Failure of communication: a patient’s story

The first author, a patient who underwent elective caesarean section and felt pain necessitating conversion to general anaesthesia, describes the experience with particular reference to the perceived poor communication between her and her anaesthetist. This extended from the preoperative visit to the information provided to her general practitioner after discharge. She makes several suggestions which would have made her experience, and those of other patients in similar circumstances, less traumatic. The second author, who had no involvement in events and works in a different Trust, comments upon the events from the perspective of an obstetric anaesthetist.     

Clinicians’ accounts of communication with patients in end-of-life care contexts: A systematic review

ObjectiveCommunication between patients and end-of-life care providers requires sensitivity given the context and complexity involved. This systematic review uses a narrative approach to synthesise clinicians’ understandings of communication in end-of-life care.MethodsA systematic, narrative synthesis approach was adopted given the heterogeneity across the 83 included studies. The review was registered prospectively on PROSPERO (ID: CRD42019125155). Medline was searched for all articles catalogued with the MeSH terms “palliative care,” “terminal care” or “end-of-life care,” and “communication”. Articles were assessed for quality using a modified JQI-QARI tool.ResultsThe findings highlight the centrality and complexity of communication in end-of-life care. The challenges identified by clinicians in relation to such communication include the development of skills necessary, complexity of interpersonal interactions, and ways in which organisational factors impact upon communication. Clinicians are also aware of the need to develop strategies for interdisciplinary teams to improve communication.ConclusionTraining needs for effective communication in end-of-life contexts are not currently being met.Practice ImplicationsClinicians need more training to address the lack of skills to overcome interactional difficulties. Attention is also needed to address issues in the organisational contexts in which such communication occurs.     

Training parents to implement communication interventions for children with autism spectrum disorders (ASD): A systematic review

This review identifies procedures used to train parents to implement communication interventions to children with autism spectrum disorders. Systematic search procedures identified 11 studies that met predetermined inclusion criteria. Across studies, 60 parents were trained to implement Pivotal Response Training, Enhanced Milieu Teaching, Natural Language Paradigm, or Early Start Denver Model. The mean time spent training parents was 17 hours. Training procedures used most often included: (a) verbal instruction and/or instruction manuals, (b) in vivo practice, (c) role playing, (d) modeling by trainer, and (e) reviewing videos of intervention sessions. Improvements in parent ability to implement intervention and child communication were ubiquitous. However, a paucity of studies in which baseline parent behavior was measured, coupled with the absence of studies evaluating individual training procedures, precludes definitive statements regarding the most effective and efficient approach to parent training and, therefore, warrant future research.