Cost-effectiveness of peer role play and standardized patients in undergraduate communication training.

BACKGROUND The few studies directly comparing the methodological approach of peer role play (RP) and standardized patients (SP) for the delivery of communication skills all suggest that both methods are effective. In this study we calculated the costs of both methods (given comparable outcomes) and are the first to generate a differential cost-effectiveness analysis of both methods. METHODS Medical students in their prefinal year were randomly assigned to one of two groups receiving communication training in Pediatrics either with RP (N = 34) or 19 individually trained SP (N = 35). In an OSCE with standardized patients using the Calgary-Cambridge Referenced Observation Guide both groups achieved comparable high scores (results published). In this study, corresponding costs were assessed as man-hours resulting from hours of work of SP and tutors. A cost-effectiveness analysis was performed. RESULTS Cost-effectiveness analysis revealed a major advantage for RP as compared to SP (112 vs. 172 man hours; cost effectiveness ratio .74 vs. .45) at comparable performance levels after training with both methods. CONCLUSIONS While both peer role play and training with standardized patients have their value in medical curricula, RP has a major advantage in terms of cost-effectiveness. This could be taken into account in future decisions.

Doctor-patient communication in the medical interaction: Context, implications, and practice

Effective communication; whether from an interpersonal, mass media, or global perspective, is a critical component in public health. It is an essential conduit in increasing public awareness of available health resources, potential health hazards and related disease prevention strategies, and in delivering better health care. Within this context, available literature asserts doctor-patient communication as central to healthcare delivery. It has been shown to affect patient health outcomes, satisfaction with care, adherence to treatment recommendations, and even understanding of medical information. While research supports the essential imperative of interventions aimed at teaching doctors and patients the communication skills necessary for a successful and meaningful medical interaction, most interventions to date, focus on teaching these communication skills to doctors and seem to rely, largely, on mass media for providing patients with the information needed to increase communication efficacy. This study sought to fill a significant gap in the doctor-patient communication literature by reviewing the context of the doctor-patient exchange in the medical interaction, the implications of this exchange in resulting care of the patient, and the potential improvements to practice through interventions aimed at improving the communication exchange. Closing with an evaluation of a patient-centered communication intervention, the “How to Talk to Your Doctor” (HTTTYD) program that combines previously identified optimal strategies for improving communication between doctors and patients, this study examined the patients’ perspective of their potential as better communicators in the medical interaction. ^ Specific Aims, Hypotheses or Questions (Aim I) To examine the context of health communication within a public health framework and its relation to health care delivery. (Aim II) To review doctor-patient communication as a central focus within health care delivery and the resulting implications to patient care. (Aim III) To assess the utility of interventions to improve doctor-patient communication. Specifically, to evaluate the effectiveness of a patient-centered community education intervention, the “How to Talk to Your Doctor” (HTTTYD) program, aimed at improving patient communication efficacy.^

Interpersonal relations and nurses' job satisfaction through knowledge and usage of relational skills

Background/rationale: Many interpersonal labor disputes stem from the lack of communication skills and the relational problems in the interactions between health professionals. Aims/methods: A qualitative study was conducted in a Spanish hospital in order to get to know how the communicative interaction between hospital nurses is like in relation to the nurses' interpersonal interaction and communication skills developed in their working relationships. Twenty-one hospital nurses between 29 and 55 years old, working in different wards, were interviewed. Open-ended interview discourses were transcribed verbatim and analyzed using qualitative content analysis. Results: The following four key themes were analyzed: communication and sender; communication and awareness of who has the problem; non-verbal communication; communication and recipient. Conclusion: The results of this study highlight the need to broaden nurses' relational–communication skills in order to increase job satisfaction.

