The Vocational and Rehabilitation Research Institute (VRRI) in Alberta is an excellent source of information for people with disabilities and people who work with them. Plain language booklets are available from the website on a range of health and life skills. Also available are short, practical publications for service providers to facilitate respectful and successful communication and support. The following recent item caught my eye:

Speaking Plain Language: How disability support workers can use plain language with clients who may have limited literacy or language comprehension skills by Aiofe Freeman. (FastFacts Vol 1, no. 2 March 2008)

While resources on plain language writing are happily fairly plentiful these days, information about how to communicate verbally in accessible language is more unusual. This brief guide with a reference list offers practical tips for conversing with people who have difficulty understanding because of literacy or language challenges. While these tips sound like common sense, consistently putting them into practice can be tricky.

Suggestions include:

• Think about your audience
• Be aware of your tone
• Reduce the amount of information you provide at one time
• Use short and everyday words
• Find out if you are being understood--but recognize that your listener may be uncomfortable admitting that they don't know what you're talking about!

How to be a "pleasantly assertive" patient

Researchers at University of North Carolina at Chapel Hill offer five ways to get more from your doctor.

These days, going to the doctor may seem more like speed dating than care giving. Patients get a few minutes with the clinician, and he or she does most of the talking. How can a person get the information they need and the outcome they desire in a 15-minute office visit? What if the treatment options don’t feel right? Is it too much for a patient to feel they are considered a partner in their own well-being?

Often, people leave their doctor’s office with more questions than answers, according to researchers at the University of North Carolina at Chapel Hill School of Medicine who are looking at how patients can get more of what they need from the health-care system. They have found that patients (or their advocates) who talk to physicians about their beliefs, values, lifestyle and
concerns can get better results from their health-care experience.

“Research shows if you ask doctors what they think is important to patients, and then ask patients what’s important to them, there’s not a great match,” said Dr. Michael Pignone, chief of the UNC division of general internal medicine.

But, as smart as doctors are, they aren’t mind readers, Pignone and his colleagues note. “A common problem is patients thinking that their physician will know how they – the patient – feels about specific decisions” said Dr. Carmen Lewis, assistant professor of medicine of general internal medicine and clinical epidemiology. “Doctors don’t – you need to tell them. People feel the doctor is the expert, but the individual is the expert about his or her lifestyle and how he or she values options and outcomes.”

Pignone offered some tips for becoming what he calls a “pleasantly assertive” patient, so that patients’ health-care providers can better help them.

1. Prepare for your visit. “It might seem silly, but it’s really helpful to write down your symptoms, complaint or problem, then summarize it into a couple of sentences,” Pignone said. “Bring your list and your summary with you to the visit. This allows the doctor to quickly review your condition and ask specific questions, instead of spending time focused on general issues. This one step can make visits 25 percent to 50 percent more effective.”
2. Have an agenda. “Before your appointment, decide what you want from the visit,” Pignone recommends. “For instance, if you’re suffering back pain, you might want to know what is causing the pain as well as a treatment plan for getting better. Make sure you share that with your doctor at the very beginning of your visit. It might feel funny at first, but your doctor will appreciate it. Sharing this information will help you all make better decisions about treatment, make the visit more efficient, and improve the chance that your health-care needs will be met effectively.”
3. Know your medical history and medications. “To help you get the treatment you need, doctors need to know what tests you’ve had – and when – as well as what medications you’re taking,” Pignone said. “Without that information, they might mistakenly re-order tests or prescribe medication that has a bad interaction with something you’re already taking. That can have adverse effects for your health and your wallet.”
4. Tell your provider about your values or lifestyle preferences that could affect your treatment. “It doesn’t make sense to agree to a treatment plan you know you won’t follow – it won’t result in your feeling better,” Pignone cautioned. “For example, if a Wednesday night smoking cessation class conflicts with your book club, it’s not going to be an effective intervention for you. On a more serious level, if you don’t want to deal with the uncertainty of a possible recurrence of cancer, you might prefer a mastectomy to a lumpectomy. Similarly, if you can’t afford medication or to take off work for recurring visits, tell your provider even if you’re embarrassed. There are often ways to work around the challenges if your care team knows about them.”
5. Clarify the decision to be made. “Sometimes you’re offered several options, so be sure you understand the alternatives and if you don’t, ask for clarification,” Pignone said. “Your doctor should be able to give you important details about each option either during the visit, or on a follow-up call. In addition to the details, ask them how good the medical information is.”

