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. 2019 Jul;34(7):1139-1145.
doi: 10.1007/s11606-019-04911-0. Epub 2019 Mar 18.

Communicating with Patients with Disability: Perspectives of Practicing Physicians

Nicole Agaronnik  1 , Eric G Campbell  2 , Julie Ressalam  2 , Lisa I Iezzoni  3   4
Affiliations

Communicating with Patients with Disability: Perspectives of Practicing Physicians

Nicole Agaronnik et al. J Gen Intern Med. 2019 Jul.

Abstract

Background: Patient-centered care for people with disability requires effective communication and compliance with the Americans with Disabilities Act (ADA).

Objective: To understand physicians' perspectives on communication experiences with people with disability.

Design: Twenty semi-structured individual interviews. Interview recordings were transcribed verbatim for analysis.

Setting: Massachusetts, October 2017-January 2018.

Participants: Twenty physicians ranging from 8 to 51 years in practice in primary care or 4 other specialties.

Measurements: Commonly expressed themes around communication with people with disability.

Results: Concerns coalesced around 4 broad categories: communication experiences with people who are deaf or hard of hearing, communication with people who are blind or have vision impairment, communication with people who have intellectual disability, and recommendations for improving communication. Although participants in this study reported various efforts to communicate effectively with patients with hearing or vision loss or intellectual disability, many gaps appear to remain, as well as instances where physicians' preferences run counter to patients' wishes and the ADA. Examples include physicians' preferences for remote, online sign language interpreters despite patients desiring in-person interpreters and suggesting that patients arrange for their own interpreters. Few educational materials are available in braille, and electronic medical records may not allow documents to be printed in large font for persons with low vision. Communicating with patients with intellectual disability raised particular concerns, with participants often preferring to interact with caregivers and minimal efforts to involve patients.

Conclusions: Effective communication is necessary for ensuring the quality of health care for people with disability, and it is legally required under the ADA. Our results suggest that important gaps may remain in ensuring effective communication, and some practicing physicians could benefit from formal training in effective methods for communicating with patients with disability.

Keywords: Americans with Disabilities Act; blind; communication; deaf; disability; hard of hearing; intellectual disability; vision impairment.

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Conflict of interest statement

The authors declare that they do not have a conflict of interest.

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References

    1. The World Report on Disability. Geneva: World Health Organization and The World Bank; 2011.
    1. Smith DL. Disparities in patient-physician communication for persons with a disability from the 2006 Medical Expenditure Panel Survey (MEPS) Disabil Health J. 2009;2(4):206. - PubMed
    1. National Institute on Deafness and Other Communication Disorders. Quick Statistics about Hearing. https://www.nidcd.nih.gov/health/statistics/quick-statistics-hearing. Accessed January 10, 2019.
    1. American Foundation for the Blind. Facts and Figures on Adults with Vision Loss. http://www.afb.org/info/blindness-statistics/adults/facts-and-figures/23.... Published 2018. Accessed January 10, 2019.
    1. Cornell University Yang Tan Institute on Employment and Disability. Disability Statistics. http://www.disabilitystatistics.org/reports/acs.cfm?statistic=1. Accessed January 10, 2019.

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