Identifying communication challenges and strategies used by healthcare professionals in acute aphasia care: an e-Delphi study

Abstract

Background: Effective communication between patients and healthcare professionals (HCPs) is crucial for involving patients in their healthcare journey. HCPs find communication with people with aphasia (PWA) challenging and reportedly feel unprepared for communication breakdowns, making patient-centred communication difficult, especially in acute stroke units. Aims: To identify the communication challenges encountered by HCPs working with PWA post-acute stroke in India and the strategies used to overcome these challenges. Methods and Procedure: The study followed a cross-sectional design incorporating a three-round e-Delphi consensus. The Delphi panel comprised 16 HCPs from speech-language pathology, neurology, nursing, neurological physiotherapy, and occupational therapy. The first round included 15 open-ended questions designed based on the literature review. Content analysis of the responses from this round was conducted using ATLAS.ti 23 software. Items that failed to achieve 70% agreement in round 1 were carried forward to round 2, where 5-point rating scales and multiple-choice questions were employed to reach consensus. Items that did not achieve majority agreement in round 2 were excluded. The final items that reached consensus in both rounds were sent to the experts in the final round. Codes from the responses and literature review were used to propose sections of a Communication Partner Training (CPT) module targeting HCPs. Outcome and results: In round 1, 126 codes were generated and grouped into the following categories: challenges, solutions, CPT components, and additional insights on communication between HCP and PWA. The challenges were subdivided into patient-related, HCP-related, environmental, cultural, and linguistic factors. The solutions were divided into strategies used, suggested by experts and other solutions. Codes related to the CPT module were categorized into CPT content and elements. Codes that did not fit into any of these categories were classified as additional insights. Of these, 118 codes were included in round 2 for further consideration. A total of 99 codes reached final agreement after completion of two rounds, with no further modifications suggested in the third. Additionally, the information obtained from the survey was used to propose a section of the training module. Conclusion: The study identified various challenges, including patient-related, HCP-related, environmental, cultural, and linguistic factors. The strategies employed by HCPs included the use of visual aids, caregiver involvement, and simplified language. Findings highlight the need for a culturally sensitive CPT module, tailored to the Indian context, which can potentially improve patient-centred care, enhance treatment adherence, and support better outcomes for PWA.