Pignone and Lewis acknowledged that this approach results in a very different doctor-patient relationship, but evidence shows that proactive patients tend to get more effective and efficient care.

“The sicker you are, the more this matters,” Pignone said. “But it’s harder to do. If you’re not comfortable interacting this way, involve other people who support you in your life to come with you and play this role.”

Research: Neutral HIV presentations more likely to be considered inviting

A recent study by University of Illinois professor of psychology Dolores Albarracín and her colleagues at the University of Florida and the Alachua County Health Department in Florida found a method to increase enrollment among high-risk individuals in HIV prevention programs.

The study, which appeared in the September 2008 issue of Health Psychology, found that by offering an experimental introduction to a counseling session, public health institutions could increase enrollment by a significant amount.

Previous research by Albarracín found that those most likely to engage in behaviour that puts them at a high risk for HIV are also the least likely to enroll and stay in HIV intervention programs.

Therefore the researchers studied the effects of delivering different messages to participants screened for high-risk behavior as an invitation to a counseling program delivered at the Alachua County Health Department in Gainesville, Fla. They found one message that increased enrollment among participants.

All the messages informed participants who had signed up for a generic health study that they could speak to an HIV-prevention counselor. In the experimental condition, they were also told that the counseling session was not intended to change their behaviour, only to provide them with the most current information. Compared with a message that indicated that the counseling increased condom use, recipients of the experimental message enrolled at a rate higher by 15 percent. This effect was particularly strong when participants had no intention of using condoms at the beginning of the study.

“Public health experts around the world are regularly in search of the most effective methods for curbing preventable health problems,” Albarracín said. “HIV is a disease caused by a number of risky behaviors like unsafe sex and unsafe needle sharing, but health information is often disseminated without complete knowledge of how it will be received by audiences,” she said.

“The research indicates that people will be more receptive to information when they don't believe they are trying to be influenced,” she said. “This approach will be helpful in giving public health professionals effective ways to introduce the public to information without repulsing those they are trying to help most.”

Other researchers involved in the study were Marta R. Durantini, Allison Earl, and Josh Leeper, of the University of Florida, and Joann B. Gunnoe of the Alachua County Health Department.

Citation:

Beyond the most willing audiences: A meta-intervention to increase exposure to HIV-prevention programs by vulnerable populations.

Albarracín, Dolores; Durantini, Marta R.; Earl, Allison; Gunnoe, Joanne B.; Leeper, Josh

Health Psychology. Vol 27(5), Sep 2008, 638-644.

Read the abstract at http://psycnet.apa.org/journals/hea/27/5/638/

US health education in barbershops and beauty salons

As part of its mission to train the next generation of physicians and scientists, the Mayo Clinic Center for Translational Science Activities (CTSA) offers the Health Disparities Field Experience, a unique course through Mayo Graduate School. For this year's fieldwork, course scholars and faculty are joining with the Center for Minority Health (CMH) at the University of Pittsburgh's Graduate School of Public Health in its innovative program called 'Take a Health Professional to the People Day' on Sept. 18, 2008. This event has been recognized nationally with a feature on the Web site of the National Center on Minority Health and Health Disparities (NCMHD), National Institutes of Health (NIH).

Health disparities — the gaps in health care access and outcomes among different populations — lead to higher rates of chronic illness, disability and death from preventable causes for minorities. Now in its seventh year, Take a Health Professional to the People Day deploys teams of physicians, nurses, pharmacists, dentists and public health educators to 10 barbershops and beauty salons in inner-city Pittsburgh to deliver health information and health screenings to customers. In 2007, 150 health professionals screened more than 556 African-Americans in these neighborhood settings.

Why take health education efforts to barbershops and beauty salons?

