Lecture 10

Communicating with Special Groups Communication Skills in Pharmacy Practice, Chps 10-11

PHA 3002C IPPE-II

Professional Communications

Janet P. Barber, PhDMarch 28, 2011

Lecture Overview

Older adults patients

Patients w/ communication impairments

Patients w/ disabilities

Terminally ill patients

Patients w/ HIV/AIDS*

Patients w/ mental health problems*

Suicidal patients*

Patients w/ mental health problems*

Patients w/ low health literacy*

Cultural competence*

Caregivers

Young patients and adolescents

*See textbook2

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General Advice

If you believe that a person has a special problem, check to see if your perception is accurate– Look for non-verbal clues– Use open-ended questions

Avoid stereotyping patients

. . . Be patient!!

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Adult Patients

Today’s adult patient population takes a more active role in the control of their health and well-being

Adults are more knowledgeable about– Treatments– Costs– Benefits– Medications

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Print Advertisements and Commercials

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Older Patients

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Increased Interaction with

Older Adults

Percentage of the elderly population increasing (12.9% in 2009; projected to be 20% in 2030)

Elderly consume a disproportionate share of prescriptions drugs (30%) and over-the-counter medications (40%)

2 out of 3 older adults take at least 1 medication per day

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Barriers to Communicating with

Older Patients

Pharmacists may not fully recognize elderly patients’ limitations and the effect of disabilities

Attitude of the pharmacist – be cognizant of age-related perceptual differences

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Limitations of the Older Patient

Hearing Loss

Vision impairment

Dementia

Language disorders

Altered pain threshold

Difficulties eating,

swallowing

Altered taste and thirst

Transportation difficulties

Mobility limitations

Propensity to fall

Limitations in activities of daily living

Reduced economic resources

Loss of physical energy

Isolation

Depression

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Physiological Changes in Older Patients

Physiological changes alter the pharmacokinetics of many drugs in the elderly– Age-related changes relevant to drug pharmacology

Absorption: > in absorptive surface & < gastric pH Distribution: > in total body water and lean body mass Metabolism: > in liver blood flow, enzyme activity Excretion: > in renal blood flow

– Result is an < risk of adversereactions and interactions in the elderly—nearly double that of younger adults

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Aging Affects Learning

Some older adults learn at a slower rate – Have the ability to learn but process information

at a slower rate

Short-term memory, recall, and attention span may be diminished

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Accommodating Learning Deficits

Speak slower

Break down learning into smaller tasks

Build on past experiences

Encourage feedback

Ask patient politely to repeat instructions

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Methods to Deal More Effectively with the Older Patient

Recognize feelings Attend to drug-use problems Provide extra time Deal with disabilities Consider patient-specific needs Provide follow-up Provide privacy

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Communication Impairments

Vision

Hearing

Speech

Aphasia

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Communicating with Patients with Visual Impairment

Large print

Pastel paper

Adequate light

Braille

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Patients with Hearing Impairment

Due to birth defects, injury, exposure to loud sound, aging

Different types: – General types: conductive, sensorineural, central– Presbycusis – hearing loss associated with aging;

affects more than half of older people

People with hearing problems often ‘speech read’– Watch lips, facial expressions and gestures

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Communicating with Patients with Hearing Impairment

Do not shout

Do not speak directly into ear

Slow down rate of speech

Facilitate speech-reading by standing in front of patient (~ 3-6 ft away)

Use a lower tone of voice

Remove environmental barriers

Use written communication

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Patients with Speech Impairments

Dysarthria– Interference with normal control of speech mechanism due

to disease (e.g., Parkinson’s, MS), strokes or accidents– Involves slurred or difficult-to-understand speech

Laryngectomy - removal of larynx– Learn to speak again (esophageal speech or with aid

of electronic device)

Aphasia – following stroke– Reduced ability to understand and speak– Recall problems; sequencing problems; short sentences

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Communicating with Patients with Speech Impairments

Be patient

Do not fill in words

Speak in brief sentences

Do not be offended by involuntary responses that seem inappropriate

Communicating with Patients with Disabilities

Wheel chair bound patients

Learning disabled patients

Homebound patients

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Communicating with Terminally Ill Patients

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Communicating with Terminally Ill Patients & Their Families

Be sensitive to stage of adjustment of patient– Ask open-ended to questions

(“How are you doing today?”)– Be aware of and honest about your own feelings

about death(I don’t know what to say right now.” “Tell me how I can help you.”)

