo Scientific Centre for Care and Well-being, Tilburg University, Tilburg, Netherlands;Nivel (Netherlands institute for health services research), PO Box 1568, 3500 BN, Utrecht, Netherlands;Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, Netherlands;Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway;Pharos, Dutch Centre of Expertise on Health Disparities, Utrecht, Netherlands;Pharos, Dutch Centre of Expertise on Health Disparities, Utrecht, Netherlands;Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, Netherlands;

关键词: Communication;    Limited health literacy;    Palliative care;    Patients;    Healthcare providers;    Cancer;    COPD;   

DOI  :  10.1186/s12904-020-00658-2

来源: Springer

【 摘 要 】

BackgroundPatients have a ‘need to know’ (instrumental need) and a ‘need to feel known’ (affective need). During consultations with patients with limited health literacy (LHL) in the palliative phase of their disease, both the instrumental and the affective communication skills of healthcare providers are important. The study aims to explore instrumental and affective communication between care providers and LHL patients in the palliative phase of COPD or cancer.MethodsIn 2018, consultations between LHL patients in the palliative phase of cancer or COPD and their healthcare providers were video-recorded in four hospitals in the Netherlands. As there was no observation algorithm available for this setting, several items were created to parameterize healthcare providers’ instrumental communication (seven items: understanding, patient priorities, medical status, treatment options, treatment consequences, prognosis, and information about emotional distress) and affective communication (six items: hope, support, reassurance, empathy, appreciation, and emotional coping). The degree of each item was recorded for each consultation, with relevant segments of the observation selected and transcribed to support the items.ResultsConsultations between 17 care providers and 39 patients were video-recorded and analyzed. Care providers primarily used instrumental communication, most often by giving information about treatment options and assessing patients’ care priorities. Care providers assessed patients’ understanding of their disease less often. The patients’ prognosis was not mentioned in half the consultations. Within the affective domain, the care providers did provide support for their patients; providing hope, reassurance, empathy, and appreciation and discussing emotional coping were observed less often.ConclusionsCare providers used mostly instrumental communication, especially treatment information, in consultations with LHL patients in the palliative phase of cancer or COPD. Most care providers did not check if the patient understood the information, which is rather crucial, especially given patients’ limited level of health literacy. Healthcare providers did provide support for patients, but other expressions of affective communication by care providers were less common. To adapt the communication to LHL patients in palliative care, care providers could be less wordy and reduce the amount of information, use ‘teach-back’ techniques and pay more attention to affective communication.

【 授权许可】

CC BY