Patients with communication disorders (speech, language, and voice disorders) experience disparities in the access to and receipt of high-quality healthcare services. Specifically, they report lower rates of satisfaction with quality of care and communication with their providers and are three times more likely to experience a preventable medical error when they are in the hospital. In descriptive studies, patients with communication disorders (CD) state that challenges in patient-provider communication are a major contributor to these disparities. Effective patient-provider communication has been identified as essential to high-quality care and multiple studies demonstrate that it confers a host of benefits to patients, including improved adherence to medical treatment and satisfaction with care. To date, no studies have directly evaluated whether there are differences in providers? communication behaviors when interacting with patients with or without a CD. Namely, it is unknown whether providers use less patient-centered communication with patients with CDs. Additionally, studies have demonstrated that provider characteristics, including their implicit and explicit biases, can significantly affect their communication behaviors during clinical encounters. While negative implicit and explicit biases toward disability has been measured in the general population, these biases have not been evaluated in healthcare providers, nor have the potential effects of these biases on patient-provider communication been described. In the United States, all medical students are required to receive training in patient-provider communication. Receiving this instruction early in their training establishes positive behaviors that they will use once they are practicing physicians. Determining whether medical students use less patient-centered communication with patients with CD and whether they have implicit and explicit disability biases will directly inform development of medical education trainings.
In Aim 1, medical students? patient-centered verbal and non-verbal communication will be compared during a clinical encounter with a standardized patient who stutters (speech disorder), has aphasia (language disorder), or does not have a CD.
In Aim 2, medical students? implicit and explicit biases towards patients with disabilities will be determined.
In Aim 3, medical students? will participate in qualitative interviews about their perceptions interacting with patients with a CD. The study will provide necessary information on medical students? communication behaviors and potential biases that can be used to create effective interventions that aim to improve how providers communicate with patients with CD. Effective interventions to improve communication are a necessary step to elimination of healthcare disparities experienced by patients with CD.

Public Health Relevance

Patients with communication disorders (speech, language, and voice disorders) experience disparities in accessing and receiving high-quality healthcare services. Healthcare providers? use of patient-centered communication can significantly impact the quality of care they provide patients with communication disorders. This study will determine whether providers use less patient-centered communication with patients with a communication disorder as compared to patients without a communication disorder, and will explore the provider-level factors, including implicit and explicit biases, that could impact the communication.

National Institute of Health (NIH)
National Institute on Deafness and Other Communication Disorders (NIDCD)
Exploratory/Developmental Grants (R21)
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Communication Disorders Review Committee (CDRC)
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Shekim, Lana O
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University of Colorado Denver
Public Health & Prev Medicine
Schools of Public Health
United States
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