The nature of communication between patient and practitioner influences patient outcomes. Specifically, the history-taking phase of a consultation plays a role in the development of a relationship and in the success of subsequent shared decision making. There is limited research investigating patient-centered communication in audiology, and this study may be the first to investigate verbal communication in an adult audiologic rehabilitation context. This research aimed, first, to describe the nature of verbal communication involving audiologists, patients, and companions in the history-taking phase of initial audiology consultations and, second, to determine factors associated with communication dynamics.
Sixty-three initial audiology consultations involving patients over the age of 55, their companions when present, and audiologists were audio–video recorded. Consultations were coded using the Roter Interaction Analysis System and divided into three consultation phases: history, examination, and counseling. This study analyzed only the history-taking phase in terms of opening structure, communication profiles of each speaker, and communication dynamics. Associations between communication dynamics (verbal dominance, content balance, and communication control) and 11 variables were evaluated using Linear Mixed Model methods.
The mean length of the history-taking phase was 8.8 min (range 1.7 to 22.6). A companion was present in 27% of consultations. Results were grouped into three areas of communication: opening structure, information exchange, and relationship building. Examination of the history opening structure revealed audiologists’ tendency to control the agenda by initiating consultations with a closed-ended question 62% of the time, followed by interruption of patient talk after 21.3 sec, on average. The aforementioned behaviors were associated with increased verbal dominance throughout the history and increased control over the content of questions. For the remainder of the history, audiologists asked 97% of the questions and did so primarily in closed-ended form. This resulted in the audiologist talking as much as the patient and much more than the companions when they were present. Questions asked by the audiologist were balanced in topic: biomedical and psychosocial/lifestyle; however, few emotionally focused utterances were observed from any speaker (less than 5% of utter ances).
Analysis of verbal communication involving audiologists, patients, and companions in the history-taking phase in 63 initial audiology consultations revealed a communicative exchange that was audiologist-controlled and structured, but covered both medical and lifestyle content. Audiologists often attempted to create a relationship with their patients; however, little emotional relationship building occurred, which may have implications later in the consultation when management decisions are being made. These results are not in line with patient-centered communication principles. Further research and changes to clinical practice are warranted to transform patient-centered communication from an ideal to a reality.
The history-taking phase of consultations is important for the development of a relationship and in the subsequent success of management planning. This study is one of the first to investigate verbal communication in an adult audiologic rehabilitation context. Sixty-three initial audiology consultations involving adult patients and audiologists were audio-video recorded and verbal communication was coded. Results revealed that audiologists tended to focus on medical history and predominantly used closed-ended questions. Consequently, audiologists often controlled and dominated the history-taking phase of initial audiology consultations. Such communication illuminates a need to consider patient-centered communication principles throughout history-taking.
1The HEARing CRC 550 Swanston St, Carlton, Victoria 3053, Australia; 2Department of Audiology and Speech Pathology, The University of Melbourne, Melbourne, Victoria 3053, Australia; 3Communication Disability Center, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland 4072, Australia; 4Eriksholm Research Center, Oticon A/S 20 Rørtangvej 3070 Snekkersten, Denmark; and 5Department of Behavioral Sciences and Learning, Linköping University, 581 83 Linköping, Sweden.
The authors acknowledge the financial support of the HEARing CRC, established and supported under the Cooperative Research Centers Program, an initiative of the Australian Government. The authors report no other conflict of interest.
Address for correspondence: Caitlin Grenness, Department of Audiology and Speech Pathology, The University of Melbourne, 550 Swanston Street, Carlton, Victoria 3053, Australia. E-mail: firstname.lastname@example.org
Received December 19, 2014; accepted July 13, 2014.