Original ArticleOlder Adults' Pain Communication During Ambulatory Medical Visits: An Exploration of Communication Accommodation Theory
Section snippets
Practitioner-Patient Communication
The importance of recognizing patients as the experts about their own health and reality is central to the reason that practitioner-patient communication needs to be understood and optimized. Roter and Hall's (2006) communication-transforming principles stress that practitioners and patients shape their relationship, influencing each other, and through the nature of their relationship, process and outcomes of care are defined. Although Roter and Hall (2006) developed a helpful method that
Communication Accommodation Theory
CAT is a theory that describes the psychologic, social, and linguistic behaviors that people exhibit when communicating with each other (Coupland, Coupland, Giles, & Henwood, 1988). In this theory, each person has his or her own personality, life experiences, and motivation when approaching a communication encounter, and these factors manifest in how they talk, listen, and respond to the other person. According to this theory, communication between two people can at any time be adjusted by
Objective
The purpose of this study was to explore the CAT strategies used by older adults and their practitioners as they discussed persistent pain issues during ambulatory medical visits.
Design
The design was a descriptive secondary analysis of patient and practitioner discussions during ambulatory medical visits. The parent study was a randomized controlled pilot study that examined the effects of a virtual pain coach intervention on subsequent elderly patient discussions of pain information (McDonald, Walsh, Vergara, & Gifford, in review).
Sample
The sample consisted of transcripts from 22 community-dwelling older adult medical ambulatory medical visits. All of the older adults were aged
Results
The majority of the older adults were college educated (59.1%), white (86.4%), and female (81.8%); the overall mean age was 74.7 (SD 7.55) years. Older adults reported a pain intensity at the time of the ambulatory medical visit with a mean of 3.6 (SD 1.55) on a 0-10 pain scale. Ambulatory medical visit length ranged from 7 to 30 minutes with a mean of 14.3 (SD 5.97) minutes. Interrater reliability across all coding resulted in a Krippendorff alpha of 0.82 and 90.8% agreement.
No pain discussion
Discussion
Results indicate use of specific communication strategies during older adult and practitioner pain discussions and support the utility of CAT in examining pain communication between practitioners and older adults. Although CAT has been used for communication research in multiple settings (Jones et al., 1999; Ryan, Hamilton, & See, 1994; Jones, Woodhouse, & Rowe, 2007), results from the present study offer an extension into the ambulatory medical visit setting.
Despite reporting an average
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Supported by the University of Connecticut, School of Nursing Toner Fund, and School of Nursing Deans' Discretionary Funds.