Original Article
Older Adults' Pain Communication During Ambulatory Medical Visits: An Exploration of Communication Accommodation Theory

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Abstract

The purpose of this descriptive secondary analysis was to explore the use of Communication Accommodation Theory as a framework to examine pain communication strategies used by older adults and their primary care practitioners during medical ambulatory care visits. Ambulatory medical visits for 22 older adults with moderate or greater osteoarthritis pain were audiotaped, transcribed verbatim, and coded by two independent raters for six a priori communication strategies derived from the attuning strategies of Communication Accommodation Theory: 1) patient selecting the pain topic; 2) patient taking a turn; 3) patient maintaining focus on the pain topic; 4) practitioner using an open-ended question without social desirability to start the pain discussion; 5) practitioner encouraging the patient to take a turn by asking open-ended questions; and 6) practitioner interruptions. The majority of practitioners did not start the pain discussion with an open-ended question, but did not interrupt the older adults as they discussed their pain. Five (22.7%) of the older adults did not discuss their osteoarthritis pain during the ambulatory medical visit. The majority of patients took their turn during the pain discussion, but did not maintain focus while describing important osteoarthritis pain information to their practitioner. Practitioners might assist older adults to communicate more information about their pain by initiating the pain discussion with an open-ended pain question. Older adults might provide more pain information to their practitioner by staying on the pain topic until they have completed all of the pain information they wish to discuss with the practitioner.

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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