Improving supportive care for women with breast cancer in Australia: The challenge of modifying health systems

Although the benefits of many psychosocial support strategies in improving well being in women with breast cancer have been demonstrated, few women receive these programs as part of routine care. This paper provides some recommendations, based on experience in Australia, about how access to evidence-based supportive care strategies might be improved through modification of health systems. It demonstrates the paucity of research about the costs and health service implications of psychosocial support strategies, which is vital to health planning and service delivery change. It outlines the systematic approach taken in Australia to improving psychosocial support nationally by: the development of research reviews; preparation of guidelines about supportive care, implementation of programs to foster the adoption of guidelines through modification of policy, health service delivery and clinician training; and monitoring programs. Coalitions of government, health care professionals and consumers are key to effective lobbying for change. If all women with breast cancer are to receive better supportive care, there is a need for approaches which: refocus the research effort in psycho-oncology; develop more strategic approaches to generating change in health systems and health policy and foster partnerships to advocate for improved resources. Copyright (C) 2003 John Wiley Sons, Ltd.

Trust me, I'm your boss: Trust and power in supervisor-supervisee communication

This study examined employees' perceptions of trust, power and mentoring in manager-employee relationships in a variety of sectors, including health care, education, hospitality and retail. The main theoretical frameworks used were communication accommodation theory and social identity theory, in examining the manager-employee relationships from an in-group/out-group perspective. Computer-aided content analyses revealed a number of emergent communication and relationship themes that impact upon the level of 'in-groupness' and therefore trust in supervisor-supervisee relationships. While it may be illusory to believe that any organization can enjoy complete trust among its workforce, it is clear that certain communication characteristics can result in greater trust in manager-employee relationships, even within the context of organizational constraints. It is argued that the results of the study could be used to inform human resource management academics of key aspects of managerial communication that should be further researched, and also provide insights into the main communication skills that managers should focus upon to improve trust in the workplace.

Evaluating parent use of functional communication training to replace and enhance prelinguistic behaviours in six children with developmental and physical disabilities

Purpose: To evaluate parent use of functional communication training (FCT) to replace and enhance prelinguistic behaviours in six young children with developmental and physical disabilities. Method: Initially, the communicative functions of the children's prelinguistic behaviours were assessed by parent interviews. Three communication functions were identified for each child and intervention goals to replace or enhance the child's existing prelinguistic behaviours were developed in consultation with parents. After a baseline phase, parents received training on implementation of FCT. Intervention was staggered across the three communicative functions in a multiple-probe design. Results: Intervention was associated with increases in the replacement communication behaviour. Treatment gains were generally maintained at the monthly follow-ups. Conclusion: The results suggest that parents can use FCT to enhance communication skills in children with developmental and physical disabilities.

Crisis management and risk communication: Why the food industry must get it right

There is public unease about food-related issues including food additives, food poisoning bacteria and GM ingredients. The public wants evidence of no risks, but all regulators can ever offer is no evidence of risk or evidence of a very small risk. The situation is complex because experts and non-experts can perceive the same risk in vastly different ways. The way in which the food industry manages crises and communicates risks will determine the public acceptance and success of new technologies such as GM foods and nanomaterials. There is a need for the food industry (including regulators and scientific experts) to sharpen up their risk communication skills to ensure that technical innovations are accepted by consumers, and crises such as food recalls do not undermine the public's confidence in the food industry. The AIFST has a key role to play in driving the risk communication process and allaying public unease about food-related issues.

Challenges of Teaching Written Communication in the Cloud

Report published in the Proceedings of the National Conference on "Education and Research in the Information Society", Plovdiv, May, 2014

Mand – to Tact Training Transfer Acquisition Rates in Children Diagnosed with Autism Spectrum Disorder with Limited Verbal Skills