These settings are effective because they are familiar community assets and trusted institutions in African-American neighborhoods where people gather to connect and exchange information. "Far too many African-Americans have no 'medical home' to access health care services, so government programs that promote 'taking a loved one to the doctor' are not as effective for this community," explains Stephen B. Thomas, Ph.D., director of CMH and the Philip Hallen Professor of Community Health and Social Justice. "Therefore, CMH created Take a Health Professional to the People Day. By focusing our efforts on a single day, we believe we can help generate a greater understanding of the importance of regular health screenings while at the same time reaching people who tend to have the least access to health care." In addition, the program serves as an excellent training opportunity for health professionals, who benefit from engaging minority populations outside of the clinical environment.

For more information about Take A Health Professional to the People Day, the NIH-NCMHD Research Center for Excellence in Minority Health Disparities, and other activities of the University of Pittsburgh Center for Minority Health, visit the University of Pittsburg Center for Minority Health Web site.

Radio stories of living with HIV reduces stigma in Ethiopia

Betengna, a radio program in Ethiopia that showcases the diaries of ordinary people living with HIV, may contribute to reducing HIV-related stigma, according to the results of a research study disseminated September 24, 2008 in Addis Ababa. Results of the research indicate that listeners of Betengna were found to have lower stigma toward people living with HIV and had greater knowledge about HIV transmission, prevention and management.

The program has aired on Ethiopian radio stations over the past two years, and it boasts an exposure of 29% in Addis Ababa and SNNPR, according to the study. It is also available for downloading on the National AIDS Resource Center’s website (www.etharc.org).

The radio diaries narrate the everyday experiences and challenges of living with HIV in Ethiopia and are broadcast weekly on five radio stations in Amharic, Tigrigna, and Oromoiffa languages. Betengna aims to decrease the stigma and discrimination that HIV positive people face in Ethiopia by exposing the human face of living with the disease and providing a platform for creating discussion on these issues among the general public. Over time, diarists cover a broad range of their everyday life experiences such as teen pregnancy, relationships with partners, family, friends and their communities, health issues, emotional and physical stress and living positively.

The research findings come from a household study conducted in November 2007 in four regions – Amhara, Tigray, Addis Ababa and SNNPR - in order to determine exposure to Betengna and the extent to which changes could be linked with exposure to the broadcast. Data was collected by a local research organization, Addis Continental Institute of Public Health.

Study results indicated that listening to Betengna was associated with increased empathy and affinity for the diarists and a better understanding of the challenges of leading an HIV positive life. Other indicators of decreased stigma were a greater perceived identification with people living with HIV and a stronger belief that HIV positive persons should be treated with respect. Caller feedback from listeners supports that Betengna is increasing empathy and reaching listeners on a more emotional level than just promoting rational thinking.

“Many people go to test after they become very sick. Sirak’s story motivated me to get tested and I found out that I’m HIV+,” indicated a male listener. “I live in South Africa, Cape Town. I always listen to Hiwot Mamo’s program and it really amazes me; she really is a wonderful woman. I just wanna tell her be strong and to always look after her self. Stay blessed,” commented a web listener.

The Radio Diaries are produced by the National AIDS Resource Center (ARC) and Johns Hopkins Bloomberg School of Public Health/Center or Communication Programs (CCP). The program's design is based on and builds on similar projects run by CCP in Nigeria and Malawi. Betengna is produced in collaboration with the National HIV/AIDS Prevention and Control Office (HAPCO) with technical assistance from Internews Network-Ethiopia. Funding is provided by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Centers for Disease Control and Prevention (CDC).

Study Explores Value of Recording Medical Visits for Cancer Patients

Patients can find it hard to absorb what their doctors tell them during stressful moments. Recordings or transcripts of office visits could help people with cancer—or their family members—recall medical information they might otherwise have missed, a new review suggests.

“It is important to consider anything that can improve the cancer patient’s experience, especially interventions that can be easily accommodated within the normal office visit,” said lead author Marie Pitkethly, co-coordinator of the Scottish Primary Care Research Network in Dundee.

