Communication in pediatric healthcare: a state-of-the-art literature review of conversation-analytic research

Communication is central to pediatric care. Conversation analytic (CA) studies of recorded naturally occurring pediatric interactions contribute distinctive understandings; however, to date there has been no detailed review of CA’s unique contributions. We searched Medline, PsychINFO, Sciencedirect, Google Scholar, and the EM/CA Wiki database, identifying 74 empirical articles across diverse areas of pediatrics. Our state-of-the-art review highlights CA of clinician and caregiver conversations about a child patient, in addition to those involving the child. The findings have the potential to enhance clinical practice by illuminating how healthcare tasks are practically accomplished and enrich our knowledge of children’s participation in consultations by revealing the mechanisms that constrain and enable their involvement. We call for better synthesis of findings with broader CA literature (e.g., nonclinical child interactions, adult triadic clinical encounters, and fundamental knowledge of social interaction). We appeal for increased support for scholarly work in non-Western settings, and emphasize scope for applied initiatives. The data reported are in multiple languages. </p

Using physical objects with young children in ‘face-to-face’ and telehealth speech and language therapy

<p><b>Purpose:</b> Speech language therapists increasingly are using telehealth to enhance the accessibility of their services. It is unclear, however, how play-based therapy for children can be delivered via telehealth. In particular, modalities such as videoconferencing do not enable physical engagement between therapists and clients. The aim of our reported study was to understand how physical objects such as toys are used in similar and different ways across videoconferenced and “face-to-face” (hereafter, “in-person”) therapy.</p> <p><b>Methods:</b> We used conversation analytic methods to compare video-recorded therapy sessions for children delivered across in-person and telehealth settings. Utilising a broader corpus of materials, our analysis focused on four client–therapist dyads: two using videoconferencing, and two who met in-person.</p> <p><b>Results:</b> Both videoconferencing and in-person sessions enabled routine affordances and challenges for delivering therapy. Within in-person therapy, therapists made access to objects contingent upon the client producing some target expression. This contingency usually was achieved by restricting physical access to these objects. Restricting access to a toy was not necessary in videoconferenced therapy; therapists instead used techniques to promote engagement.</p> <p><b>Conclusions:</b> When delivering play-based therapy via telehealth, our study demonstrates how practitioners adapt the intervention to suit the particular medium of its delivery.Implications for Rehabilitation</p><p>Telehealth enhances equitable access for those who cannot physically access rehabilitation services.</p><p>Telehealth modalities can create practical challenges, however, when delivering interventions such as play-based therapy.</p><p>Practitioners should intentionally adapt telehealth interventions to suit the particular telehealth modality they are using.</p><p></p> <p>Telehealth enhances equitable access for those who cannot physically access rehabilitation services.</p> <p>Telehealth modalities can create practical challenges, however, when delivering interventions such as play-based therapy.</p> <p>Practitioners should intentionally adapt telehealth interventions to suit the particular telehealth modality they are using.</p

Communicating with patients and families about illness progression and end of life: a review of studies using direct observation of clinical practice

Background: There is growing recognition that a diverse range of healthcare professionals need competence in palliative approaches to care; effective communication is a core component of such practice. This article informs evidence-based communication about illness progression and end of life through a rapid review of studies that directly observe how experienced clinicians manage such discussions. Methods: The current rapid review updates findings of the 2014 systematic review focussing more specifically on evidence related to illness progression and end-oflife conversations. Literature searches were conducted in nine bibliographic databases. Studies using conversation analysis or discourse analysis to examine recordings of actual conversations about illness progression or end of life were eligible for inclusion in the review. An aggregative approach was used to synthesise the findings of included studies. Results: Following screening, 26 sources were deemed to meet eligibility criteria. Synthesis of study findings identified the structure and functioning of ten communication practices used in illness progression and end-of-life discussions. Conclusion: The ten practices identified underpin five evidence-based recommendations for communicating with patients or family members about illness progression and end of life

Datasheet2_Communication and access to healthcare: Experiences of Aboriginal and Torres Strait Islander people managing pain in Queensland, Australia.pdf