Autism Spectrum Disorder () is defined as “the presence of severe and pervasive impairments in reciprocal social interaction and in verbal and nonverbal communication skills” (Diagnostic & Statistical Manual, 2000). It is estimated that 1 in 68 children across the United States are diagnosed with ASD. One of the most common delays that children diagnosed with ASD experience are language delays. Children with ASD that have a language delay will often develop maladaptive behaviors as a result of poor communication skills (Carr & Durand, 1985). The failure to develop mand acquisition in typical fashion results in behaviors ranging from social withdrawal to self-injurious behaviors (Cooper et. al, 2007). A lack of a strong tact repertoire can further impede and complicate the learning of other necessary components of language due to the inability to successfully label items and events in the physical environment of the child. The purpose of this study is to replicate with a reversal in verbal operant training of the procedures described in Wallace et al. (2006) in which two children with ASD underwent tact training to facilitate the formation of mands; essentially this study aims to accomplish mand training first to establish as tact. It is hypothesized that mand training will result in a greater repertoire of tacts due to strength of the relationship between mands and the control over the social environment (Cooper et al., 2007). The two children in the study will be taught to mand items that will be ranked in order of preference via stimulus preference assessment. This study is of great importance due to the indispensable value of effective social communication skills. Data gathered on improving communication skills is of great value to the ASD community as the implications for functional skills result in better communication with family and greater control of individual functioning.

Mand – to Tact Training Transfer Acquisition Rates in Children Diagnosed with Autism Spectrum Disorder with Limited Verbal Skills

Autism Spectrum Disorder () is defined as “the presence of severe and pervasive impairments in reciprocal social interaction and in verbal and nonverbal communication skills” (Diagnostic & Statistical Manual, 2000). It is estimated that 1 in 68 children across the United States are diagnosed with ASD. One of the most common delays that children diagnosed with ASD experience are language delays. Children with ASD that have a language delay will often develop maladaptive behaviors as a result of poor communication skills (Carr & Durand, 1985). The failure to develop mand acquisition in typical fashion results in behaviors ranging from social withdrawal to self-injurious behaviors (Cooper et. al, 2007). A lack of a strong tact repertoire can further impede and complicate the learning of other necessary components of language due to the inability to successfully label items and events in the physical environment of the child. The purpose of this study is to replicate with a reversal in verbal operant training of the procedures described in Wallace et al. (2006) in which two children with ASD underwent tact training to facilitate the formation of mands; essentially this study aims to accomplish mand training first to establish as tact. It is hypothesized that mand training will result in a greater repertoire of tacts due to strength of the relationship between mands and the control over the social environment (Cooper et al., 2007). The two children in the study will be taught to mand items that will be ranked in order of preference via stimulus preference assessment. This study is of great importance due to the indispensable value of effective social communication skills. Data gathered on improving communication skills is of great value to the ASD community as the implications for functional skills result in better communication with family and greater control of individual functioning.

The impact of income and social status on population health: a scenario based simulation for nursing students

The development of critical thinking and communication skills is an essential part of Baccalaureate and Practical Nursing education. Scenario-based simulation, a form of experiential learning, directly engages students in the learning process. This teaching learning method has been shown to increase students’ understanding of the influence of their personal beliefs and values when working with clients and to improve therapeutic communication and critical thinking skills. Students in both the BN (Collaborative) and PN Programs at the Centre for Nursing Studies demonstrate a strong theoretical understanding of the impact of income and social status on population health but often experience difficulty applying this knowledge to the clinical situations involving clients and families. The purpose of the project was to develop a scenario-based simulation activity to provide nursing students with first-hand experiences of the impact of income and social status on health service accessibility. A literature review and stakeholder consultations were conducted to inform the project. The findings of these initiatives and Kolb’s Experiential Learning Theory were used to guide all aspects of the project. This report is an account of how the income and social status simulation and its accompanying materials were developed. This project provided an excellent learning opportunity that demonstrated the use of advanced nursing competencies.

Communication and behavior in high reliability organizations: An Analysis of Communication in Civil Aviation

