Published on May 19th, 2015


Improving Effective Communication With Families by Learning to Embrace Silence

By Selena Vermey, Winner of the 2015 Isabel Richard Student Paper Award (Below Doctoral Category)

Please note that this paper appears in its original form, in the language in which it was submitted; we have not edited it for style or grammar.

As audiologists and speech language pathologists, we are often considered to be communication specialists and pride ourselves in our ability to help our patients improve their own communication skills. However, it is very easy for us to fall short in our supposed area of expertise when providing information to our patients and their families.

There is overwhelming evidence indicating a strong positive relationship between a health care provider’s ability to communicate information and a patient’s adherence to their recommendations (Clark, 2003). A patient’s family is a key member of their health care team, and in many instances may be the primary contact with whom communication health professionals interact with. We rely heavily on families for pediatric, elderly, and special needs populations to help carry out agreed upon intervention plans, in addition to our diagnostic assessments. To this end, we should make it a priority to strive to provide quality and effective exchange of information with caregivers.

As is seen in any variety of team, be it an interdisciplinary team or a professional sports team, the best outcomes are achieved when every individual understands their role. Family is an essential player on an individual’s health care team, and equipping them with the knowledge and the skills they need to play their position is fundamental to the team’s success. We may involve caregivers by inquiring about their views and attitudes on the patient’s progress, or by encouraging them to contribute their ideas as we develop assessment strategies and treatment plans. After all, it is the caregivers who know our patients best, and we should honour the expertise each of us brings to the table. When we give families the opportunity to be actively involved in the care of their loved one, they will develop a sense of empowerment leading them to realize what a vital role they play. Furthermore, this will help establish a sense of trust and confidence in their clinician, which is paramount to building a constructive relationship.

A crucial step towards establishing dialogue is by creating an environment that promotes natural communication. By developing good rapport, a family will feel more at ease with their clinician and less anxious, thereby enabling them to concentrate on what is most important – the information being provided (Frampton et al., 2008). Health care can be a challenging subject to discuss because the information conveyed is complex, and is further complicated by the fact that it is often emotional. In our clinical practice, we will inevitably find ourselves in a position where we must engage in difficult conversations. Revealing that a child has permanent hearing loss can be devastating news for families, and we must recognize that all individuals have different ways of coping with stress. Some may want information immediately, while others may need time to just sit and reflect — and clinicians need to be comfortable with this silence. There is no denying that clinic can become busy. There will be times when counseling sessions will be rushed, and clinicians may feel pressured to go over only the most important information quickly when pressed for time. In these situations, families should be encouraged to schedule another appointment or find another means by which to finish the conversation. By rushing important conversations, we may be doing a disservice to the family.

As a communication health care professional, it is our responsibility to ensure that the appropriate information is not only provided, but also understood. It has been said that individuals either forget or do not understand up to 80% of what is discussed in a typical office visit (Kessels, 2003). Therefore, when important decisions are to be made, it is essential that we provide families with information they can comprehend and will recall correctly. We may disseminate information more effectively by avoiding the use of technical jargon and ensuring that we communicate using language that they can easily understand. In many instances, it is wise to send them home with written materials that they may review at a later time.

In the communication health profession field, we work with diverse populations in our practice. When a language barrier exists, explaining results and treatment options can become very challenging. Even if the family has a reasonable understanding of the information being provided, they may miss important details that can have lasting implications. In these instances, use of an interpreter, who may be another family member or a hired professional, is highly recommended. Having access to written resources in multiple languages can also be very useful in these situations. When working with other cultures, it is important to remain respectful and culturally sensitive, which may encompass modifying our language. For instance, when counseling First Nations families, it may be more appropriate to present our beloved “speech banana” in a way that is more relevant to their culture, such as a “speech canoe” (Approaches to Audiology & SLP for People of First Nations, Metis, or Inuit Heritage class discussion, 2014).

Perhaps the most fundamental aspect of effective interaction is being able to listen. Communication is a two-way street, and is most successful when both parties contribute to the conversation equally. As clinicians, we may find ourselves doing most of the talking, however, we should try to refrain from commandeering the conversation and rather support the caregivers to be actively involved in the dialogue. When this occurs, both the family and the clinician will feel more confident in each other’s abilities. By actively listening, asking open-ended questions and allowing sufficient time for caregivers to respond, we gain a better insight into their individual circumstances and can provide better care. It is human nature to fill empty conversational space to avoid awkwardness, but it may be more valuable at times for the clinician to endure the silence. Frequently, if the other party is forced to break the silence, they often bring up a question they would have otherwise not yet worked up the courage to ask. When we are responsive and receptive to questions, we create an environment in which families are comfortable asking for clarifications without feeling that their concerns are trivial. It is important not to let our own assumptions or judgments influence our clinical practice. By empathizing with families, treating them with respect, and refraining from sugarcoating delicate matters, we build stronger partnerships. Recognizing that as we share knowledge and give families the opportunity to learn, the conversations we engage in will evolve. By being cognizant of this fact, we can progressively modify our language to nurture this maturation in understanding and avoid being perceived as talking down to patients and their families.

Open and honest communication builds strong relationships, which is absolutely critical for a successful health care team. By recognizing what a vital role family plays on this team, and being versatile in the ways we discuss health care information with them, we can establish interactions that are both effective and valued. In many ways, we must adopt our own recommendations and ensure that we actively listen, effectively explain, and become comfortable with silence as we work alongside families.

Clark, P. (2003). Medical practice’s sensitivity to patients’ needs: Opportunities and practices for improvement. Journal of Ambulatory Care Management, 26(2) 110-123. 

Kessels, R. (2003). Patient’s memory for medical information. Journal of the Royal Society of Medicine, 96(5) 219-222. 

Frampton, S., Guasterllo, S., Brady, C. Hale, M., Horowitz, S., Bennett Smith, S., and Stone, S. (2008) Patient Centered Care Improvement Guide. Planetree Inc and Picker Institute, 77-91.

Selena Vermey

About the author:
Selena Vermey, M.Sc. Audiology
Winner of the 2015 Isabel Richard Student Paper Award (Below Doctoral Category)
University of British Columbia

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