BackgroundPain management requires a multidisciplinary approach and a collaborative relationship between patient-provider in which communication is crucial. This study examines the communication experiences of Aboriginal and Torres Strait Islander patients and Aboriginal and Torres Strait Islander Hospital Liaison Officers (ATSIHLOs), to improve understanding of how pain is managed in and through patient-health professional communication.MethodsThis qualitative study involved a purposive sample of patients attending three persistent pain clinics and ATSIHLOs working in two hospitals in Queensland, Australia. Focus groups and in-depth interviews explored the communication experiences of patients managing pain and ATSIHLOs supporting patients with pain. This study adopted a descriptive phenomenological methodology, as described by Colaizzi (1978). Relevant statements (patient and ATSIHLOs quotes) about the phenomenon were extracted from the transcripts to formulate meanings. The formulated meanings were subsequently sorted into thematic clusters and then integrated into themes. The themes were then incorporated into a concise description of the phenomenon of communication within pain management. Findings were validated by participants.ResultsA total of 21 Aboriginal and Torres Strait Islander participants were involved in this study. Exploration of the communication experiences of patients and ATSIHLOs revealed overlapping themes of important barriers to and enablers of communication that affected access to care while managing pain. Acknowledging historical and cultural factors were particularly important to build trust between patients and health professionals. Some patients reported feeling stigmatized for identifying as Aboriginal and Torres Strait Islander, while others were reluctant to disclose their background for fear of not having the same opportunity for treatment. Differences in the expression of pain and the difficulty to use standard pain measurement scales were identified. Communication was described as more than the content delivered, it is visual and emotional expressed through body language, voice intonation, language and the speed of the conversation.ConclusionCommunication can significantly affect access to pain management services. Aboriginal and Torres Strait Islander patients highlighted the burden of emotional pain caused by historical factors, negative stereotypes and the fear of discrimination. Pain management services and their health professionals need to acknowledge how these factors impact patients trust and care.</p

Datasheet1_Communication and access to healthcare: Experiences of Aboriginal and Torres Strait Islander people managing pain in Queensland, Australia.pdf

BackgroundPain management requires a multidisciplinary approach and a collaborative relationship between patient-provider in which communication is crucial. This study examines the communication experiences of Aboriginal and Torres Strait Islander patients and Aboriginal and Torres Strait Islander Hospital Liaison Officers (ATSIHLOs), to improve understanding of how pain is managed in and through patient-health professional communication.MethodsThis qualitative study involved a purposive sample of patients attending three persistent pain clinics and ATSIHLOs working in two hospitals in Queensland, Australia. Focus groups and in-depth interviews explored the communication experiences of patients managing pain and ATSIHLOs supporting patients with pain. This study adopted a descriptive phenomenological methodology, as described by Colaizzi (1978). Relevant statements (patient and ATSIHLOs quotes) about the phenomenon were extracted from the transcripts to formulate meanings. The formulated meanings were subsequently sorted into thematic clusters and then integrated into themes. The themes were then incorporated into a concise description of the phenomenon of communication within pain management. Findings were validated by participants.ResultsA total of 21 Aboriginal and Torres Strait Islander participants were involved in this study. Exploration of the communication experiences of patients and ATSIHLOs revealed overlapping themes of important barriers to and enablers of communication that affected access to care while managing pain. Acknowledging historical and cultural factors were particularly important to build trust between patients and health professionals. Some patients reported feeling stigmatized for identifying as Aboriginal and Torres Strait Islander, while others were reluctant to disclose their background for fear of not having the same opportunity for treatment. Differences in the expression of pain and the difficulty to use standard pain measurement scales were identified. Communication was described as more than the content delivered, it is visual and emotional expressed through body language, voice intonation, language and the speed of the conversation.ConclusionCommunication can significantly affect access to pain management services. Aboriginal and Torres Strait Islander patients highlighted the burden of emotional pain caused by historical factors, negative stereotypes and the fear of discrimination. Pain management services and their health professionals need to acknowledge how these factors impact patients trust and care.</p

Supplemental Material - Yarning about pain: Evaluating communication training for health professionals at persistent pain services in Queensland, Australia

Supplemental Material for Yarning about pain: Evaluating communication training for health professionals at persistent pain services in Queensland, Australia by Christina M Bernardes, Stuart Ekberg, Stephen Birch, Andrew Claus, Matthew Bryant, Renata Meuter, Jermaine Isua, Paul Gray, Joseph P Kluver, Eva Malacova, Corey Jones, Kushla Houkamau, Marayah Taylor, Ivan Lin and Gregory Pratt in British Journal of Pain</p