Communication in Health

1. Communication in Health Dr Fraser Reid, Prof Judy Edworthy, Dr Elizabeth Hellier Department of Psychology, University of Plymouth

2. Teleconsultations: Some psychological implications and hypotheses

3. IHSM Report 1998 • Telemedicine technologies now proven • Productivity gains and increased accessibility in healthcare delivery • Changes in the way people work • Loss of personal contact less important than expected

4. A failure of evaluation? • Quality assessment based on clinical process and user satisfaction • Too few studies of consultation process • Most of these are based on retrospective surveys • Known positivity biases in user satisfaction assessment

5. The consultation as social encounter • Patient-centred model of care • Patient satisfaction • Adherence and compliance • Health and clinical status • Recall and understanding • Psychological wellbeing

6. Does the medium matter? • Media affordances • Modality—Verbal or visual-verbal? • Interactivity—Synchronous or asynchronous? • Telephone consultations • Email and texting • Video links

7. The bandwidth hypothesis • Interactive visual-verbal media will be best overall • No—for information giving, interactivity matters, modality doesn’t • No obvious advantage in adding vision to speech • Failure of the videophone and poor prospects of 3G mobiles

8. The cognitive cueing hypothesis • Non-visual media should disrupt conversation patterns • No—people compensate with formal turn taking techniques • Non-visual media should disrupt joint reference • Yes—video provides listener feedback crucial to mutual understanding

9. The social cueing hypothesis • Non-visual media will be less expressive • Yes—phone calls are more task focussed and impersonal • But—less inhibited online • Non-visual media will disrupt decision making • Yes—mutual agreement is harder to achieve online or on the phone

10. Some implications • The medium matters—email, video or phone? • A trade-off between improved access and reduced quality of care? • Over-diagnosis and increased demand on the NHS? • A less patient-centred service?

11. Warnings in healthcare

12. Alarms in the ICU and operating theatre • Usual problems with alarms • Too many • Hard to tell apart • Badly designed acoustically • Not matched to situations

13. Alarms • Research findings can be applied to • Make warnings better acoustically • Produce appropriate urgency • Reduce numbers

14. Visual warnings • New cigarette warnings • Design features e.g. font size, colour, borders • Habituation • Explicitness of message • Education about risks

15. Compliance with warnings • Must be seen as cost/benefit analysis • Costs: • time, money, effort • adverse effects • social effects

16. Recent research results • Pesticide labelling • Personal pronoun use • Locating safety information within product instructions • Differences for amateurs and professionals