The review included 16 studies of 2,318 adults who either had cancer themselves or were dealing with a close relative with cancer. The researchers looked at the effects of providing recordings or summaries of doctor-patient interactions on information recall and understanding, participation in follow-up visits, satisfaction and other concerns.

The review appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews like this one draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Richard Frankel Ph.D., a professor of medicine and geriatrics at the Indiana University School of Medicine, said many people who receive cancer information at the doctor’s office do not accurately remember what the physician said.

“Anything that can be done to increase their potential for retaining information is worth trying,” he said. “This review shows that the use of audio or videotapes can be very useful in some patients, but not all patients. The primary lesson this review teaches us that there needs to be an individualized approach to having difficult conversations with patients.”

For more on this study:
Pitkethly M, et al. Recordings or summaries of consultations for people with cancer. Cochrane Database of Systematic Reviews. Issue 3, 2008.

"Doctor and Patient, Now at Odds"--New York Times blog

Doctor and Patient, Now at Odds

By TARA PARKER-POPE
Published: July 29, 2008
New York Times Health blog: Well

Excerpt:
“By the time you’re done with your training, you feel, in many ways, that you are as far as you could possibly be from the very people you’ve set out to help,” said Dr. Pauline Chen, most recently a liver transplant surgeon at the University of California, Los Angeles, and the author of Final Exam: A Surgeon’s Reflections on Mortality (Knopf, 2007). “We don’t even talk the same language anymore.”

Continued: http://well.blogs.nytimes.com/2008/07/28/doctors-and-patients-a-rocky-relationship/

Patient-physician Communication: Research

With their waiting rooms crowded and exam rooms full, many physicians say they are too busy to be good communicators. Those who study physician time-management think otherwise. Certain communication skills can foster efficiency and effectiveness during an office visit without sacrificing rapport with patients, according to researchers at the University of Washington (UW) and the University of Rochester.

Their guide to a smoother flow of communication between doctors and patients appears in the July 14, 2008 issue of the Archives of Internal Medicine. Their model is based on the authors' observation: "Effective communication in primary care must include skills that enhance the quality of care while helping patients and physicians use time wisely… Making the best use of available time is important for visits of any duration."

A few of the lessons the researchers presented in the resulting article, "Relationship, Communication, and Efficiency in the Medical Encounter: Creating a Clinical Model from a Literature Review" include:

• focus the purpose of the visit with the patient: Instead of addressing each issue as it surfaces, creating a list at the start enables the doctor to confirm which problem is most medically urgent or most important to the patient. This approach also reduces the "Oh, by the way" issues brought up at the end of the visit.
• understand the patient's perspective: Exploring the patient's viewpoint is useful for promoting self-management, suggesting healthy changes, assessing motivation, learning the patient's family and cultural beliefs, understanding the social and psychological problems that are diminishing the patient's ability to function, or getting to the root of medically unexplained symptoms.
• reach a mutual agreement on a plan: The physician and patient decide on approaches the patient is willing to follow to manage or prevent the health concerns explored during the visit.

Throughout the office visit, it's helpful for physicians to:

• establish rapport and maintain the relationship: Some ways doctors do this are by eye contact, recognizing others in the room, or a brief warm greeting, such as, "Nice to see you." On the other hand, too much small talk steals away time from considering the patient's problems.
• practice mindfully: This occurs when physicians pay close attention to their own beliefs and reduce distractions in order to observe their patients' response to what is being said and done, and adjust accordingly. For example, a doctor lecturing on excess weight might notice the patient withdrawing. The doctor stops and asks about the patient's views. A physician who doesn't continuously monitor the interaction or doesn't check in with the patient may cover areas of little interest to the patient, and miss significant issues.
• track topics: Sometimes an interview veers off course, particularly when there are multiple topics and no clear agenda. Unless the conversation is redirected, it's likely that no clear decisions will be made on some problems before the end of the visit. Sharing an impression of what has and hasn't been covered and realigning by agreeing on what to talk about next can keep the discussion organized.
• acknowledge cues: When a physician responds with empathy to a patient's cues, a patient may reveal beliefs and preferences that can shape a successful treatment plan. Also, once their concerns are taken into account, most patients don't keep restating them. This saves time.
  

