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Patient-centered conversations with a patient who has multiple disabilities in a medical setting

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This study investigated how communication partners talk to a non-speaking patient with multiple disabilities and examined how to make such conversations more patient-centered while providing care. Ten care providers were equally divided into 2 groups. A member of both groups engaged in a 5-minute bedside conversation with the 32-year-old patient who has quadriplegia, vision impairment, intellectual disability, and a tracheostomy with a mechanical ventilator; however, group (a) used the words on the vocabulary list and group (b) didn’t refer to it. Group (b) produced significantly more declarative statements per 5 minutes (M = 12.6 utterances) than group (a) (M = 3.8 utterances). The response levels that the patient could offer to open-ended questions were higher in group (a) (M = 77.8%) than group (b) (M = 22.6%). The following narrative theme emerged from the qualitative analysis of the descriptive data of the questionnaire: “Staff communicates with patients to understand their needs and help patients fulfill their needs. Staff should support patients by ensuring enough time, openness and opportunity for communication, in addition to caring, and monitoring the method of communication.” The structure of the vocabulary list enabled participants to ask the patient open-ended and multiple-choice questions that provided the patient with numerous opportunities to communicate. Communication partners expected to use verbal exchanges to support the patient; however, when it became difficult to understand the patient, they tended to interrupt the developing silence with declarative sentences.


Hiromi Chinen    
Chiba Rehabilitation Center

Tomoko Kiyasu    
Chiba Rehabilitation Center


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