Communication can be seen as one of the most important features to manage conflicts and the stress of the work teams that operate in environments with strong pressure, complex operations and continuous risk, which are aspects that characterize a high reliability organization. This article aims to highlight the importance of communication in high-reliability organizations, having as object of study the accidents and incidents in civil aviation area. It refers to a qualitative research, outlined by documental analysis based on investigations conducted by the Federal Aviation Administration and the Center of Investigation and Prevention of Aeronautical Accidents. The results point out that human errors account for 60 to 80 percent of accidents and incidents. Most of these occurrences are attributed to miscommunication between the professionals involved with the air and ground operation, such as pilots, crewmembers and maintenance staff, and flight controllers. Inappropriate tone of voice usage, difficulties to understand different accents between the issuer and the receiver or even difficulty to perceive red flags between the lines of verbal and non-verbal communication, are elements that contribute to the fata of understanding between people involved in the operation. As a research limitation this present research pointed out a lack of a special category of "interpersonal communications failures" in the official agency reports. So, the researchers must take the conceptual definition of "social ability", communication implied, to classify behaviors and communication matters accordingly. Other research finding indicates that communication is superficially approached in the contents of air operations courses what could mitigate the lack of communications skills as a social ability. Part of the research findings refers to the contents of communication skills development into the program to train professional involved in air flight and ground operations. So, it is expected that this present article gives an appropriate highlight towards the improvement of flight operations training programs. Developing communication skills among work teams in high reliability organizations can contribute to mitigate stress, accidents and incidents in Civil Aviation Field. The original contribution of this article is the proposal of the main contents that should be developed in a Communication Skills Training Program, specially addressed to Civil Aviation operations.

Cancer diagnosis disclosure from Portuguese physicians

OBJECTIVE: Doctor-patient communication in oncology, particularly concerning diagnostic disclosure, is a crucial factor related to the quality of the doctor-patient relationship and the psychological state of the patient. The aims of our study were to investigate physicians' opinions and practice with respect to disclosure of a cancer diagnosis and to explore potential related factors. METHOD: A self-report questionnaire developed for our study was responded to by 120 physicians from Coimbra University Hospital Centre and its primary healthcare units. RESULTS: Some 91.7% of physician respondents generally disclosed a diagnosis, and 94.2% were of the opinion that the patient knowing the truth about a diagnosis had a positive effect on the doctor-patient relationship. A need for training about communicating with oncology patients was reported by 85.8% of participants. The main factors determining what information to provide to patients were: (1) patient intellectual and cultural level, (2) patient desire to know the truth, and (3) the existence of family. SIGNIFICANCE OF RESULTS: Our results point to a paradigm shift in communication with cancer patients where disclosure of the diagnosis should be made part of general clinical practice. Nevertheless, physicians still experience difficulties in revealing cancer diagnoses to patients and often lack the skills to deal with a patient's emotional responses, which suggests that more attention needs to be focused on communication skills training programs.

Promoting the 6Cs of Nursing in Patient Assessment

Recognising the deteriorating patient is an essential nursing skill, and structured frameworks should be in place to assist effective patient assessment. The aim of this article is to encourage nurses to consider how to promote the 6Cs of nursing within such assessment. The article provides an overview of the Patient Assessment and Clinical reasoning Tool designed to facilitate the development of clinical reasoning skills and effective communication with other healthcare professionals, therebyenhancing patientcentred care.

Cancer diagnosis disclosure from Portuguese physicians

OBJECTIVE: Doctor-patient communication in oncology, particularly concerning diagnostic disclosure, is a crucial factor related to the quality of the doctor-patient relationship and the psychological state of the patient. The aims of our study were to investigate physicians' opinions and practice with respect to disclosure of a cancer diagnosis and to explore potential related factors. METHOD: A self-report questionnaire developed for our study was responded to by 120 physicians from Coimbra University Hospital Centre and its primary healthcare units. RESULTS: Some 91.7% of physician respondents generally disclosed a diagnosis, and 94.2% were of the opinion that the patient knowing the truth about a diagnosis had a positive effect on the doctor-patient relationship. A need for training about communicating with oncology patients was reported by 85.8% of participants. The main factors determining what information to provide to patients were: (1) patient intellectual and cultural level, (2) patient desire to know the truth, and (3) the existence of family. SIGNIFICANCE OF RESULTS: Our results point to a paradigm shift in communication with cancer patients where disclosure of the diagnosis should be made part of general clinical practice. Nevertheless, physicians still experience difficulties in revealing cancer diagnoses to patients and often lack the skills to deal with a patient's emotional responses, which suggests that more attention needs to be focused on communication skills training programs.