Researcher Larry Mauksch said, "Visits with the doctor that contain these fundamental elements lead to greater patient satisfaction, better adherence to medical regimes, increased self-management, better health outcomes, lower costs, and fewer malpractice claims. These skills enable physicians to do it right the first time, so they don't have to do it over."

The researchers are Larry Mauksch, a UW behavioral scientist in family medicine who studies and teaches doctor/patient communications; David C. Dugdale, an internal medicine physician and director of the UW Hall Health Primary Care Center; Sherry Dodson, UW clinical medical librarian; and Ronald Epstein, professor of family medicine, psychiatry, and oncology at the University of Rochester School of Medicine and Dentistry and its Center to Improve Communication and Health Care.

To read more about the project: http://uwnews.org/article.asp?articleID=42811

Consumer Health Tip Sheets

The US Agency for Healthcare Research and Quality (AHRQ) offers many consumer health resources, including:

20 Tips to Help Prevent Medical Errors
Patient Fact Sheet
http://www.ahrq.gov/consumer/20tips.htm

20 Tips to Help Prevent Medical Errors in Children
Patient Fact Sheet
http://www.ahrq.gov/consumer/20tipkid.htm

Quick Tips—When Getting Medical Tests
http://www.ahrq.gov/consumer/quicktips/tiptests.htm

Quick Tips—When Talking with Your Doctor
http://www.ahrq.gov/consumer/quicktips/doctalk.htm

Bringing Companions to Medical Visits: US Study

According to a survey of 12,018 US Medicare beneficiaries 65 years or older, bringing a family member or friend to medical visits improves patient satisfaction with medical care. Researchers found that:

• 38.6 percent of participants reported regularly being accompanied to medical visits
• Companions included spouses (53.3 percent); adult children (31.9 percent); other relatives (6.8 percent); roommates, friends or neighbours (5.2 percent); non-relatives (2.8 percent); or nurses, nurse aides or legal or financial officers (less than 1 percent)
• 63.8 percent of companions helped with communication, including 44.1 percent who recorded physician comments and instructions, 41.5 percent who communicated information about the patient’s medical condition to the physician, 41 percent who asked questions, 29.7 percent who explained physician’s instructions and 3.3 percent who translated the English language
• 28.4 percent of companions were reported to be present for company and moral support, 52.3 percent to assist with transportation, 16.6 percent to help schedule appointments and 8.4 percent to provide physical assistance.

Beneficiaries with regular companions were more highly satisfied with their physician’s technical skills, information-giving and interpersonal skills. Those whose companions more actively helped with communication rated their physicians’ information-giving and interpersonal skills more favourably. This relationship was stronger among patients who reported themselves to be in worse health.

Article:
Jennifer L. Wolff; Debra L. Roter
Hidden in Plain Sight: Medical Visit Companions as a Resource for Vulnerable Older Adults
Arch Intern Med. 2008;168(13):1409-1415.

Healthcare providers who discuss intimate piercings earn patients' trust

Patients with genital and nipple piercings, also known as “intimate piercings,” are best served by healthcare providers who initiate positive discussions about them, according to a new article in the journal Nursing for Women’s Health.

Yet, too often, such discussions do not occur, even when treating infections and other conditions related to the piercings, due to healthcare providers’ uneasiness over this increasingly common form of body art. An estimated 30 to 50% of youth ages 18 to 23 have piercings in places other than in their ear lobes, so it is highly likely that healthcare will encounter such piercings in their patients.

An article by Cathy Young, DNSc, APRN, BC, Associate Professor at Texas Tech University’s School of Nursing and Myrna L. Armstrong, EdD, RN, FAAN, Professor at Texas Tech University’s School of Nursing offers a comprehensive, practical overview of the clinical issues healthcare providers are likely to encounter related to intimate piercings. Issues range from why individuals seek and obtain such piercings to which medical procedures require such piercings to have been removed.

This study is published in the April/May 2008 issue of Nursing for Women’s Health.
Article abstract available.

