About 40 million people have a communication disability (CD), which includes hearing,
speech, language, and voice disabilities. Compared to non-disabled patients, patients
with CD are more likely to have a greater number of chronic conditions, and have higher
rates of asthma, hypertension, emphysema, cardiovascular disease, diabetes and arthritis.
Approximately one third of people with CD report the quality of their health as fair/poor
as compared to only 11% of patients without CD. Patients with CD are 2-4 times more
likely to report difficulty finding a provider than those without CD. When they do access
care, they report that the quality of care and communication they receive is low.
Communication strategies that patients with CD require may vary, and providers need to
elicit and then adapt to patients' preferences for communication strategies. Provider
education and patient-prompt tool interventions have demonstrated effectiveness in
general populations. Provider communication education significantly improves their
patient-centered communication. Patient-prompt tools empower patients to identify topics
and communication styles they prefer and then share this information with their
healthcare provider. While provider education and patient-prompt tools have been proven
effective, their effectiveness has not been compared in the primary care setting for
patients with CD. Therefore, the aim of this study is to adapt these two types of
interventions for patients with CD in the primary care setting and then compare their
effectiveness at improving patient-reported health related quality of life and experience
with care.
In this study we will conduct a stepped-wedge randomized control trial design. The study
will take place at 4 sites that have unique contributions that will add to the
generalizability and dissemination of the results. They are diverse in their geographic
location, include academic and community clinics, represent urban and suburban locations,
and include racially and ethnically diverse patients. Eight clinics, 2 at each site, will
be part of the trial.
All participating clinic sites will receive the healthcare team-directed intervention
(intervention A) and then will be randomized as to when they begin implementing the
patient-directed tool (intervention B). The A versus A+B study design ensures all
participating healthcare team members receive the training, as national policies require
healthcare team members receive training on effective communication with patients with
CD. We will randomize at the clinic-level cluster to eliminate spillover intervention
effects amongst providers within the same clinic.
Participating healthcare team members will all receive the healthcare team-directed
intervention (a general overview training about communication disabilities and
communication strategies that can be used with patients) during the month preceding trial
roll-out. Clinics will be randomized as to when they begin implementing the
patient-directed tool, with a new clinic beginning every two months. One month prior to
implementation, the healthcare team members will receive a booster education training, be
introduced to the patient-directed tool, and alerted that they will be handed the
completed tool by patients with CD during the patients' clinical encounters.
To measure patient and provider perceptions, both groups will complete a survey after the
clinical encounter. A subset of encounters will be videotaped, and content analysis will
document providers' use of patient-centered strategies and any adaptations made to the
intervention strategies. Chart review will document patients' healthcare utilization over
time. To understand providers' experiences with both interventions and perceptions of
feasibility, healthcare team members will participate in qualitative focus groups and
interviews at 3 time points.
The outcomes from this study may help create patient and provider training and tools
that, if proven successful, could be disseminated to other healthcare arenas to improve
patient-provider communication and ultimately improved health outcomes for this
vulnerable population.
