Collaborative talk in healthcare interactions between students and people with aphasia.

Abstract

People with language impairments are at a higher risk of receiving inappropriate or inadequate healthcare, often stemming from ineffective exchanges between patients and healthcare professionals. This study explores a possible factor in such exchanges: the use of collaborative forms of talk in interaction with people with aphasia. To investigate if and how collaborative forms of talk are used as a conversational resource in healthcare interactions by students and their effects on the acquisition of information from the patient. The transcripts of two simulated healthcare interactions between a man with aphasia and two students (i.e., a nursing student and a speech-language pathology student) were analysed through conversation analysis. The analysis aimed to locate instances of collaborative forms of talk, which included joint productions, acknowledgement tokens, reframing of questions, gesture, laughter and engagement with alternative communication methods. The analysis also tracked the progressivity of the interactions and information checking. The students engaged in a range of collaborative forms of talk, which aided the person with aphasia to participate more fully in conversation. However, some issues arose with progressivity, topic continuity and checking for understanding when turns were left incomplete, no candidate understandings were provided or no repair or joint production sequences were initiated. These occurrences may increase the possibility of misunderstandings or loss of important information. Communication training should include conversational strategies that help to promote collaboration, focusing on enhancing the ability to perceive, and attend to collaboration requests. Training also should help trainees to find ways to frequently check understanding. What is already known on the subject People with language impairments, including those with aphasia, face important challenges when communicating with healthcare professionals and are often at risk of receiving inadequate care as a consequence. While it is known that some of the causes of such communicative issues may be tied to limited time availability on the part of healthcare professionals, the exclusion of spouses from interactions, and lack of communication training, it remains unclear whether these issues influence the use of collaborative forms of talk on the part of providers in interaction with people with aphasia. What this paper adds to existing knowledge Healthcare students seemed to be able to engage in a variety of collaborative forms of talk even without formal communication training. However, some issues arose with progressivity, topic continuity and checking for understanding when turns were left incomplete, no candidate understandings were provided, or no repair or joint production sequences were initiated. These occurrences may increase the possibility of misunderstandings or loss of important information in these crucial interactions. Influencing factors may include the nature of institutional interactions, speaker unfamiliarity, concerns about speaking for patients and lack of training. What are the potential or actual clinical implications of this work? Potential clinical implications for communication training include the need to implement modules or activities which increase trainees' ability to perceive and attend to collaboration requests (i.e., pauses, gestures, gaze, etc.) and to frequently check understanding.