Making Preventive Health Care Work for You

Making Preventive Health Care Work for You—A Resource Guide for People with Physical Disabilities (110 pages)

Covers:
Ways to make preventive screening work for you
Can you have a disability and still be healthy?
How can you increase your odds for a healthy life?
What are your risk factors?
What is routine health screening?
Will your doctor tell you what you need?
Why is routine screening especially important for people with disabilities
Why are checkups important?
What about vaccines?
What is healthy lifestyle counselling?
How can you create your own routine screening and immunization plan?
Why is it important to have good relationships with your providers?
Should you speak up?
Why is it important to plan ahead?
How can you improve your communication with your health care providers?
The DES script: A tool for improving communication
How can you understand and remember information from visits with health care providers?
How can you be sure to get your test results?
What else should you know about routine screenings and vaccines?
Organizations and web sites
Routine preventive screening for people with disabilities: Tips for health care providers
Various tools and checklists

Available from the Center for Disability Issues and the Health Professions (CDIHP) in the following versions:
Braille Ready File
Large Print version Microsoft Word
Microsoft Word Document Version
Portable Document Format (PDF) Version
http://www.cdihp.org/products.html#prevent

PatientsLikeMe.com: Online community of patients, doctors, and organizations

PatientsLikeMe.com was launched in 2004 by "three MIT engineers." It is described as:

a privately funded company dedicated to making a difference in the lives of patients diagnosed with life-changing diseases. Our personal experiences with ALS (Lou Gehrig's disease) inspired us to create a community of patients, doctors, and organizations that inspires, informs, and empowers individuals. We're committed to providing patients with access to the tools, information, and experiences that they need to take control of their disease.

For more, visit: http://www.patientslikeme.com

Ontario Health Promotion Summer School

Time sensitive

15th Annual Ontario Health Promotion Summer School (2008)

Health Promotion Under Pressure: Strengthening Community Action
presented by the Centre for Health Promotion, University of Toronto

June 23 - 25, 2008
(Preschool courses June 22, 2008)
Location: Westin Prince Hotel (Toronto)
at Don Mills and York Mills
Please identify the name of the event when reserving your accommodation (University of Toronto, Ontario Health Promotion Summer School) so as to take advantage of their reduced rates for Summer School guests.

Contact Information
Lisa Weintraub, HPSS Coordinator
416-469-4632 or hpss@rogers.com

Watch an introduction video about the Health Promotion Summer School by Suzanne Jackson, Director, Centre for Health Promotion and Co-Chair of HPSS 2008 (in French).

Listen to Pepper Lazore and Walter J. Cooke talk about the First Peoples' program.
** Videos are in .wmv format and will require Windows Media Player**

The Ontario Health Promotion Summer School is funded by:

* ONTARIO MINISTRY OF HEALTH PROMOTION
Healthy Eating and Active Living Strategy
Smoke-Free Ontario Strategy
* CANADIAN HERITAGE

http://www.utoronto.ca/chp/hpss/generalinfo.html

Nurses’ Advice Boosts Smokers’ Chances of Quitting

January 22, 2008
By Joan Hennessy, Contributing Writer
Health Behavior News Service
Center for the Advancement of Health

Despite countless public service ads, educational programs and the scary warnings on cigarette packs, roughly one in every five American adults still smokes. However, a new systematic review finds that nurses can get the “quit now” message across effectively.

The analysis of 31 clinical studies—comprising some 12,000 adult smokers—finds that smokers offered advice by nurses have an increased likelihood of quitting compared to smokers without such intervention.

The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Studies analyzed involved at least two groups of patients: one that received advice from nurses and another that did not. Some studies were low intensity, involving a single 10-minute consultation with no more than a single follow-up session, while high-intensity intervention provided longer consultations in which patients were given materials and strategies and received additional follow-up care.

Reference:
Rice VH, Stead LF. Nursing interventions for smoking cessation (Review). Cochrane Database of Systematic Reviews 2008, Issue 1.

Media release:
http://www.hbns.org/getDocument.cfm?documentID=1636