– Show concern

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Stages of Dying Kubler-Ross, MD (1970)

Natural progression of dying process Patients come to terms with impending deathPsychological reactions to their situation

Five stages1. Avoidance and denial (“No, not me”)2. Anger, hostility, resentment (“Why me?)3. Bargaining with God to postpone inevitable (“Yes, me, but…”)4. Depression (“Yes, me”)5. Acceptance–productive ways of dealing with death (“I’m ready”)

Applies to most major stresses/losses in life

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Pharmacist Response to Dying Patient

Denial Understand, listen; do not try to convince

Anger Do not respond in anger; let patient vent feelings; empathize; realize patient is not angry with you

Bargaining Listen; help patient focus on what is possible

Depression Allow patient to express sorrow; listen if patient wants to talk

Acceptance Be affirming

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Definition of Caregivers

Caregivers are an formal/informal network of individuals who take care of impaired relatives/friends who can not take care of themselves.

Caregiving refers to– Activities and experiences involved in providing

direct assistance to relatives or friends who are unable to perform independently normal activities of daily living

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Communicating with Caregivers

Caregivers can be people who– Take care of older adults with chronic conditions– Parents who take care of children during acute

illnesses– Take care of family members, friends– Are hired assistants

Certain strategies must be used since you can’t communicate directly with patients

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Sources of Caregiver Stress

Primary sources– Care recipient’s cognitive status– Care recipient’s problematic behavior– Number of activities for which impaired

recipient is dependent on caregiver– Extent of dependency of each activity– Caregiver overload or burnout

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Outcomes of Stress

Depression

Anxiety

Physical health decline

Giving up caregiver role

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How Pharmacists Communicate with Caregivers

Help caregiver understand the patient’s condition and treatment and how to communicate specific instructions to the patient

Teach caregiver how to monitor patient therapeutic response to a specific medication

Encourage caregiver to contact you if they have questions/problems

Communicating with Young Patients and Adolescents

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Communicating with Young Patients and Adolescents

Certain patient characteristics affect the emphasis that needs to be placed on certain aspects of counseling

Different than communicating with adults in two distinct ways:

Communication typically involves 3 people

RPh needs to communicate at a level that is appropriate for the cognitive developmental level of the child

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Four Stages of Cognitive Developmental in Children

(Based on work of Jean Piaget, 1932)

Sensory motor stage (birth to 2 yrs)– Learning centered around child; no concept of objects

outside of selfPre-operational stage (2 to 7 yrs)

– Children consider only a single aspect of a situation; concrete reasoning of here and now

Concrete operational stage (7 to 12 yrs)– Separate internal and external worlds; become problem

solvers; begin to understand disease prevention; still objective

Formal operational stage (age 13 to adult)– Capable of hypothetical, abstract thought; reason logically;

understand idea of personal control of one’s health

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Communicating with Young Children

Attempt to communicate at child’s level

Ask open-ended questions so that you can assess what the child understands

Use simple sentences for all children

Ask whether the child has questions

Use both written and verbal communication

Don’t ignore child!

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School-AgedChildren & Adolescents

At 5 or 6 child can be more involved in education about their medicines

Adolescents may want to speak with pharmacist without parent present– Allows you to build trust with the teen– Oral contraceptives and STD’s

Teenagers can be given educational messages that would be given to an adult, but are more responsive to shock appeal