Quality clinical audiologic care begins with effective communication with patients. Effective communication includes accurate understanding of the patient's questions, concerns, and needs as well as communicating in a way that enhances patient understanding, compliance, and satisfaction. These aspects of communication are essential to obtaining appropriate clinical outcomes.
There is no single correct way to communicate with patients; research on communication skills has not resolved all the specific issues related to various communication methodologies. However, it is clear that audiologists are responsible for fostering communication to provide high-quality care, establish and maintain interaction with their patients, provide timely information, assist in reducing patient anxiety, achieve compliance in the follow-up process, create realistic expectations, and maintain basic fundamental communication for legal and ethical purposes.
Understanding Learning Styles
An audiologist can improve the patient's comprehension of information presented during a clinical visit and foster the patient's success in following up on recommendations by understanding the patient's learning style. This understanding can determine how to disseminate information to ensure better patient comprehension and treatment outcomes. There are several methods and questionnaires that help determine learning style.
The Index of Learning Styles Questionnaire (Solomon & Felder, 1991) is a 44-item open-access Web-based questionnaire designed to identify a person's four pairs of learning styles. Although individuals may have learning style tendencies toward one component of each pair listed below, they usually benefit from information presented using all four learning styles. The four pairs are presented with explanations from the Web site adapted to interactions between audiologists and patients. Additional information and comprehensive explanations of the learning pairs and the analysis of the results are available on the Web sites listed in the reference at the end of the article.
Some individuals are strong at actively discussing or applying information; others prefer to reflect on newly presented information. These types of learning styles often are demonstrated in the clinic. One patient may ask many questions and prefer to see visuals; another patient may review the report, consider the information provided, and contact the clinician in the future. The latter patient will go home and ponder the recommendations. These active and passive learners need to gain knowledge in different ways. The audiologist should not try to not push an active listener to be reflective or vice versa.
Sensing learners want to know the facts of the situation. Intuitive learners prefer exploring relationships between what they know and what they've learned. Analogies are often helpful when talking with intuitive learners.
Visual learners prefer pictures, photos, charts, videos, and demonstrations. Verbal learners get more out of written and spoken explanations. Most people learn more quickly and with greater understanding when information is presented in a multisensory way. Using the patient's primary learning style with other inputs is most effective.
Sequential learners tend to gain understanding in linear steps, with each step logically following the previous one. Global thinkers do not learn sequentially; they learn by gathering bits and pieces of information in what may appear to be a random fashion and then understand the message.
Most audiologists cannot take time to administer a 44-item questionnaire to determine a patient's preferred learning styles, but taking a minute to ask direct questions that relate to learning styles can save time over the course of a relationship with the patient. Some questions to ask when assessing learning styles include:
- Would you like to take notes or just listen?
- Do you want to take these handouts and graphs that will explain what we will talk about?
- Do you want to see pictures of what is going on?
- Do you want me to tell you how your concerns are connected to your hearing?
- Would you like some Web sites to refer to?
- Do you want me to discuss this in detail now or would you like to set up another meeting later?
Observing the patient and family in the early stages of the appointment also can provide valuable insight into how they will learn from you. Some patients will gravitate toward a poster or pick up a brochure. Other patients may touch a three-dimensional model of the ear or comment on a video in the waiting room.
Your observations and the answers to the questions can help you determine what kind of learning styles the patient or family member uses to grasp the information and help you present information in a manner that is most effective for the patient.
Another component of effective patient communication is the use of plain language. A health literacy survey of patients at two public hospitals showed that 42% were unable to understand directions for taking medicine on an empty stomach; 26% did not understand information about the schedule for their next appointment; and 60% did not understand an informed consent form (Williams, 1995). The information a clinician presents must be easy to comprehend. Use short sentences without excessive jargon. Avoid words with multiple meanings and ask the patient to reiterate what was learned.
Readability and plain language are critical to effective communication in printed materials. Several published programs can determine the reading level of printed information. Information written at a reading level beyond the reach of the reader will hinder comprehension and halt compliance.
The Flesch Reading Ease formula, which is found with many word processing programs, can help determine if your message is easy to read or understand. The formula produces an output score from 0 to 100. High scores indicate easier reading levels. The Flesch-Kincaid Grade Level formula converts the Reading Ease Score to a U.S. grade-school level, which the audiologist can use to determine if the material presented is too easy or difficult. (For more information about health literacy, go to ASHA's Web site and search "health literacy" or "patient-provider communication.") Regardless of reading ease and grade level, the message must be accurate and based on evidence.
Fundamental ways to improve communication and counseling include the use of appropriate language, plain language, materials at a suitable readability level, and a variety of media to explain information. Patients and family absorb information and recommendations in many ways; clinicians should understand and adjust their communication to adapt to how the patient and family prefer to receive information and by using plain language to convey the message.